How is hyperpronation/forced pronation reduction of a radial head subluxation performed?

Updated: Apr 08, 2020
  • Author: Gretchen S Lent, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

Although the hyperpronation technique (also known as the forced pronation technique) was first described in 1886 by Hutchinson, it has only comparatively recently begun to emerge as a potentially superior means of reduction.

First, the patient’s elbow is held in 90° of flexion. (Some practitioners prefer to have the elbow extended for this technique.) Next, the wrist is firmly hyperpronated (see the image and videos below). As with the supination-flexion technique, a palpable or audible click is associated with a high probability of successful reduction.

Reduction of subluxated radial head: hyperpronatio Reduction of subluxated radial head: hyperpronation/forced pronation. With one hand placed distally, arm is hyperpronated while other hand holds elbow steady with thumb on radial head.
Reduction of subluxated radial head: hyperpronation/forced pronation. Side view of technique.
Reduction of subluxated radial head: hyperpronation/forced pronation. Front view of technique.

In a few studies, the hyperpronation technique resulted in fewer failures than supination. [1] It has been suggested that hyperpronation may also be less painful; accordingly, some have advocated hyperpronation as the first-line reduction maneuver. [17, 18, 19]

Using a combination of the two techniques (hyperpronation followed by supination) to ensure reduction has been proposed. Such a combined approach would allow simultaneous assessment the return of proper range of motion.


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