Key Points To Remember
- A pulled elbow is caused by a sudden yank or pull on a childs lower arm or wrist, or by a fall.
- Seek immediate medical assistance, because the longer the elbow has been out of place, the more painful and difficult it is to put back into place.
- A pulled elbow will not cause any long-term damage to your child.
- Dont pick your child up by the lower arms or wrists and teach others the correct way to pick up your child.
What Is Nursemaids Elbow
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Nursemaids elbow, also known as radial head subluxation or simply a pulled elbow, is a common injury that affects children five and under. Nursemaids elbow occurs when the elbow bone, or radius, becomes partially dislocated from the elbow joint or humerus. This is not a full dislocation. Instead, the radius stops just short of coming completely loose from the joint. This is whats known as subluxation, where the bones are just slightly misaligned.
Nursemaids elbow is most common among children between the ages of one and four, and it is slightly more common among girls than boys. Nursemaids elbow is rare at the age of five because the ligaments around the elbow are much stronger by this time. You wont typically see this injury in anyone age six or older.
How To Fix Nursemaids Elbow According To A Surgeon
Nursemaid’s elbow is nothing to freak out about. Here’s what parents need to know.
Swinging their kids by their wrists for fun or pulling them out of the street for their safety is a normal occurrence in parenthood. However, having their arm go limp suddenly is extremely alarming. Rest assured that its incredibly common in children, and its not even a fully dislocated elbow, even if it very much resembles one. Its nursemaids elbow, otherwise known as a pulled elbow or radial head subluxation.
Nursemaids elbow is not typically painful, has no known long-term consequences, and mostly just scares the hell out of moms and dads. The only issue is that children cannot usually use that arm until someone pops it back into place, says Jennifer Weiss, M.D., of the American Academy of Orthopedic Surgeons. Here, she shares what parents need to know about how to fix nursemaids elbow and how to avoid it in the first place.
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Is Nursemaids Elbow An Emergency
Is nursemaids elbow an emergency?
Nursemaids elbow is a common injury in young children. It is caused when the childs arm is pulled too hard and the radius pops out of the ulna .
Nursemaids elbow is not usually a serious injury, but it can be painful. If your child has nursemaids elbow, you should take him or her to a doctor or emergency room for treatment.
The doctor will gently push the radius back into the ulna. He or she may also give the child a pain reliever. Most children recover quickly and have no long-term problems.
Treatment For Nursemaid’s Elbow
Specific treatment for nursemaid’s elbow will be determined by your child’s doctor based on the following:
Your child’s age, overall health, and medical history
The extent of the condition
Your child’s tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
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How To Know If A Child Is Experiencing Nursemaids Elbow
It can be difficult to know if a child is experiencing nursemaids elbow. Usually there is no swelling, redness, or bruising to indicate this specific injury however, there may be swelling or bruising from other injuries sustained in the same incident. Observe the child to see if there are changes in his or her behavior. If a child is experiencing nursemaids elbow, the following may be seen:
- the child may verbally indicate the arm/elbow hurts when moving it
- the child may simply hold the arm close by his or her side and/or
- the child may refuse to bend or rotate the elbow or use the arm.
If a child is showing any of these behaviors, first find out whether one of the common causes of nursemaids elbow occurred. Was there a struggle with putting a jacket or coat on the child? Did the child get picked up or pulled by the arm, wrist, or hand?
If a potential cause for nursemaids elbow occurred and any of the above symptoms are present, take the following steps:
Diagnostic Tests For Nursemaid’s Elbow
If the child is cooperative and there is no pain with palpation of the arm, its perfectly reasonable to attempt to reduce the dislocation without an x-ray.
If youre unsure, or there is evidence of trauma you should get an x-ray. Now, a nursemaids elbow without evidence of trauma will appear normal on an x-ray. So, you must look for physical signs of a nursemaids elbow instead of relying on an x-ray to confirm your diagnosis.
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How Does Nursemaid Elbow Happen
Even a little force can be enough to pull a young childs elbow joint out of place. Common causes include:
- Swinging your child around by the hands.
- Lifting your child up by the hands.
- Pulling your childs arm through a jacket sleeve.
- Catching your child from falling by the hand.
- Pulling your child suddenly by the hand to avert danger.
Physical Signs Of Nursemaid’s Elbow
The child will not be in any pain but will refuse to use the affected arm and will hold it slightly flexed with the wrist pronated. This posture will prompt parental concern.
