Nursemaid elbow, medically known as radial head subluxation, is a common injury in young children. It occurs when the radius, a forearm bone, partially slips out of its normal position at the elbow joint. This typically results from a sudden pulling force on a child’s arm, causing a ligament to become momentarily trapped. While concerning for parents, this injury is often easily resolved by a medical professional.
Recognizing Nursemaid Elbow
Recognizing nursemaid elbow involves observing specific behaviors and symptoms after a pulling incident. Children with this injury commonly refuse to use the affected arm, holding it limply at their side or slightly bent. They may cry immediately after the injury and experience pain when the arm is moved.
Unlike fractures, nursemaid elbow typically presents without visible swelling, bruising, or deformity around the elbow joint. It frequently occurs when an adult pulls a child by the hand or wrist, such as when lifting them, preventing a fall, or during playful swinging. Even minor actions, like pulling a child’s arm through a jacket sleeve, can cause this subluxation.
When Self-Reduction Is Not Advisable
It is crucial to seek professional medical attention if there is any uncertainty about the injury. Self-reduction should never be attempted if visible swelling, bruising, or deformity is present around the elbow, as these signs may indicate a more serious injury like a bone fracture. A healthcare provider will often want to rule out a fracture before attempting to correct the elbow.
Professional evaluation is also important if the child has other injuries, is in severe distress, or if the injury involved a fall or direct trauma. Nursemaid elbow is most common in children aged one to four, but can occur from birth up to age seven. If the child is outside this typical age range, or if this is their first such injury, a proper diagnosis by a medical professional is necessary to ensure the correct course of action.
Understanding the Reduction Process
A medical professional resets a nursemaid elbow through a quick, gentle manipulation known as reduction. Two primary techniques are employed: the supination-flexion method and the hyperpronation technique. Both maneuvers aim to guide the displaced radial head and its surrounding ligament back into its correct anatomical position.
In the supination-flexion technique, the medical professional holds the child’s wrist and elbow, then rapidly supinates (turns the palm upward) the forearm while flexing (bending) the elbow. The hyperpronation technique involves holding the elbow at a 90-degree angle and rapidly hyperpronating (turning the palm downward) the forearm. A faint “pop” or “click” may be heard or felt as the bone slips back into place, signaling successful reduction. Studies suggest hyperpronation may have a higher success rate on the first attempt and cause less pain. These maneuvers should only be performed by trained healthcare professionals, such as doctors, nurses, or physician assistants, to prevent misdiagnosis or further injury.
Aftercare and Prevention
Following successful reduction, children often experience immediate relief and may begin using their arm normally within minutes, though some may take longer to regain full movement. Typically, no special aftercare, such as immobilization, is needed for a first-time injury, but pain medication like acetaminophen or ibuprofen may be recommended if there is discomfort. It is important to monitor the child and seek medical attention if the arm is not used normally the following day.
Nursemaid elbow can recur, especially in children with ligamentous laxity. To prevent future occurrences, caregivers should avoid lifting or swinging a child by their hands or wrists. Instead, children should be lifted by grasping them under their armpits or around their torso. Educating all caregivers about safe handling techniques can help minimize the risk of this common childhood injury.