Nursemaid’s Elbow is a common orthopedic concern in pediatrics, medically termed radial head subluxation. This injury involves the partial dislocation of the elbow joint where the radius bone meets the humerus. This condition generally resolves completely and immediately once treated correctly by a medical professional using a precise maneuver.
Understanding the Injury
Nursemaid’s Elbow occurs when a quick, longitudinal pull or tug on a child’s arm causes the radial head to slip out of its normal position. The mechanism of injury forces the radius bone to partially dislocate from the elbow joint, trapping the annular ligament in the joint space. This ligament normally holds the head of the radius in place, but in young children, it is relatively loose and easily displaced.
This injury is seen most frequently in toddlers and preschoolers, typically between six months and five years of age. Children in this age group have developing ligaments that are more susceptible to this partial dislocation. Caregivers often observe the child holding the arm still at their side, frequently with the elbow slightly bent and the hand turned inward. The child may refuse to use the arm due to immediate pain, but there is usually no visible swelling or bruising around the elbow joint.
Immediate Resolution Through Reduction
The injury resolves only after a healthcare provider performs a specific treatment known as a reduction maneuver. This procedure involves a quick, precise movement of the forearm to guide the radial head and the trapped annular ligament back into position. The two primary techniques used are the hyperpronation maneuver and the supination-flexion maneuver, with hyperpronation often having a higher success rate.
The process is fast, typically taking only a few seconds, though the child may experience brief discomfort as the joint is repositioned. A subtle “pop” or “click” may be heard or felt as the ligament slips back over the radial head. The success of the procedure is demonstrated almost immediately by the child’s willingness to use the arm again.
Many children begin moving the injured arm within five to fifteen minutes following a successful reduction. If the initial maneuver is unsuccessful, the provider may attempt the alternative technique. If the child does not regain full arm function, X-rays may be ordered to rule out a fracture before further attempts are made.
Long-Term Outlook and Prevention
Once the radial head is successfully reduced, Nursemaid’s Elbow causes no permanent damage to the elbow joint. The child’s prognosis is excellent, with a full return to function expected. While the joint structures are not weakened long-term by the event, there is a chance of recurrence.
A child who has experienced this injury once is slightly more susceptible to it happening again. The risk of recurrence diminishes significantly as the child grows older. Most children outgrow the tendency for Nursemaid’s Elbow by age five or six, as their ligaments strengthen and tighten.
To prevent future episodes, caregivers should avoid activities that place sudden, longitudinal traction on the child’s arm. Never lift a child by their hands or wrists, and refrain from swinging them by the arms. Instead, children should be lifted by supporting them under the armpits or around the torso.