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Pronation and Supination Compared for Pulled Elbow

Last Updated: October 14, 2009.

In the treatment of children with pulled elbow, limited evidence suggests that pronation may be a more effective and less painful manipulative intervention than the standard supination method, according to an review published online Oct. 7 in the Cochrane Database of Systematic Reviews.

WEDNESDAY, Oct. 14 (HealthDay News) -- In the treatment of children with pulled elbow, limited evidence suggests that pronation may be a more effective and less painful manipulative intervention than the standard supination method, according to an review published online Oct. 7 in the Cochrane Database of Systematic Reviews.

Marjolein Krul, M.D., of Erasmus MC University Medical Center in Rotterdam, Netherlands, and colleagues reviewed three trials including 313 patients under the age of 7 years which compared manipulation by pronation versus supination.

The researchers faulted all three trials for low methodological quality due to incomplete reporting and potential bias resulting from a lack of assessor blinding. Based on the evidence, they found that pronation had a lower risk of treatment failure than supination. Pain perception was reported for two of three trials, but data was unavailable for pooling. However, pronation was associated with lower pain perception than supination in the two studies.

"There is limited evidence from three small low-quality trials that the pronation method might be more effective and less painful than the supination method for manipulating pulled elbow in young children. However, only a small difference in effectiveness was found," the authors conclude. "We recommend that a high quality randomized trial be performed to strengthen the evidence."

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