tests, and radiographs localize the site and etiology of the pathology, the physician can begin specific management Some children with no history of trauma in whom a thorough initial evaluation is unrevealing will have a nursemaid’s elbow Therefore, an attempt at reduction is warranted in selected cases Children with persistently diminished arm movement who are afebrile and nontoxic, with no localized findings, normal neurovascular function, and normal laboratory tests, likely have an occult soft tissue injury and can be managed as outpatients A few of these children may have indolent pathologic processes or occult fractures; therefore, close follow-up must be ensured These patients should be reevaluated every few days until normal arm use is regained or until evidence of a pathologic process develops If arm disuse persists, a more extensive evaluation to diagnose or exclude occult fracture, infection, tumor, or inflammatory process is in order Suggested Readings and Key References Absoud M, Greenberg BM, Lim M, et al Pediatric transverse myelitis Neurology 2016;87(9 Suppl 2):S46–S52 Aylor M, Anderson JM, Vanderford P, et al Videos in clinical medicine Reduction of pulled elbow N Engl J Med 2014;371(21):e32 Bexkens R, Washburn FJ, Eygendaal D, et al Effectiveness of reduction maneuvers in the treatment of nursemaid’s elbow: a systematic review and meta-analysis Am J Emerg Med 2017;35(1):159–163 Browner EA Nursemaid’s elbow (annular ligament displacement) Pediatr Rev 2013;34(8):366–367 Carson S, Woolridge DP, Colletti J, et al Pediatric upper extremity injuries Pediatr Clin North Am 2006;53(1):41–67, v Eismann EA, Cosco ED, Wall EJ Absence of radiographic abnormalities in nursemaid’s elbow J Pediatr Orthop 2014;34(4):426–431 Hopkins SE, Elrick MJ, Messacar K Acute flaccid myelitis—keys to diagnosis, questions about treatment, and future directions JAMA Pediatr 2019;173(2):117–118 Rudloe TF, Schutzman S, Lee L, et al No longer a “nursemaid’s” elbow: mechanisms, caregivers, and prevention Pediatr Emerg Care 2012;28(8):771– 774 Swaiman K, Ashwal S, Ferriero D, et al Swaiman’s Pediatric Neurology 6th ed Philadelphia, PA: Elsevier; 2017