In a patient with nursemaid's elbow, what should be the first step in the management?

In the management of nursemaid's elbow, performing a closed reduction is the first step because this condition is characterized by a subluxation of the radial head, typically occurring in young children due to pulling or swinging motions of the arm. The primary goal is to restore the normal anatomical position of the radial head, which can often be achieved through a simple and quick non-invasive technique.

Closed reduction involves a specific maneuver where the clinician holds the child's elbow in one hand while supinating the forearm and flexing the elbow. This method is effective and has a high success rate, resulting in immediate relief of pain and restoration of function.

Radiographic imaging is not necessary unless there is a concern for a fracture, as the diagnosis of nursemaid's elbow is primarily clinical. Referring to a specialist or administering analgesics may be considered later if initial reduction attempts fail or if there are complicating factors, but these actions would not be the first step in the immediate management of the condition.