A 2-year-old girl presented to the Paediatric Emergency Department following an unwitnessed injury to her left arm while playing at nursery limiting further examination. On assessment she was reluctant to use her left arm and further examination was difficult. In cases of unwitnessed and undifferentiated elbow injuries point of care ultrasound (POCUS) can be used to evaluate for elbow joint effusion, fracture, or radial head subluxation, also known as nursemaid's elbow. Pulled elbow is a commonly encountered paediatric injury but based on the history and examination findings it may not always be obvious. We present an approach to the child with an undifferentiated elbow injury incorporating POCUS as a means of increasing the reliability of findings on clinical examination.