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

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.