Sir.—The article by Quan and Marcuse1 certainly does a creditable job of describing the epidemiology of radial head subluxation (RHS), but I found it lacking in one important respect. With regard to mechanism of injury, the authors stated: "In 93% of the cases, the accompanying adult described a pull or lift on the arm...." In the 37% of children with histories of recurrent RHS and especially in the four children with multiple subluxations during the study period, was the diagnosis of abuse entertained and ruled out appropriately? In their discussion the authors stated that they could not define any characteristics peculiar to those with recurrent RHS, but they did not raise the issue of abuse.
I do not advocate reporting to protective services every parent whose child presents with RHS. On the other hand, when presented with a history of recurrent RHS or multiple visits for RHS in