title: Randomized comparison of pain perception during radial head subluxation reduction using supination-flexion or forced pronation.
abstract: OBJECTIVE
  To determine if a difference exists in perceived pain between the forced pronation and supination-flexion methods of radial head subluxation (RHS) reduction.
  
  
  METHODS
  We developed a prospective randomized trial of children aged 6 months to 7 years who presented to the emergency department (ED) at Miami Children's Hospital with an immobile arm and physical findings suggestive of RHS. Children were randomized into 2 groups for RHS reduction: forced pronation and supination-flexion. Parents, physicians, and nurses were given a standard visual analog pain scale for pain assessment before, during, and at 1 minute after successful reduction.
  
  
  RESULTS
  Seventy-five children presented to the ED with RHS; 3 children were excluded from the study because of nonadherence to the protocol and another 9 were excluded because of unsuccessful reduction during the first attempt. Of the remaining children, 32 children underwent forced pronation and 31 underwent supination-flexion. Physicians did not find a significant difference in gain scores between their perceptions of the premeasure and postmeasure of pain between those patients receiving supination-flexion and those receiving forced pronation. For nurses (P < 0.031) and parents (P < 0.043), there were statistically significant differences in gain scores. Nurses and parents perceived forced pronation as being less painful. The mean difference for parents was 1.7 cm, which exceeded the value of 1.3 cm identified as clinically significant.
  
  
  CONCLUSIONS
  Forced pronation is perceived as less painful than the supination-flexion method by parents of children treated for RHS in our ED.
authors.affiliation: Baylor College of Medicine and Emergency Center, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Green
authors.forename: Marc Y-R
authors.initials: MY
authors.lastname: Linares
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Garcia Peña
authors.forename: Barry
authors.initials: B
authors.lastname: Greenberg
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Baker
mesh_terms: D001134:Arm Injuries / Q000150:complications* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004635:Emergency Medicine / Q000379:methods; D016529:Emergency Nursing / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods; D010372:Pediatrics / Q000379:methods; D011403:Pronation; D011446:Prospective Studies; D011884:Radius / Q000293:injuries*; D013484:Supination