Nursemaid’s elbow, also known as radial head subluxation, is a common injury in young children. This condition occurs when the radius, a forearm bone, partially slips out of its normal position at the elbow joint. Ligaments normally hold the radius securely in place. However, in young children, these ligaments are still developing and are more flexible, making them susceptible to displacement from a sudden pulling motion on the arm or hand.
Identifying Nursemaid’s Elbow
Nursemaid’s elbow primarily affects toddlers and preschoolers (ages one to five) because their ligaments are still developing and more flexible. Children over six rarely experience it as their ligaments strengthen with age. If a child has nursemaid’s elbow, they will typically hold their arm still, often close to their body or slightly bent, refusing to use it, and moving it causes pain. Unlike many other injuries, nursemaid’s elbow usually does not present with visible swelling or bruising. Children might cry immediately after the injury but then quiet down, continuing to avoid movement of the affected arm.
Professional Medical Care
Correcting nursemaid’s elbow requires the intervention of a medical professional; parents or caregivers should never attempt to fix it themselves. The treatment is a simple, non-surgical reduction maneuver, which gently guides the radial head back into its proper alignment. One common technique involves supporting the child’s elbow while gently turning the forearm (supination) and then bending the elbow (flexion); another method, hyperpronation, involves rapidly pronating the forearm. A faint “pop” or “click” may be heard or felt as the bone and ligament return to their correct position. The procedure is quick, taking only seconds, and typically provides immediate relief to the child; anesthesia is generally not required, and X-rays are usually unnecessary unless there is suspicion of a fracture or other injury.
Post-Treatment and Prevention
After a successful reduction, children typically regain full use of their arm within minutes. While the injury should not return once corrected, recurrence is possible, particularly if ligaments are loose or in the weeks following the initial incident. To prevent nursemaid’s elbow, caregivers should avoid pulling or yanking motions on a child’s arm or hand. When lifting a child, support them from under their armpits or around their torso, rather than by their hands or wrists. Avoid swinging a child by their arms during play, and be patient when dressing them, especially when guiding arms through jacket sleeves, to prevent pulling. Most children outgrow the susceptibility to nursemaid’s elbow by around age five or six as their ligaments and joints naturally strengthen.