Nursemaid’s elbow is a common injury in young children resulting from a sudden pull on the forearm. It occurs when the radius, one of the two forearm bones, partially slips out of alignment at the elbow joint. A small band of tissue called the annular ligament becomes momentarily trapped between the bones, causing immediate pain and a refusal to use the arm. The injury is temporary, does not cause permanent damage, and is easily treatable by a medical professional.
Recognizing the Injury
The injury usually results from sharp, longitudinal traction applied to the hand or wrist, such as when a child is abruptly pulled or swung by the arms. This action allows the ligament holding the radius bone in place to slip and become entrapped. It is most common in toddlers and preschoolers, generally between the ages of one and four, because their ligaments are still flexible.
The classic presentation is a child who suddenly refuses to use the affected arm, holding it limply at their side or slightly bent with the palm down. They may cry immediately after the injury but often stop shortly after, continuing to protect the arm. Unlike a fracture, Nursemaid’s elbow rarely causes visible swelling, bruising, or deformity. The child will have pain if the arm is moved or rotated.
Immediate Steps for Caregivers
If you suspect this injury, remain calm and reassure the child. Do not attempt to pop the elbow back into place yourself, as this can cause unnecessary pain or further injury if the diagnosis is incorrect. The child should be comforted and discouraged from moving the arm.
The child needs to be taken to a healthcare professional, such as a pediatrician or an emergency room physician, for definitive diagnosis and treatment. During transport, gently support the arm in a comfortable position, typically close to the body. Be prepared to describe the exact situation that caused the injury. Seeking medical attention quickly is advised, as the treatment is simple and provides fast relief.
The Professional Treatment Procedure
The treatment involves a quick maneuver called a closed reduction, which manually moves the radial head and annular ligament back into position. This procedure is typically performed without sedation or anesthesia. The clinician confirms the diagnosis based on the classic history and physical signs before proceeding.
Two primary manual techniques are used: the supination-flexion method and the hyperpronation method. The supination-flexion technique involves holding the elbow at a 90-degree angle, turning the palm upward (supination), and then bending the elbow fully. The hyperpronation method, which is often preferred, involves forcefully turning the forearm downward (hyperpronation) while the elbow is kept bent.
The hyperpronation method generally has a higher success rate on the first attempt. When the reduction is successful, a slight click or pop may be felt or heard as the ligament slips back into place. Although the maneuver may cause a brief moment of pain, relief is almost immediate once the joint is realigned.
Post-Treatment Care and Prevention
A successful reduction is confirmed when the child begins to spontaneously use the arm again, usually within 5 to 15 minutes of the procedure. No splinting or sling is typically necessary. If the child still refuses to use the arm after about 30 minutes, the doctor may attempt the alternate reduction maneuver or order an X-ray to rule out a fracture.
While the injury is easily fixed, there is a risk of recurrence, especially in children under five years old. The most important preventive measure is to avoid activities that involve a sharp pull on the child’s hand, wrist, or forearm. Never lift or swing a child by their arms or hands. Instead, always lift toddlers by placing hands under their armpits or around their chest.