We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

Amara is an 18-month-old girl brought to clinic by her caregiver after a sudden injury to her right arm earlier today. The nanny reports that Amara began running toward the road, prompting her to grab Amara’s hand and pull her back quickly. Immediately afterward, the child cried and refused to move her right arm. On exam, she holds the arm close to her body with the forearm pronated and elbow slightly flexed. There is no swelling, deformity, or bruising visible. However, she cries and pulls away when attempts are made to supinate the forearm. Her caregiver is anxious and worried that the arm might be broken. (7 points)

1. What structure is commonly affected in nursemaid’s elbow? (1 point)

   Answer: Annular ligament subluxation

2. Describe the typical arm position seen on exam. (1 point)

   Answer: Arm pronated, slightly flexed, held close to body

3. Is imaging required in this classic presentation? (1 point)

   Answer: No, imaging unnecessary if classic features present

4. Name one acceptable reduction maneuver. (1 point)

   Answer: Hyperpronation or supination-flexion maneuvers

5. How quickly should symptoms resolve after reduction? (1 point)

   Answer: Within minutes

6. Provide one prevention strategy to discuss with caregivers. (1 point)

   Answer: Avoid pulling or swinging child by the hands/forearms

7. When should referral be considered? (1 point)

   Answer: Failed reduction attempts or atypical findings (e.g., swelling, deformity, NV concerns)