What is the Role of Point of Care Ultrasound for Suspected Pulled Elbow in Children? A Narrative Literature Review

TL;DR

This paper reviews how point-of-care ultrasound can help diagnose pulled elbow in children and when it is reliable.

Contribution

The paper systematically reviews sonographic signs and their reliability for diagnosing pulled elbow in children using POCUS.

Findings

POCUS can diagnose pulled elbow using signs like hook/J-sign and absence of effusion.

Elbow effusion detected by POCUS suggests possible bony injury requiring X-ray.

More prospective studies are needed to confirm POCUS effectiveness in diagnosing elbow injuries.

Abstract

Our objective was to evaluate and appraise the existing evidence on the use of point of care ultrasound (POCUS) for pulled elbow, including its positive findings and their reliability.

We searched PubMed, Medline, EMBASE, CINAHL and Google Scholar for prospective and retrospective studies evaluating POCUS use for suspected pulled elbow. We identified positive sonographic findings along with their sensitivity and specificity relating to this diagnosis.

We included 13 studies that reviewed ultrasonographic findings in suspected pulled elbow. These studies discussed a range of sonographic findings between them, including radio- capitellar distance, ‘J-sign'/‘Hook sign', fat pad sign and partial eclipse sign. The studies were of mixed quality and were susceptible to bias.

Children presenting with suspected pulled elbow who have evidence of hook sign (or J-sign) and an absence of elbow effusion on POCUS can be diagnosed with pulled elbow and safely undergo reduction. POCUS can be used following reduction to demonstrate resolution of these signs and confirm its success. Elbow injuries with effusion are likely to have bony injury, meaning that X-ray is required. Additional prospective study of children presenting with elbow injury would be required to accurately determine the effectiveness of POCUS in the diagnosis of pulled elbow.

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