An Overview of Nursemaid's Elbow in Children

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 have slid out of proper position. The nursemaid's elbow injury usually occurs in children age 5 or younger.

Causes

A nursemaid's elbow can be caused by many types of injuries, 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. This injury can also occur when an adult or older child swings a young child around in the air held by their arms alone.

If the arm is in a certain position, the radial head can be susceptible to subluxation. 

Symptoms

A child who sustains a radial head subluxation will have sudden pain around the elbow joint. The child often holds their elbow flexed and against their body. Common symptoms of a nursemaid's elbow include:

• Sudden pain around the elbow
• Inability to bend or straighten the elbow
• Swelling or discoloration around the elbow

A diagnosis of a nursemaid's elbow is made with an X-ray, which can show the radial head out of its normal position. It can be difficult to make this diagnosis because children's bones are not yet fully formed, and the subluxation might not be easily detected. X-rays of the uninjured elbow may be obtained for comparison. Other tests such as ultrasound can be helpful if the diagnosis is unclear.

Your healthcare provider will also consider other problems that can cause similar symptoms including elbow fractures. Congenital radial head dislocations, which are abnormalities that can exist from birth, can cause similar symptoms too.

Treatment

The subluxated radial head can usually be placed back into position by your child's healthcare provider. Sometimes light sedation is used for comfort, but often this is not necessary. When the radial head is repositioned (called a reduction), your healthcare provider can usually feel it 'pop' back into position. Children will usually feel an immediate decrease in pain. The maneuver is performed by rotating the forearm while holding pressure on the radial head while bending the elbow.

If the injury is treated quickly, and if this is the first radial head subluxation the child has had, then immobilization is usually 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.

Prevention

Parents need to be aware of the limits of their children's bodies; 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.