It is important to make sure there is no other injury, such as a fracture of the clavicle, humerus, radius, or ulna. Be sure to palpate these areas.
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What Are The Signs And Symptoms Of Nursemaid Elbow
If you didnt witness the injury, it might not be obvious just looking at it. Children will cry from the pain at first, but they might not complain much afterward. It won’t cause swelling. Pay attention if your child:
- Cries or expresses pain after being pulled by the arms or hands.
- Avoids moving their arm below the shoulder.
- Supports one arm with the other hand.
- Holds their arm straight or slightly bent and close to the body.
- Refuses to rotate their palm.
How Is Nursemaid’s Elbow Treated
Sometimes the ligament gets unstuck by itself. But in most cases, a health care professional does a gentle arm move called a reduction to get the ligament out from between the two bones. The child sits on a parent’s lap as the doctor moves the arm, which takes only a few seconds. You might hear a pop as the joint moves back into place. The move might be briefly uncomfortable, but kids quickly feel much better. Most have full use of their arm in 515 minutes. Some might need than one reduction to successfully fix the injury.
Occasionally, a child may not want to use the arm after a reduction if they worry it might be painful. If there is some discomfort, the doctor may put the arm in a sling and say it’s OK to give acetaminophen or ibuprofen for pain relief. In some cases, the doctor may place a splint or a sling on the arm until a specialist can check it after a few days of rest. The specialist can look for any other problems.
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How Is This Condition Diagnosed
If your child is holding their arm in an awkward way or is complaining of pain, make an appointment with their pediatrician.
Their doctor will typically make a physical assessment of the injured arm, diagnosing nursemaid elbow based on the way the elbow was injured and how the child is holding their arm. An X-ray isnt required, but may be done in order to rule out fractures and broken bones.
What Is The Treatment For Nursemaids Elbow
There is a quick and simple treatment for nursemaids elbow, but its best to have your childs doctor perform it. The doctor will gently move the elbow bone and ligament back into place by folding the childs arm upward so that the wrist pulls toward the shoulder. Though this is a simple procedure that takes only seconds, performing it wrong can cause more serious damage, so parents are discouraged from trying it at home.
Moving the elbow back into place may be painful initially, but the child typically feels better within 45 minutes. If the pain and discomfort are not gone within an hour, your doctor may recommend imaging if this was not performed earlier, or order additional tests to check for other possible diagnoses.
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How To Fix A Nursemaid Elbow6 Min Read
how to fix a nursemaid elbow
A nursemaid elbow is a condition that affects the elbow joint. It is caused when the ligaments that hold the bones in the joint together stretch or tear. This can happen when the arm is twisted or turned too far, or when it is bent backwards. Nursemaid elbow is most common in children, but it can also occur in adults.
The symptoms of nursemaid elbow include pain, swelling, and stiffness in the elbow joint. The arm may also feel weak and be difficult to move. In severe cases, the joint may become locked in a bent position.
The best way to treat nursemaid elbow is to rest the joint and apply ice to the area. You can also take over-the-counter pain medication to help reduce the inflammation and discomfort. If the joint is locked in a bent position, you may need to see a doctor to have it straightened out.
Relevant Anatomy For Nursemaid Elbow Reduction
The annular ligament wraps around the radius and attaches at both ends to the ulna and thus holds the radius in place against the ulna at the radioulnar joint.
The radial head can be palpated superficially at its articulation with the lateral humeral epicondyle. Unlike the epicondyle, the radial head rotates when the wrist is pronated or supinated.
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Can You Prevent Nursemaid’s Elbow
As your child grows, their ligaments will get stronger. So it will become less likely that pulling a child’s arms will cause nursemaid’s elbow. Until then, you may be able to prevent nursemaid’s elbow if you follow these tips:
- Do not lift a child up by the arms or hands. Lift the child under the arms instead.
- Do not tug or jerk a child’s hand or arm.
- Never swing a child by the hands or arms.
Kids who have had nursemaid’s elbow are more likely to get it again in the future.
Can You Fix The Condition At Home
Do not try to correct or fix nursemaids elbow on your own, as it can cause further damage to the childs bone and joints. If nursemaids 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.
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How Is Nursemaid Elbow Treated
Your childs doctor will treat nursemaid elbow through a process called reduction. It involves gently moving the bone and ligament back into place. The doctor will fold the childs arm upward from a straight position, turning the palm as the arm bends at the elbow. Theyll support your childs elbow with the other hand. You may hear a faint pop or click.
