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Nursemaid's Elbow

Subluxation of the radial head in a child

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Updated December 13, 2004

What is a nursemaid's elbow?
A nursemaid's elbow is a common elbow injury seen in young children. The injury causes a subluxation of one of the bones (the radius) at the elbow joint. Subluxation means the bones has slid out of proper position .The nursemaid's elbow injury usually occurs in children age 5 or younger.

What causes a nursemaid's elbow?
A nursemaid's elbow can be caused many ways, but the classic mechanism is a sudden pull on a young child's arm. For example, an adult trying to prevent a child from falling, may suddenly pull the child by his or her hand. If the arm is in a certain position, the radial head is susceptible to subluxation.

What are the symptoms of a nursemaid's elbow?
Children who sustain a radial head subluxation have sudden pain around the elbow joint. The children often hold their arm flexed and against their body. Common symptoms of a nursemaid's elbow include:

  • Sudden pain around the elbow
  • Inability to bend the elbow
  • Swelling or discoloration around the elbow
A diagnosis of a nursemaid's elbow is made by x-ray showing the radial head out of position. It can be difficult to make this diagnosis as children's bones are not fully formed, and seeing the subluxation can be difficult. X-rays of the uninjured elbow may be obtained for comparison.

Your doctor will also consider other problems that can cause similar symptoms including elbow fractures and congenital radial head dislocations.

What is the treatment of a nursemaid's elbow?
The subluxed radial head can usually be placed back into position by your physician. Sometimes light sedation is used for comfort, but often this is not necessary. When the radial head is repositioned your doctor can usually feel it 'pop' back into position. Children will usually feel immediate improvement in pain.

If the injury is treated quickly, and if this is the first radial head subluxation in the child, then usually immobilization is not necessary. In some cases, a splint may be applied for about a week. If multiple radial head subluxations occur, a cast may be applied for a period of time to allow the ligaments around the elbow to heal.

How can I prevent a nursemaid's elbow?
Parents need to be aware of the limits of their children's body; they are resilient, but they can be hurt! Try not to lift your children by the end of one arm--sudden pulls of the hand or wrist can cause a radial head subluxation in young children.

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