The “pulled elbow” is a common emergency department diagnosis that presents with a classic history and examination. A differential diagnosis should be sought in all children with atypical clinical features or in those in whom manipulation is unsatisfactory. The importance of follow-up should also be highlighted in the atypical pulled elbow. An unusual presentation of osteomyelitis of the ulnar head initially diagnosed as a pulled elbow in a 9-month-old boy is discussed. This case was further complicated by the lack of inflammatory response to infection and the manifestation clinically of signs apparently within the elbow rather than the osteomyelitic inferior radioulnar joint.
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