Nursemaid’s elbow, known medically as radial head subluxation, is a common pediatric injury involving a partial dislocation of the elbow joint. This condition occurs when the head of the radius bone slips out from under the annular ligament that normally holds it in place. The injury is prevalent in children between the ages of one and four years old, though it can happen up to age seven, because their ligaments are still relatively loose. It typically results from a sudden pull or tug on the child’s forearm, such as when a caregiver lifts a child by the hands or yanks them to prevent a fall.
Recognizing the Signs of Nursemaid’s Elbow
Parents should look for specific physical and behavioral signs to confirm a pulled elbow injury, as there is often no obvious bruising or swelling. The most telling symptom is the child’s sudden refusal to use the injured arm, often referred to as pseudoparalysis. The child will typically hold the arm still, slightly bent or straight, and close to their body, protecting it from any movement.
Pain is usually localized near the elbow, wrist, or forearm. Initial distress and crying after the injury may subside quickly, but the child will maintain their guarded posture because moving the arm remains painful. If a fall or direct trauma caused the injury, or if severe pain, bruising, or swelling are present, the injury may be a fracture, not a simple subluxation.
Why Professional Medical Intervention Is Necessary
Seeking professional medical attention is the safest and most appropriate course of action for a suspected Nursemaid’s elbow, even though the treatment is quick. A trained healthcare provider can first rule out more serious injuries. An X-ray may be ordered to ensure the child does not have a fracture or a more complex dislocation, as attempting a reduction maneuver on a broken bone could cause further damage.
The primary risk of attempting to correct the injury at home is misdiagnosis, since the symptoms can resemble those of a fracture. Untrained manipulation of the joint risks causing additional trauma to the radial head or the surrounding growth plate in the developing elbow. Self-treatment should not be attempted unless the cause of the injury is clearly a pull and not a fall. A medical professional also knows how to confirm the procedure’s success, which is something an untrained caregiver cannot reliably do.
The Technique Used for Reduction
The treatment for Nursemaid’s elbow involves a gentle procedure called closed reduction, which manually guides the radial head back into its correct position. Healthcare professionals typically use one of two maneuvers: the Supination-Flexion method or the Hyperpronation method. The Supination-Flexion technique is the traditional approach, where the provider applies slight pressure to the radial head while twisting the child’s forearm to a palm-up position and then fully bending the elbow.
Alternatively, the Hyperpronation method involves holding the elbow at a 90-degree angle and forcefully twisting the forearm to a palm-down position. Studies suggest that the Hyperpronation method may have a higher success rate on the first attempt compared to the Supination-Flexion method. A faint click or pop may be felt or heard as the annular ligament slides back over the radial head, signaling a successful reduction. These maneuvers are brief, causing momentary pain before providing immediate relief.
Immediate Care and Preventing Recurrence
Following a successful reduction, most children experience immediate relief and often start using the injured arm within 5 to 15 minutes. If the child does not regain full function within about 30 minutes, the healthcare provider may attempt a different reduction technique or order imaging to check for other issues. No splinting or casting is typically needed after a successful reduction, as the joint is restored to its proper alignment.
Parents should understand that a child who has experienced a pulled elbow is at an increased risk for recurrence. To prevent future episodes, caregivers must avoid activities that place sudden, axial traction on the arm. This means never lifting a child by their hands or wrists, avoiding swinging them by the arms, and instead, lifting them by the torso or under the armpits. The risk of recurrence significantly decreases as the child grows older and the ligaments naturally tighten, with the condition becoming rare after the age of five.