Nursemaid’s elbow, known medically as radial head subluxation, is a common injury of early childhood – especially among children under the age of five. It is sometimes referred to as a “pulled elbow,” because it occurs when a toddler or preschooler’s elbow is pulled and partially dislocates. Dislocation means the bone shifts and slips out of its normal position.
The injury usually occurs during routine contact between the child and parents or caregivers. Hence, the common name of the condition: nursemaid’s elbow. In a small number of cases, a pulled elbow can happen in adolescents or adults, usually after a fall. It’s usually accompanied by a fracture of the forearm as people get older, as the bones are not as flexible as they are during childhood. Luckily, an elbow subluxation is a pretty straightforward injury that can be treated successfully.
Causes
The elbow joint is made up of the upper arm bone (humerus) and the two bones in the forearm (radius and ulna). The radius runs from the elbow to the thumb side of the wrist. Nursemaid’s elbow occurs when there is a partial separation of the radius bone from the joint.
Strong ligaments (tough, flexible bands of fiber-like tissue that connect bones to one another) on the inner and outer sides of the elbow hold the joint together and help it perform its movement and functions.
However, a young child’s muscles and ligaments may not be completely formed, hence it can take only a little force to pull the bones of the elbow partially out of place and cause the nursemaid’s elbow injury.
The injury can happen when a child is pulled up too hard by their lower arm, hand, or wrist. To help a small child to get into a car or negotiate a high step, parents or caregivers sometimes accidentally put excessive stress on the elbow joint. Nursemaid’s elbow can also happen during play when an adult pulls a child up by his arms to swing or move him or her around. Holding their hands and swinging them around seems like unbridled fun for all, but it is actually quite a risky maneuver.
Symptoms
Moving the injured arm may be painful and very uncomfortable, and the child will likely hold the arm close to the body and be reluctant to bend his elbow or move it in any way.
Diagnosis
A pediatrician, general practitioner, emergency room doctor, or orthopedic specialist can diagnose nursemaid’s elbow. An X-ray is not usually required to diagnose and treat an elbow dislocation, but your child’s doctor may request one to confirm there are no broken bones or other trauma.
Treatment
For most cases of nursemaid’s elbow, the doctor will administer minor sedation to the patient, and then move the bones back into normal position. This process is called a reduction.
During reduction, the doctor holds the child’s wrist or forearm and rotates it so that the palm faces up. Putting pressure at the top of the radius bone in the forearm, the doctor slowly bends the elbow, returning it to its normal location. Pain and discomfort usually go away immediately, although the initial process of reduction is often painful and sedation is recommended.
Never try to fix the dislocation yourself, as additional pain and further damage the joint is very likely. Instead, ice and immobilize the elbow and have your child seen by a doctor as soon as possible. Sometimes the elbow will slip back into position on its own, but it is still important for the child to see a health care provider to make sure things are aligned and set for optimal healing.
If you have questions about nursemaid’s elbow or other musculoskeletal pain, contact the expert team at Greater Chesapeake Hand to Shoulder. Since 1987, they’ve diagnosed and treated a host of shoulder, arm, wrist, and elbow conditions. Highly-experienced and board certified, our surgeons will work hard to ensure you achieve optimal results. For more information, or to schedule an appointment, call (410) 296-6232.
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