Nursemaid’s elbow, also known as pulled elbow or radial head subluxation, is a common injury affecting young children. This condition occurs when the radius, one of the forearm bones, partially slips out of its normal position at the elbow joint. Because ligaments in young children are still developing and are relatively loose, it does not take much force to cause this partial dislocation.
Identifying Signs
A child with nursemaid’s elbow will show immediate signs of discomfort and reluctance to use the affected arm. They may cry from the initial pain and hold the arm still, often limp at their side or slightly bent at the elbow. The forearm is often pronated, with the palm turned inward or facing downward. The child might support the injured arm with their other hand.
A characteristic of nursemaid’s elbow is the child’s refusal or inability to bend, straighten, or rotate the elbow. While shoulder movement may still be possible, any attempt to move the elbow joint, especially rotating the palm, will cause pain and resistance. Despite the pain and limited movement, there is no visible swelling, bruising, or deformity around the elbow, which differentiates it from a fracture.
Immediate Steps
If nursemaid’s elbow is suspected, seek prompt medical attention. A pediatrician, urgent care clinic, or emergency room can provide the necessary evaluation and treatment. Do not attempt to “fix” the elbow at home, as this could cause further injury or mask a more serious condition like a fracture. Healthcare providers need to rule out other injuries before attempting to reduce the dislocation.
A healthcare professional can treat nursemaid’s elbow quickly and effectively through a gentle maneuver called a reduction. This procedure involves specific movements of the arm to guide the radial bone back into its correct position. Relief is immediate once the elbow is reset, and many children regain full use of their arm within minutes.
Common Causes
Nursemaid’s elbow results from a sudden pulling or tugging force applied to a child’s hand or forearm. Common scenarios include lifting a child by their hands or wrists, swinging a child by their arms during play, or pulling a child by the hand to prevent a fall.
The injury occurs when the annular ligament, which holds the radial bone in place at the elbow, slips and becomes trapped. This partial dislocation of the radial head is more common in children between 1 and 4 years old, as their joints and ligaments are not yet as strong or tightly formed as in older children or adults. As children grow, their ligaments strengthen, making them less susceptible to this type of injury.