Whenever you reach out to a young child, be mindful not to pull or jerk his or her hands or arms. A quick tug of a toddler's arm can easily result in a slip or subluxation (partial dislocation) of an elbow bone. This is called "nursemaid's elbow" or pulled elbow.
Nursemaid's elbow most commonly occurs in kids 1 to 3 years old, though infants and older kids can experience it, too.
In younger children, the ligaments (bands of muscle that hold bones together) are loose and bones are not yet fully developed, making it easy for them to slip in and out of place.
As kids get older, however, their ligaments tighten, bones enlarge and harden, and the risk of nursemaid's elbow significantly decreases.
Causes of Nursemaid's Elbow
The elbow joint connects the humerus (upper arm bone) to the radius and ulna (lower arm bones). The rounded tip of the radius (the radial head) is surrounded by a ligament that is sometimes loose in kids.
If not tight enough, the ligament may slip over the radial head if a small amount of pressure is applied. This causes the bones to move out of place, or subluxate.
Any of the following can cause a subluxation:
- Jerking a child's arm. Pulling a toddler along while walking or quickly grabbing his or her hand can jerk the arm, resulting in slipping of the radial head. Use caution when taking a child by the hand.
- Pulling a child up by the hands. Pulling on hands or forearms can put stress on the elbows. Never pick up a toddler or infant by the hands or wrists. Lifting under the armpits is the safest way to lift a child.
- Swinging a toddler by the arms. Any type of swinging by holding the hands or wrists can strain the elbow joint and should be avoided.
- Breaking a fall with the arm. The natural response to falling is outstretching an arm for protection. The elbow can overextend during this type of injury, resulting in a slip of the radial head.
- Rolling over in an awkward way. Sometimes rolling over in a crib, bed, or on the floor can cause nursemaid's elbow in infants and very young children.
When Your Child Is Injured
A child with nursemaid's elbow will probably not look outwardly injured because the subluxation does not cause the arm to twist or bend awkwardly.
However, a child may exhibit warning signs that should signal a red flag to parents. Here's what to look for:
- The child refuses to use an arm. A child will not be able to use the injured arm without pain. Therefore, the arm is usually kept in a fixed, straight position or with a slight bend in the elbow.
- Use of the arm is painful. Toddlers may tell you the forearm hurts, or they may cry or shout out in pain if you touch it. This doesn't necessarily indicate a case of nursemaid's elbow. Fractures and bruises will hurt, too. You'll just know something isn't right and a doctor needs to check it out.
Contact your doctor if you suspect a case of nursemaid's elbow. Do not attempt to put the bone back into place yourself. Timely treatment by a medical professional can ease pain and reduce the risk of further complications.
At the Doctor's Office
If your family doctor is not able to treat nursemaid's elbow, an orthopedic specialist may provide care. A doctor at a local emergency department can also see your child.
The doctor will first determine whether your child has nursemaid's elbow. The arm and shoulder will be felt to make sure there's no swelling or other abnormality, which could point to a fracture instead. If no swelling is present, the doctor will attempt to manually push the radial head back into place. The medical term for this is reduction.
Your child may be given some medicine for anxiety relief before the reduction, but anesthesia is not needed. The procedure is very quick and takes only a few seconds. A child is usually asked to sit on a parent's lap while the doctor attempts to reduce the elbow. During this procedure, the arm is taken from a straight position and quickly bent upwards. The doctor will listen and feel for a "pop" or "click" sound, indicating the bones are back in place. A child may experience a moment of pain in the elbow at the time of the reduction. After treatment, most kids have full use of the arm within 5 to 10 minutes.
Some cases may require more than one try to successfully reduce the elbow. Occasionally, a child may not use the arm after the reduction for a brief time, fearing it will be painful. If discomfort continues, the doctor may put the arm in a sling and recommend acetaminophen or ibuprofen for pain relief.
Kids who've had nursemaid's elbow are at risk of a recurrence, so it's important to be careful when picking up your child or holding hands. Never jerk, swing, or tug on a young child's hands or arms.