Nursemaid’s elbow is a common injury seen in early childhood. It is also referred as pulled elbow because it occurs when a child’s elbow is pulled and partially dislocates. Medically this injury is called as radial head subluxation. This happens when a ligament slips out of place and gets caught between two bones of the elbow joint and cause the injury.

In young children, the bones and muscles are still developing. So, typically it takes very little force to pull the bones of the elbow partially out of place, making this injury very common. The age group which is most prone to it is between 1 to 4 years, but it can happen any time from birth up to 6 to 7 years old. This injury causes initial pain, the doctor will easily reset the elbow, quickly relieving any discomfort and restoring arm movement.

In this article:

Anatomy
Causes of Nursemaid’s Elbow in Children
Symptoms of Nursemaid’s Elbow in Children
Treatment of Nursemaid’s Elbow in Children
Prevention of Nursemaid’s Elbow in Children

Anatomy

The elbow is made up of humerus (upper arm bone) and radius and ulna (the two bones in the forearm) and the joint formed is called as elbow joint. On the inner and outer sides of the elbow, strong ligaments hold the elbow joint together and prevent dislocation.

The two joints in the elbow are –

• The humeroulnar joint between the ulna and humerus which allows the bending of the elbow.
• The radiocapitellar joint, made up of the radius and part of the humerus which allows rotation of the forearm so that the hand can be turned palm up or palm down.

Basically, the radiocapitellar joint is involved in nursemaid’s elbow and cause injury.

A Guide for Nursemaid’s Elbow in Children

It occurs when there is partial separation of the radiocapitellar joint. Because a young child’s ligaments – the strong tissues that attach bones to each other are not fully formed, even a mild force on the joint may cause it to shift or partially dislocate. The annular ligament which surrounds the radius and may be particularly loose in some young children, which leads to nursemaid’s elbow recurring over and over again.

Causes of Nursemaid’s Elbow in Children

The ligaments of the child are a bit loose, so it can be easy for a ligament in the elbow to slip into the joint and get stuck.

It can happen with just a small amount of force, for example –

• Pulling a child by the hands can put stress on the elbows, so never pick up by the hands or wrist but lift the child by the armpits properly.
• Swinging a child by holding the hands or wrists can put stress on the elbow joint and should be avoided for safety.
• Jerking an arm when pulling child along or quickly grabbing the hand can make the ligament slip. Always be gentle when taking a child by the hand.
• Breaking a fall by reaching an arm out for protection can overextend the elbow which cause ligament to slip.
• Rolling over in an awkward way in a crib, bed or on the floow can cause the injury in infants and very young

As the child gets older, the ligaments tighten. Most won’t get nursemaid’s elbow after turning 5 years old. Though it can happen up to age of 6 or 7 years.  It is rarely causes by a fall. If a child injures the elbow when falling onto an outstretched hand or directly onto the elbow, it may be a broken bone rather that nursemaid’s elbow.

Symptoms of Nursemaid’s Elbow in Children

Because moving the injured arm may be painful, the primary symptom of nursemaid’s elbow is that the child will hold the arm still on the side and refuse to bend or rotate the elbow or use the arm. A child will not use the injured arm because moving it is painful. It doesn’t cause deformity or swelling.

Doctor Examination

A doctor can typically make the diagnosis of nursemaid’s elbow based on how the injury occurred and the manner in which the child holds the arm. Although an x-ray image is not required for the doctor to diagnose nursemaid’s elbow.

Sometimes, it gets unstuck by itself in which a doctor gets the ligament back in place by doing a quick and gentle move of the arm.

Treatment of Nursemaid’s Elbow in Children

The doctor will gently move the bones back into normal position to correct the injury. This procedure medically is called as reduction and it takes only a few seconds. The doctor will hold the child’s wrist or forearm and turn the hand so that it faces palm up which may be painful. While putting pressure near the top of the radius bone with the thumb, the doctor will slowly bend the elbow. A faint pop or click sound may be heard when the joint goes back into place.

Sometimes, to relieve pain acetaminophen or ibuprofen is given.

Usually, no special tests are required to diagnose nursemaid’s elbow. X-rays are done only if fracture is present.

Prevention of Nursemaid’s Elbow in Children

Once a nursemaid’s elbow has occurred, there is a high likelihood of recurrence. For this reason as well as to prevent an initial occurrence, there are some guidelines that may prevent the injury –

• Safely lift the child and grasp gently under the arms.
• Do not lift the child by holding the hands or arms.
• Do not swing the child by holding the hands or arms.
• Avoid tugging or pulling on the child’s hands or arms.

Conclusion

Nursemaid’s elbow is a common injury in toddlers and preschoolers. It means the elbow is lipped form its normal position. Care and safety must be taken of the child while handling. Consult the doctor for the treatment if there is such injury.

References

https://kidshealth.org/en/parents/nursemaid.html

https://orthoinfo.aaos.org/en/diseases–conditions/nursemaids-elbow