You may or may not have seen the injury, but now your young child won’t use the arm. Is it broken? Nursemaid’s elbow can be quite painful, but it can also be fixed in moments with dramatic relief.
In children under about 4 years old, the head of the radius bone (a bone in the forearm) is not as big proportionately as it will be later. When the arm is straightened and pulled, the elbow joint is loose enough to separate for a moment while a bit of ligament slips between the bones before they snap back together. Ouch!
Elbow subluxation is a common injury in toddlers and preschool children. It is most common when children are swung, pulled, or lifted with the arm at full length. It is especially common if kids are yanking their arms against the pull. The injury also happens sometimes with falls.
The main symptom of elbow subluxation is refusal to use the affected arm. Kids will usually hold the arm close to the body, with the elbow bent. The hand is usually turned down or toward the body.
Kids may scream if you attempt to turn the hand or move the elbow, but there is unlikely to be swelling or bruising.
Nursemaid’s elbow usually lasts until someone manipulates the joint to free the trapped ligament.
The diagnosis is usually made based on the history and physical exam. If there is a question that there is a fracture, X-rays may be needed.
If there is clearly no fracture of the bones around the elbow, elbow subluxation is treated by manipulating the head of the radial bone to allow the trapped ligament to spring free. This is done by turning the hand upward and bending the elbow while holding pressure over the head of the radius. Some doctors use a different technique, where they turn the hand downward until the palm is facing out (called hyperpronation).
A click is often felt as the joint springs back to normal position.
This causes a moment of increased pain before dramatically increasing the child’s comfort. Moments later, you will often see the child running and playing as though nothing had happened.
Avoiding pulling on the outstretched forearm of young children can prevent some cases of this common injury. Special care should be taken when lifting or swinging children.
Dislocated elbow, Nursemaid’s elbow, Pulled elbow