Nursemaid’s elbow, medically known as radial head subluxation, is a frequent injury seen in young children, typically those between one and five years old. It occurs when a sudden pull on the arm causes the annular ligament, which holds the radius bone in place at the elbow, to slip out of its normal position and become trapped. Although painful, it is not a serious condition and is easily corrected by a medical professional.
Recognizing the Signs of Nursemaid’s Elbow
Parents should look for a distinct refusal by the child to use the injured arm following a sudden tug or pull on the hand or wrist. The child will often hold the affected arm still, slightly bent, and close to their body, sometimes supporting it with their other hand. While the child may cry out in pain immediately after the injury, the physical appearance of the elbow will not typically show any visible swelling or bruising.
The injury mechanism is usually a longitudinal traction force applied to an extended arm, such as when a child is lifted abruptly by one hand or swung playfully by the arms. Since soft tissues and ligaments in young children are not fully developed, they are more susceptible to this partial dislocation. If this injury is suspected, parents should seek immediate medical attention, such as visiting an urgent care facility or emergency room. Avoid attempting to manipulate the arm back into place at home, as this could lead to complications or misdiagnosis.
The Medical Procedure to Fix Nursemaid’s Elbow
The treatment for Nursemaid’s elbow is a quick, non-surgical procedure called closed reduction, performed by a trained medical professional. This maneuver gently guides the radial head and the trapped annular ligament back into their correct anatomical position. The procedure typically takes only a few seconds and often provides the child with immediate and complete pain relief.
Two common techniques are used for reduction: the supination-flexion method and the hyperpronation method. The hyperpronation technique is often favored as it has demonstrated a higher first-attempt success rate, sometimes exceeding 85%, and may be less painful for the child. This maneuver involves holding the child’s elbow at a 90-degree angle and then quickly and firmly rotating the forearm so the palm faces downward.
In contrast, the supination-flexion technique requires the practitioner to fully turn the child’s palm upward (supination) while simultaneously bending the elbow completely toward the shoulder (flexion). A successful reduction with either technique is often indicated by a faint click felt or heard by the practitioner as the ligament slips back into place. Due to the need for precise technique and to rule out other possible injuries like a fracture, these maneuvers should only be performed by a qualified medical provider.
Immediate Care and Recovery After Reduction
Recovery after a successful reduction is typically rapid, with many children beginning to use their arm normally within five to fifteen minutes. The immediate return to function confirms the procedure was successful and the pain has resolved. The child may experience some residual tenderness or soreness at the elbow for a short period after the maneuver.
For minor discomfort, a medical provider may suggest an over-the-counter pain reliever, such as acetaminophen or ibuprofen. No immobilization, such as a cast or splint, is necessary following a successful reduction where the child regains full function. Parents should simply monitor the child for the next few hours to ensure the arm use remains normal. If the child continues to refuse to use the arm after a period of observation, further evaluation may be needed to check for an incomplete reduction or a different underlying issue.
Handling Techniques to Prevent Recurrence
Once a child has experienced Nursemaid’s elbow, the joint and ligaments are more prone to recurrence, making preventive handling techniques essential. The main goal is to avoid any sudden or forceful longitudinal traction on the child’s arm. Parents and caregivers should completely stop lifting or swinging the child by their hands or wrists.
To lift a young child safely, always grasp them gently under their armpits or support them around their chest or torso. Avoid pulling on the child’s arm to hurry them along or to help them up a curb or step. By consistently using proper lifting and handling methods, the risk of the radial head subluxating again is significantly reduced until the child’s ligaments strengthen, which typically happens by the age of six or seven years old.