A 20-year-old amateur weightlifter presents to the urgent care with sudden-onset right elbow pain after attempting a heavy bench press. He describes feeling a “pop” in his elbow while pushing the bar upward, followed by immediate pain and difficulty moving his elbow. He also reports weakness and limited supination. There was no direct trauma or fall.
On examination, the patient has mild swelling over the lateral elbow, tenderness over the lateral epicondyle and posterolateral aspect of the elbow, and pain with passive forearm supination. He shows no bruising, deformity, or neurovascular deficits. X-rays reveal no fractures or dislocations.
Of the following, what is the most likely diagnosis?
- Flare in chronic lateral epicondylitis (“tennis elbow”)
- Biceps tendinopathy
- Radial head subluxation (“nursemaid’s elbow”)
- New-onset rheumatoid arthritis
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Answer: c. Radial head subluxation (“nursemaid’s elbow”)
Though more common in children, radial head subluxation can occur in adults due to excessive sudden pulling or axial loading, often seen in weightlifting, arm wrestling, or sudden jerking movements. Because you knew about nursemaid’s elbow in children, you used the supination-flexion technique to reduce the radial head, which provided immediate relief to your patient. You prescribed NSAIDs for pain, a sling for comfort if needed, and a referral for physical therapy. You cautioned your patient to avoid sudden pulling motions or axial loads on the extended arm to prevent it from recurring.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
