Nursemaid’s Elbow

Nursemaid’s elbow, also known as radial head subluxation, is a common injury among young children. This condition occurs when the radius, one of the bones in the forearm, partially slips out of its normal position at the elbow joint. It is particularly prevalent in children under the age of five due to their still-developing ligament structure.

Many children laugh with joy when you swing them around by their arms. However, this enjoyable activity can lead to one of the most common injuries in young kids.

This injury is known as nursemaid’s elbow, which can cause significant discomfort for your child.

Nursemaid’s elbow occurs when the elbow slips out of its normal position at the joint.

The radius (elbow bone) connects to the humerus (elbow joint) with elastic bands called ligaments. As children grow, these ligaments become stronger and tighter. In young kids and babies, the ligaments are still loose, making it easy for the elbow to dislocate.

Healthcare professionals might refer to nursemaid’s elbow using different terms, such as:

• Pulled elbow
• Radial head subluxation

Causes

Nursemaid’s elbow can occur when you tug or pull on a child’s lower arm or hand, especially if the arm is twisted. This injury doesn’t require much force. The most common cause is a pulling-type injury. Nursemaid’s elbow can happen if you:

• Catch a child by the hand to stop a fall
• Lift a child by the hands or wrists
• Pull a child’s arm through a jacket sleeve
• Swing a child by the arms or hands
• Yank on a child’s arm to make them walk faster

Additionally, nursemaid’s elbow can occur if:

• An infant rolls over onto their arm
• A child braces themselves with their hands during a fall

Prevalence

Nursemaid’s elbow commonly affects toddlers and preschoolers.

This injury is rare in children older than 5 or 6 because, as children grow, their bones become harder and their ligaments get tighter and thicker. This increased strength and thickness help keep the elbow in place.

Additionally, girls are slightly more likely than boys to experience nursemaid’s elbow.

Symptoms

What Are the Symptoms of Nursemaid’s Elbow?

The primary symptom of nursemaid’s elbow is pain when the child moves their arm. This condition can be quite painful, but there is usually no swelling, bruising, or other signs of a serious injury.

The child may:

• Complain of elbow pain
• Cry when the arm is moved or touched
• Hold the arm close to their side or support it with the other arm
• Avoid using the arm

Important Precautions

You should not attempt to straighten the arm or move the elbow back into place, as this can cause more serious damage and the child will resist.

Severe pain without swelling could indicate a broken bone. If your child injures their elbow, call your doctor immediately.

Risk Factors

Several factors can increase the risk of nursemaid’s elbow:

• Age: Children under five are at higher risk.
• Activities: Activities involving pulling or jerking movements of the arm.
• Previous Injury: A history of nursemaid’s elbow increases the likelihood of recurrence.

Understanding these risk factors can help in taking preventive measures to avoid this painful injury.

Diagnosis

Diagnosis of nursemaid’s elbow is primarily clinical. A healthcare professional will assess the child’s arm and inquire about the circumstances leading to the injury. X-rays are rarely needed unless a fracture or other injury is suspected. The physical examination typically involves gentle manipulation to confirm the diagnosis.

Treatments

Treatment for nursemaid’s elbow varies based on the child’s age and overall health. The doctor will first examine the child to ensure the bone isn’t broken, typically without needing X-rays.

Pain Management

Over-the-counter pain medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be given. Always consult your healthcare provider for the correct dosage. Never give aspirin to children under 12 years old.

Reduction Maneuver

The primary treatment is a procedure called a “reduction maneuver.” Here’s how it works:

1. Examination: The doctor will hold the child’s wrist and elbow.
2. Adjustment: The doctor gently moves the arm in a specific manner until the elbow pops back into place, often producing a “click” sound.

The healthcare provider will perform one of two common reduction techniques:

1. Supination-Flexion Technique: The forearm is gently turned (supinated) and the elbow is bent (flexed).
2. Hyperpronation Technique: The forearm is rotated inward (pronated).

These maneuvers often result in immediate relief and the child typically regains full use of their arm within minutes.

This maneuver takes just a few seconds and is usually done in the doctor’s office. While briefly painful, causing the child to cry for a few moments, most children can use their arm without pain within 10 to 15 minutes.

Post-Procedure

Some children might be hesitant to use the arm immediately due to the memory of the pain. In such cases, the doctor might recommend pain relief and observe the child for about an hour to ensure they regain normal use of the arm.

X-rays are generally not necessary because they typically show normal results for nursemaid’s elbow. However, if the child doesn’t move the arm after the reduction, an X-ray might be taken to rule out other issues.

Multiple Attempts and Further Care

Occasionally, the first reduction attempt may not succeed, and it might take several tries to reposition the elbow correctly. Surgery is rarely needed. If the doctor is unable to fix the elbow, emergency care will be recommended.

Consideration of Child Abuse

Nursemaid’s elbow can sometimes indicate child abuse, especially if there are other signs or if it occurs in older children. In such cases, an investigation may be conducted.

Home Care Tips

After the elbow is reduced, home care involves:

• Avoiding activities that could cause re-injury.
• Observing the child for any signs of discomfort or limited movement.
• Encouraging gentle use of the arm.

Ice packs can help reduce any residual pain or swelling, and it’s crucial to keep the child calm and comforted.

Prevention

As children grow, their ligaments strengthen, reducing the likelihood of nursemaid’s elbow. However, while your child is still young and their ligaments are more vulnerable, you can take steps to prevent this injury:

• Lift Properly: Avoid lifting a child by their arms or hands. Instead, lift them under their arms.
• Gentle Handling: Do not tug or jerk a child’s hand or arm.
• Avoid Swinging: Never swing a child by their hands or arms.

It’s important to note that children who have experienced nursemaid’s elbow are at a higher risk of it happening again. Taking these precautions can help prevent future occurrences.

When to See a Doctor

Seek medical attention if:

• The child refuses to use the arm despite home care.
• There is significant swelling or deformity.
• The child experiences persistent pain.

Timely medical intervention ensures proper diagnosis and treatment, preventing further complications.

Outlook/Prognosis

The prognosis for nursemaid’s elbow is excellent. With prompt treatment, children typically recover fully without any long-term effects. Recurrence is possible, but preventive measures and awareness can help mitigate this risk.

Sources

1. American Academy of Pediatrics. (2022). Nursemaid’s Elbow.
2. Mayo Clinic. (2021). Nursemaid’s Elbow: First Aid.
3. National Library of Medicine. (2023). Radial Head Subluxation
4. Cleveland Clinic. (2022). Nursemaid’s Elbow in Children.
5. Healthy Children: “Nursemaid’s Elbow.”
6. KidsHealth web site: “Nursemaid’s Elbow.”
7. Boston Children’s Hospital web site: “Nursemaid’s Elbow.”