Nursemaid’s elbow, medically known as radial head subluxation, is a frequent injury seen in young children. The condition involves a partial dislocation where the head of the radius, one of the two forearm bones, slips out from under the annular ligament that holds it in place at the elbow joint. It is one of the most common upper extremity injuries in pediatric patients, causing immediate pain and an inability to use the arm. This is a mechanical problem that requires a specific maneuver to return the ligament to its correct position.
How the Injury Occurs
The injury results from a sudden pulling or jerking force applied to the child’s hand or forearm while the elbow is extended. This longitudinal traction causes the annular ligament to momentarily stretch and then become trapped between the radial head and the humerus. Caregivers often unintentionally cause this injury by lifting a child by one hand or by quickly pulling their arm to prevent a fall. The condition is most prevalent in children between the ages of one and four or five years old. They are susceptible because their ligaments are still relatively loose and not fully matured, making the elbow joint less stable than in older children or adults.
Identifying the Key Signs
The most distinguishing feature of Nursemaid’s elbow is not a visual abnormality but rather a behavioral response. The elbow joint itself shows no visible signs of injury, meaning there is no swelling, bruising, or obvious deformity. The absence of these external markers helps differentiate it from a fracture or a more severe dislocation. The child’s immediate reaction is to refuse to use the injured arm, often crying out right after the incident due to the initial sharp pain.
The child will hold the affected limb in a characteristic position, allowing the arm to hang limp at their side. The forearm is held slightly bent and pronated (palm turned downward or inward). They may use their other hand to gently support the injured arm. Any attempt by a caregiver to move the arm, especially to turn the palm upward (supination) or lift the arm, will elicit immediate pain and resistance from the child.
Seeking Immediate Medical Attention
Caregivers should seek professional medical attention immediately once the signs of a pulled elbow are recognized. Avoid trying to straighten, shake, or manipulate the child’s arm, as this can cause unnecessary pain. The child should be kept calm and comfortable by allowing them to hold the arm in their preferred, protective position. A medical professional will perform a closed reduction maneuver to correct the subluxation.
This procedure involves a quick, specific movement of the forearm that gently slides the annular ligament back into position around the radial head. The reduction is accomplished in seconds and often results in a nearly instantaneous relief of pain and a restoration of function. Following a successful reduction, most children will begin using their arm normally again within minutes.