Nursemaid's elbow is a partial dislocation of the elbow, which occurs when the lower part of the arm (forearm) slips out of its normal position at the elbow joint.
The injury is also called radial head dislocation.
Radial head dislocation; Pulled elbow; Dislocated elbow - children; Elbow - nursemaid's; Elbow - pulled; Elbow subluxation; Dislocation - elbow - partial; Dislocation - radial head
Causes, incidence, and risk factors
Nursemaid's elbow is a common condition in young children and generally affects children under age 5. The injury occurs when a child is pulled up too hard by the hand or wrist. It is often seen after someone lifts a child up by one arm up. (For example, when trying to lift the child over a curb or high step.) Swinging a young child from the arms while playing can also cause this injury.
When the injury occurs, the child usually begins crying immediately and refuses to use the arm. The child may hold the arm so that is slightly bent (flexed) at the elbow and pressed up against the belly (abdominal) area. The child will move the shoulder, but not the elbow. Some children stop crying as the immediate pain goes away, but continue to refuse to move the elbow.
Once the elbow dislocates, it is likely to do so again, especially in the 3 or 4 weeks following the injury.
Nursemaid's elbow does not usually occur after age 5. By this time, a child's joints and surround structures are stronger, and the child is less likely to be in a situation where this injury might occur. However, in some cases, the injury can occur in older children or adults, usually from a fracture of the forearm.
- Immediate crying
- Complaints of elbow pain
- Refusing to use the arm that is injured
- Holding elbow slightly bent at the elbow
- Holding the lower part of the arm against the belly area (abdomen)
- Moving arm at shoulder but not elbow
If you think your child has nursemaid's elbow:
- DO NOT move the child without first splinting the arm.
- DO NOT try to straighten the arm or change its position.
Apply an ice pack to the elbow. Splint the injured arm in the position in which you found it. Keep the area both above and below the injured elbow from moving, including the shoulder and the wrist, if possible.
Take the child to the doctor's office or emergency room.
Signs and tests
The health care provider will examine the child.
The child will be unable to rotate the arm at the elbow so that the palm is up and will have trouble bending (flexing) the elbow all the way.
The doctor will fix the dislocation by gently flexing the elbow and rotating the forearm so that the palm is facing upward. DO NOT try to do this yourself as you may harm the child.
In some cases of frequently recurring nursemaid's elbow, your health care provider may teach you how to attempt to correct the problem yourself. See your health care provider for assistance.
If nursemaid's elbow remains untreated, it may result in permanent inability to fully move the elbow. With treatment, there is usually no permanent damage.
In some cases, the child may have problems that limit movement of the arm.
Calling your health care provider
Call your provider if you suspect your child has a dislocated elbow or refuses to use an arm.
Avoid lifting a child by one arm only, either from the wrist or hand. Lift from under the arms, from the upper arm, or from both arms. Do not swing children by the hand or forearm. To swing a young child in circles, provide support under the arms and hold the upper body next to yours.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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