Though the process will only take a few seconds, your child may experience temporary pain during the reduction. Afterward, theyll usually feel much better than before. Most of the time, children are able to use their arm again within 5 to 10 minutes. However, its possible your child might require more than one reduction to heal.
Common Questions Our Doctors Are Asked:
If my child has had a pulled elbow once, is he more likely to have it again because his ligament has stretched?
Having a pulled elbow doesnt cause any long-term damage and wont stretch the ligament. However, some children are more susceptible to getting a pulled elbow more than once because they have loose joints and their radius bone is more likely to slip out.
My child has had a pulled elbow before, and I know how toput the arm back into place. Is it OK to do this if we are not near a doctor?
Never attempt to relocate a pulled elbow by yourself. It should always be managed by a medical professional.
My child loves it when I swing her by the hands when we are playing. Is this dangerous?
Even though its fun for the child, swinging them by their arms, hands or wrists puts them at risk of a pulled elbow.
What can we do at The child plus childrens hospital?
We are expert at diagnosis and treatment of paediatric and childhood illness. Feel free to contact us if any help regarding your childs health. We are happy to help.
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What Are The Causes
Cases of nursemaids elbow are most often seen in children under the age of five. This is because the ligamentsthe strong tissues that hold bones togetherare still developing and the elbow joints are weaker. Typically, the injury occurs when a childs lower arm or hand is pulled, especially when the childs arm is twisted at the time of the tugging. Examples of the most common causes include when a person:
- catches a child by the hand to stop a fall or pull them away from a dangerous situation
- is holding a childs hand when the child suddenly steps off a curb or stair step
- lifts a child up by the hands or wrists
- pulls a childs arm too roughly through a jacket sleeve
- swings a child by the arms or hands or
- yanks on a childs arm to make them walk faster.
While this is not a complete list, it provides an idea of how the injury can occur.
What Causes Nursemaid Elbow
Nursemaid elbow results from a sudden pulling force applied to the extended arm of a child. Due to the relative strength of the adult in comparison to the weakness of the child’s supportive annular ligament, the applied force may not seem strong to the parents and they may not realize an injury has occurred.
Examples of typical situations that can produce the mechanism of force required to cause this injury are lifting the child up from the ground by the hand or wrist, swinging the child while holding the child by the hands or wrists, pulling arms through the sleeves of jackets, catching a child by the hand to prevent a fall, and pulling a child along when in a hurry or the child suddenly collapsing to the ground in an effort to avoid going with their parent.
The young child is prone to this type of injury largely because of the anatomical features of their bones and ligaments. Understanding the mechanism of this injury is helpful in explaining the cause.
The doctor will move the bones back into place in this manner:
Should initial reduction attempts be unsuccessful and a splint is required, follow-up should be done in 24-48 hours. If the child continues to have any loss of function of the affected arm, bruising, deformities, or other unexpected or unusual findings, a reevaluation is in order. Should the child experience this condition time after time, the doctor may put the arm in a cast to keep it immobile and discuss surgery to “tighten” the annular ligament.
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How Do You Treat A Nursemaid Elbow
A nursemaid elbow, also called a pulled elbow, is a common injury in children. The injury occurs when the elbow is bent and then quickly straightened. This causes the ligaments that hold the bones in the joint together to stretch too far. The result is pain and swelling in the elbow.
Most nursemaid elbow injuries can be treated at home. The most important thing is to keep the elbow straight. You can do this by using a splint or by wrapping the arm with a bandage. Ice can also be helpful in reducing swelling. The child should avoid using the arm until the pain and swelling have gone away.
If the injury does not improve after a few days, or if the child experiences severe pain, then it is best to seek medical help. A doctor may need to X-ray the elbow to make sure there is no damage to the bones or ligaments. Treatment may include physical therapy or surgery.
How To Fix Nursemaids Elbow
As a parent, its only natural to want to lift your child into your arms, swing them around, and enjoy high-spirited playtime. However, the very activities you love to engage in can cause a painful condition known as nursemaids elbow.
Nursemaids elbow is a common problem for young children. Though its not typically a cause for major concern, its not something you can afford to ignore, either. Learn how to recognize nursemaids elbow so you can take your child to their doctor when needed and have this condition treated promptly to relieve the pain and discomfort that it will cause.
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