Nursemaid’s elbow, medically known as radial head subluxation, is a common pediatric injury. It occurs when the radius bone partially slips out of the annular ligament that holds it in place at the elbow joint. While not life-threatening, the injury causes immediate pain and prevents the child from using the arm, requiring prompt medical attention. It is considered an urgent situation that needs immediate treatment to restore function.
Identifying Nursemaid’s Elbow
The injury typically happens when a sudden pulling force is applied to a young child’s arm while the elbow is straight and the forearm is turned. This often occurs during common interactions, such as an adult swinging a child by the hands, pulling a child up onto a step, or quickly yanking the arm to prevent a fall. The ligaments in young children, particularly those between the ages of one and four, are still relatively loose and immature, making them susceptible to this partial dislocation with minimal force.
The presentation of Nursemaid’s elbow is distinct, allowing caregivers to recognize the condition quickly. Immediately following the injury, the child will cry out in pain, but the crying may subside shortly after the initial trauma. The child will then refuse to use the injured arm at all, holding it limply at their side, often slightly bent and with the palm turned downward.
A defining characteristic is the absence of visible swelling, bruising, or obvious deformity around the elbow joint. The child will typically only experience pain if the arm is moved by an external force, but they can still move their fingers and wrist without complaint. If there is significant swelling, bruising, or a clear deformity, the injury is more likely to be a fracture, which requires a different diagnostic approach than a simple radial head subluxation.
Triage: When to Seek Prompt Medical Care
Nursemaid’s elbow requires professional medical intervention, but it rarely necessitates an Emergency Room (ER) visit unless specific red flags are present. Because the child is in pain and cannot use the limb, prompt reduction is necessary to resolve symptoms quickly. In most cases, the condition can be treated effectively in a less intensive setting than the ER.
For most instances where a pulling injury is the clear cause and there is no swelling or visible deformity, a pediatrician’s office or an orthopedic urgent care clinic is the appropriate choice. These facilities are equipped to perform the simple reduction maneuver and can often accommodate same-day appointments for this common injury. Seeking care at one of these locations can save time and be more cost-effective than an ER visit.
An Emergency Room visit is warranted if the cause of the injury was not a simple pull, such as a fall from a significant height or a high-impact trauma. The ER is also the correct destination if the child exhibits signs of a more serious injury, including severe swelling, significant bruising, or visible bone deformity. In these cases, a healthcare provider will likely need to perform an X-ray before attempting reduction to rule out a fracture, which could be complicated by the manipulation used to treat a Nursemaid’s elbow.
The Reduction Procedure and Post-Treatment Expectations
The definitive treatment for Nursemaid’s elbow is a quick, gentle physical maneuver performed by a trained healthcare professional called a closed reduction. The goal of this procedure is to physically slip the trapped portion of the annular ligament back into its correct position around the radial head. The two most common techniques are the hyperpronation method and the supination-flexion method, both of which are highly effective and are performed without sedation.
The hyperpronation technique involves the provider applying pressure to the radial head while quickly turning the child’s forearm into a palm-down position. Alternatively, the supination-flexion method involves turning the forearm palm-up and then bending the elbow. A faint “pop” or “click” may be heard or felt as the ligament slides back into place, signaling a successful reduction.
The most reassuring part of the treatment is the immediate relief and resolution of symptoms. While the child may cry briefly during the maneuver, they typically begin using the arm normally within minutes of the successful reduction.
Post-treatment care is minimal, typically requiring no cast or sling, but caregivers should be mindful of recurrence. The injury is most common in children between one and four years old. Susceptibility decreases significantly as the annular ligament naturally strengthens and tightens, usually by age six or seven.