Nursemaid’s elbow—also referred to as pulled elbow, slipped elbow, and toddler elbow—is a common injury of early childhood. In fact, it represents more than 20% of upper-extremity injuries in young children.
As a child grows, their bones and muscles develop and become much stronger. But for young children, even slight jerks or pulls to the arm can cause this type of dislocation. Unfortunately, these scenarios are all-too-common scenes of everyday life with kids, such as playfully swinging your child around by the arms, lifting them to their feet during a tantrum, or pulling them back from the curb to avoid oncoming traffic.
The important thing to know is that this is a very common injury that your doctor can address. Read on to learn everything you need to know about identifying nursemaid’s elbow and how to treat it so that your child can get back to normal as quickly as possible.
What Is Nursemaid’s Elbow?
Nursemaid’s elbow is a type of elbow injury in children caused by the dislocation of a bone. Radial head subluxation (its medical term) occurs when a forearm bone called the radius slips out of place. It is a common condition in children younger than age four but can occur in children up to seven years old.
Because a young child’s ligaments—the strong tissues that attach bones to each other—are not fully formed, even mild force to the joint may cause it to shift or partially dislocate. The recurrence rate for nursemaid’s elbow is approximately 20%.
What Are Symptoms of Nursemaid’s Elbow?
Nursemaid’s elbow can affect each child differently, but the most common symptoms include:
- Immediate pain in the injured arm
- Difficulty moving the injured arm
- Support of the affected arm with the opposite hand
- Nervousness or anxiety in response to the pain
- Reluctance to let anyone touch the injured arm
It is not uncommon for a child to feel upset or nervous by the pain and try to limit the function of the arm to avoid examination. If you sense that your child is or has experienced any of these symptoms, consult your doctor, even if the pain seems to have disappeared.
What Causes Nursemaid’s Elbow?
Nursemaid’s elbow often occurs when a child’s hand, wrist, or arm is pulled suddenly on one side. This could be something as simple as pulling a child out of harm’s way or preventing a fall. It can also occur during play when a child is swung around holding just the arms or hands.
Although it is less common, nursemaid’s elbow can be caused by falling onto an outstretched hand or awkwardly rolling over while in bed or lying on the floor. If a child injures the elbow in a fall, it may be a broken bone rather than nursemaid’s elbow.
Nursemaid’s Elbow Diagnosis and Treatment
Most doctors can diagnose nursemaid’s elbow once they learn what caused the injury and observe how the child holds their arm. The child will be unable to rotate or bend the arm at the elbow without experiencing pain. Even if they suspect nursemaid’s elbow, a doctor will perform a physical examination.
Nursemaid’s elbow treatment depends on the severity of the injury as well as the child’s age and general health. If there is no sign of swelling or other injury, the doctor will begin a maneuver called reduction. By carefully moving the child’s arm, they move the joint back into place. To help ease pain, medicines such as acetaminophen (Children’s Tylenol) may be used.
To perform reduction, the child typically sits in their caretaker’s lap. The doctor applies pressure near the top of the child’s radius with his or her thumb. Then they gently move the arm (bending or straightening it) while turning the palm to the floor. This action moves the bone and ligament back into place. A faint pop or click might be heard. This whole process usually takes only a few seconds.
The child may experience some brief pain during reduction but will feel much better once it is complete. Most children regain full use of their arm within 5-10 minutes of successful reduction, and within 30 minutes, 90% of children are asymptomatic with no splinting or sling necessary.
Can it resolve on its own?
When a child has nursemaid’s elbow, the bone can move back into place on its own. However, it is strongly recommended that the child be examined by a healthcare professional even if you suspect the injury has resolved on its own.
Can you fix the condition at home?
Do not try to correct or fix nursemaid’s elbow on your own, as it can cause further damage to the child’s bone and joints. If nursemaid’s elbow returns several times, your doctor may teach you how to correct the problem at home, but it is important to consult with a doctor every time the injury occurs.
Nursemaid’s Elbow Prevention
To avoid nursemaid’s elbow or any sort of recurrence, parents or caregivers should be aware of and try to limit motions that lead to nursemaid’s elbow including: lifting, jerking, or swinging a child by the hands, wrists, or forearms. To safely lift a child, grasp gently under both arms. Although this is easier said than done, it helps to keep this information top of mind.
When to See a Doctor
If your child complains of pain in their arm, holds their arm in an awkward way, or avoids normal use of their arm, contact your doctor. When you visit, they will most likely ask about any recent known trauma to the arm and perform an examination.
During the examination, your doctor should fully inspect the affected arm and clavicle. The arm should also be prodded gently to determine the tenderness of the bones and joints. Although an x-ray is not required to diagnose nursemaid’s elbow, your doctor may order one to ensure there are no other injuries such as a broken bone.
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