Recurrent Elbow Pain in an Adolescent: An Atypical Presentation of Missed Radial Head Subluxation in Outpatient Practice

Background: Radial head subluxation, also known as “nursemaid’s elbow,” is a common injury in children under the age of six, typically caused by axial traction on the forearm. Its occurrence in adolescents is exceedingly rare, often leading to misdiagnosis. This case highlights an unusual presentation of recurrent elbow pain in an adolescent patient, ultimately confirmed as a missed radial head subluxation. Case Presentation: A 13-year-old adolescent presented to an outpatient clinic with recurrent episodes of right elbow pain and functional limitation after minor traction injuries, such as being pulled by the arm during play. The pain was described as acute, sharp, and associated with limited supination, but without swelling, bruising, or deformity. Initial evaluations elsewhere had diagnosed the condition as a soft tissue strain, and the patient had been treated with analgesics and rest without significant improvement. On examination, the elbow showed tenderness over the lateral aspect and restricted supination, but radiographs revealed no evidence of fracture or dislocation. A clinical diagnosis of radial head subluxation was considered despite the patient’s atypical age. Closed reduction was performed using the supination-flexion technique, producing an audible “click” and immediate pain relief. At follow-up, the patient remained asymptomatic, with no recurrence after initiation of a physiotherapy program focusing on strengthening and ergonomic education. Conclusion: This case emphasizes that radial head subluxation, although rare in adolescents, should remain a differential diagnosis for recurrent elbow pain following minor traction injuries. Awareness of this atypical presentation in outpatient practice can prevent unnecessary imaging, inappropriate management, and prolonged morbidity. Prompt recognition and simple reduction techniques remain highly effective, while physiotherapy plays a key role in preventing recurrence.