Nursemaid’s elbow, known medically as radial head subluxation, is a common orthopedic injury affecting young children, typically between the ages of one and five years old. This condition involves a partial dislocation where the top of the radius bone slips out of the annular ligament that holds it in place at the elbow joint. The injury occurs because the ligaments in very young children are still relatively loose and immature, making them susceptible to displacement from sudden forces.
How Nursemaid’s Elbow Occurs
The injury is usually caused by a sudden, sharp pull or jerk on the child’s hand or forearm while the elbow is extended and the forearm is pronated (palm down). Common scenarios include an adult pulling a child up by the wrist, quickly lifting a child over a curb, or swinging a child by their arms during play. This longitudinal traction on the arm causes the radius bone to be pulled slightly out of its socket, trapping a portion of the annular ligament between the two bones of the elbow joint.
Once the annular ligament is caught, the child will exhibit sudden, noticeable symptoms, primarily a refusal to use the injured arm. They often hold the arm limp, close to the body, with the elbow slightly bent and the palm turned inward. Unlike a fracture, Nursemaid’s elbow rarely causes visible swelling or bruising around the joint. Pain is usually localized to the elbow, wrist, or forearm, and the child will cry immediately after the injury, though they still refuse to move the arm even after calming down.
Why Medical Intervention is Necessary
The core question for many caregivers is whether Nursemaid’s elbow can resolve itself, and the answer is that it almost never does. The annular ligament is physically trapped within the joint space, which prevents the radial head from returning to its correct anatomical position. Waiting for the injury to spontaneously correct only prolongs the child’s discomfort and inability to use the arm.
A physician must intervene promptly. Seeking immediate medical care ensures that the child is not suffering undue pain and that the arm’s function is restored quickly and safely. Furthermore, limited arm movement prevents caregivers from ruling out a more serious injury, such as a fracture. This condition requires a specific maneuver to physically free the entrapped ligament.
The Reduction Procedure
The medical solution for Nursemaid’s elbow is a simple procedure called a closed reduction, which is performed by a trained healthcare professional without the need for sedation. The goal of the reduction is to gently manipulate the bones to allow the trapped annular ligament to snap back into its normal position. This maneuver is very quick, typically taking only a few seconds to complete.
There are two primary techniques used for reduction: the hyperpronation method and the supination-flexion method. The hyperpronation technique, which involves turning the forearm palm-down while applying pressure to the radial head, has shown a higher first-attempt success rate in studies. The supination-flexion technique involves turning the forearm palm-up and then bending the elbow. A faint “pop” or “click” may be felt or heard when the ligament relocates, which signals a successful reduction.
Following a successful reduction, the child often experiences immediate relief and is usually willing to begin moving the arm again within five to ten minutes. The healthcare provider will typically have the child attempt to use the arm to confirm that full function has returned. In rare cases where the first attempt is unsuccessful or if there is concern about a fracture, an X-ray may be ordered to ensure no other damage occurred.
Techniques for Prevention
Caregivers can take practical, actionable steps to prevent both the initial occurrence and recurrence of Nursemaid’s elbow. The most effective way to prevent this injury is to completely avoid pulling or yanking on a child’s hands or wrists. This includes refraining from lifting them by one arm or swinging them around while holding their hands.
The safer method for lifting a child is to grasp them gently under the armpits or to support them around the torso. It is important to teach other caregivers, such as babysitters or grandparents, about these safe handling practices. Children who have experienced the injury once are slightly more susceptible to recurrence, though susceptibility decreases significantly after about age five to seven as the ligaments naturally strengthen and mature.