Nursemaid’s elbow is a frequent childhood injury that affects the elbow joint, often causing immediate pain and refusal to use the arm. This article explains the medical nature of this common ailment, the origin of its unusual title, and the simple, effective procedure used for correction.
What Exactly is Nursemaid’s Elbow?
The medical term for Nursemaid’s elbow is radial head subluxation, which describes a partial dislocation of the elbow joint. The elbow is a hinge joint formed by three bones: the humerus in the upper arm and the radius and ulna in the forearm. The radius has a small head that is normally held firmly in place against the ulna by a strong, fibrous band of tissue called the annular ligament.
In young children, typically those between one and five years old, the ligaments are still somewhat loose and immature, making them susceptible to this injury. The subluxation occurs when the radial head slips out from under the annular ligament. The ligament then becomes trapped between the radial head and the humerus, preventing the child from moving the arm fully.
Where Did the Name Come From?
The common name, Nursemaid’s elbow, relates to the scenario in which the injury was historically observed. During the 19th and early 20th centuries, a nursemaid or other caregiver was often the person inadvertently responsible for the injury.
The injury is caused by a sudden, forceful pull or tug on a child’s hand or forearm while the elbow is extended. Caregivers might have caused this accidentally, perhaps while trying to lift a child over a curb, prevent a fall, or simply hasten their pace. This historical context of the caregiver’s common action led to the injury being labeled with the occupational title of the person who often caused it.
How the Injury is Treated
Diagnosis of radial head subluxation is usually based on the child’s medical history and physical presentation, as swelling or bruising is typically minimal. The child will often refuse to use the injured arm, holding it close to the body with the elbow slightly bent and the palm turned downward. A healthcare professional can usually confirm the injury without needing an X-ray, though imaging may be used to rule out a fracture if the mechanism of injury suggests it.
The treatment for Nursemaid’s elbow is a simple, non-surgical technique known as a reduction maneuver. This procedure involves a gentle, specific manipulation of the arm to guide the radial head back into its correct position. The physician may use one of two primary techniques: the supination-flexion method or the hyperpronation method.
During the maneuver, a faint click or pop may be heard or felt as the entrapped annular ligament slides back over the radial head. The procedure takes only a few seconds, and while it may cause momentary discomfort, the relief is almost immediate. Most children begin using their arm normally within minutes, and prevention involves educating caregivers to avoid lifting children by their hands or wrists.