Parents have been twisting my arm to explain what a nursemaid’s elbow is and how it can be treated or prevented. Let me lend a hand to everyone on this topic.

Nursemaid’s elbow is one of the most common injuries of early childhood. It is another term for a partially dislocated elbow joint and carries the medical name “radial head subluxation.” 

Nursemaid’s elbow is also affectionately called a pulled elbow due to the way this injury occurs in children between 1 and 4 years of age. At those young ages, the ligaments or bands that hold in place the radius bone of the elbow are loose and not fully formed. As a result, the bone can slip out of those bands. With aging, these bands become tighter around the radius, which is why we don’t see this problem in older children.  

Here are some examples of how nursemaid’s elbow can happen:

  • Pulling a child up by their hands or wrists rather than under their armpits
  • Swinging a toddler by their arms or wrists
  • Jerking a child’s arm suddenly while walking to pull them back from traffic
  • Breaking a fall with an outstretched arm

How do you know this type of injury has occurred? Pain is not a prominent sign. Instead pain is usually mild and doesn’t last long. What you are more apt to see is a child who refuses to use an arm. Children will instead keep their arm in a fixed position to their side with a slight bend in the elbow and palm turned toward the body. 

If someone tries to straighten the elbow, or turn the palm upward, there can be more pain without significant visible swelling. In fact if there is a lot of pain, that may signal more of a fracture or bruise than a dislocation. If you are not sure what is causing your child’s arm pain, seek medical attention to help make the diagnosis.

Your child’s health care provider can examine the arm and make sure it is a simple dislocation. If the arm hasn’t relocated by itself, and some do, the provider can do a brief maneuver to relocate the ligament back into position. Usually the arm is mobile within minutes after doing this relatively painless maneuver. If not, x-rays may be needed to make sure there is no missed fracture.  

Can you prevent a nursemaid’s elbow? Sometimes you simply cannot, since kids are prone to injury. But parents should avoid tugging, swinging, pulling up or jerking on their young child’s hands or arms. 

Hopefully tips like this will relocate any out-of-joint thoughts about a nursemaid’s elbow.

Lewis First, MD, is chief of Pediatrics at The University of Vermont Children’s Hospital and chair of the Department of Pediatrics at the Robert Larner, M.D. College of Medicine at the University of Vermont.  You can also catch “First with Kids” weekly on WOKO 98.9FM and MyNBC 5, or visit the “First with Kids” video archives at www.UVMHealth.org/MedCenterFirstWithKids.

 

Lewis First, MD, is chief of Pediatrics at The University of Vermont Children’s Hospital and chair of the Department of Pediatrics at the Robert Larner, M.D. College of Medicine at the University of Vermont.

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