Nursemaid’s elbow, also known as a pulled elbow or radial head subluxation, is a common injury in young children, typically toddlers and preschoolers (ages one to four). This injury occurs when one of the forearm bones partially slips out of its normal position at the elbow joint. It causes immediate pain and refusal to use the arm. While the event can be frightening, the condition is usually temporary and does not cause long-term damage once properly treated.
How the Elbow Joint Gets Injured
The elbow joint involves three bones: the upper arm bone (humerus) and the two forearm bones (radius and ulna). The radius is held in place against the humerus by the annular ligament, a band of tissue.
Young children are susceptible because their ligaments are not fully developed and are looser than those in adults. This anatomical difference means only a small force is needed to stretch the ligament. The injury occurs when a sudden pulling motion on the hand or wrist causes the annular ligament to slide over the radial head and become trapped between the bones.
The mechanism of injury involves a sudden, strong, longitudinal traction force applied to the child’s hand or forearm while the elbow is extended. Common causes include abruptly pulling a child by the hand to prevent a fall or hurry them along. Swinging a child by their arms or lifting them by their hands are also frequent causes. The injury is rare after age five because the annular ligament thickens and strengthens.
Essential Handling Techniques to Prevent Injury
Preventing Nursemaid’s elbow requires caregivers to be mindful of how they interact with the child’s arms. The fundamental rule is to never lift, swing, or pull a young child by their hands, wrists, or forearms. This avoids the longitudinal traction force that directly causes the subluxation.
Proper lifting techniques involve supporting the child under their armpits or around their chest and torso. This distributes weight across the body’s core, preventing stress on the elbow ligaments. Caregivers should also be cautious when dressing a child, ensuring movement is gentle and does not involve a forceful yank, especially when pulling clothing over the arm.
If a child is about to fall, caregivers should try to grab the upper arm or shoulder instead of the hand, or use the child’s trunk for support. Teaching older siblings and other caretakers proper handling techniques is also an important preventative measure. If a child has experienced this injury once, they are at an increased risk for recurrence until their ligaments mature, usually by age six or seven.
What to Do If Nursemaid’s Elbow Occurs
If Nursemaid’s elbow is suspected, the child will typically exhibit immediate pain and refuse to use the injured arm. They often hold the arm limp, slightly bent, and close to the body. Unlike a fracture, there is usually no visible swelling, bruising, or deformity around the joint. The child may cry initially but often remains in little distress unless the arm is moved.
The most important step is to seek medical attention promptly from a healthcare professional. Do not attempt to move the child’s arm, force them to use it, or try to put the elbow back into place yourself, as this can cause further injury. While waiting for medical help, keep the child calm and comfortable, avoiding any activity that involves pulling or twisting the affected limb.
A doctor will perform a simple physical maneuver, called a reduction, to move the radial bone back into its correct position. The procedure is quick, typically taking only a few seconds, and often results in immediate relief. The reduction involves specific movements, such as gentle rotation and flexion of the arm, which guide the trapped ligament back into alignment. A small ‘pop’ or ‘click’ may be felt when the joint relocates.
After a successful reduction, children usually begin using their arm normally within minutes. No further treatment, such as casting, is typically necessary unless the child continues to refuse to move the arm.