What is nursemaid's elbow?
Nursemaid's elbow, also called radial head subluxation, means that the radius has pulled away from its normal position. (The radius is one of two long bones in the lower arm, or forearm.) The ligament that supports the radial bone then slips into the elbow joint. When this happens, the radial bone can't move back into its normal place.
The radius connects to the elbow joint at one end. The other end connects into the wrist joint.
What causes it?
Nursemaid's elbow usually occurs in young children. It happens when a young child is pulled or lifted by the hand or wrist while their arm is held straight. For example, the bone can pull out of position, or sublux, when you try to lift a child up onto a sidewalk by the hand. Or it could happen when you pull a child's hand to get them to move faster or when you hold onto a child's hands and swing them around while playing.
Nursemaid's elbow most often occurs in young children. This is because the socket of the elbow joint and the supporting ligaments are not fully developed. This injury is especially common in children between ages 2 and 3 years. But it can happen anytime between 6 months of age and 7 years. After age 3, children's joints and ligaments gradually grow stronger. This makes nursemaid's elbow less likely to occur.
Although physical abuse is sometimes the cause of this injury, most often a parent, caregiver, or sibling is simply playing or is trying to help or hurry a child along. But if the injury recurs often, abuse may be suspected.
What are the symptoms?
Symptoms of nursemaid's elbow include:
- Refusal to move the arm. Your child may keep the arm dangling down the side of their body. Sometimes the dangling arm turns slightly inward (pronates).
- Crying. Your child may cry from the pain and because they are scared.
- Pain anywhere between the hand and shoulder.
Medical attention is needed if your child has symptoms of nursemaid's elbow.
How is it diagnosed?
Your doctor usually suspects the injury from your report of how it happened, your child's symptoms, and results of the physical exam. The doctor will feel different areas of the arm and try to move it into certain positions. Usually X-rays of the elbow are not needed. But your doctor may order one to find out if your child has a more serious injury.
How is nursemaid's elbow treated?
Nursemaid's elbow should be treated by a doctor.
Allow your child to keep the arm in the most comfortable position until you get medical help.
You can also put an ice pack on your child's elbow. But if your child resists, don't insist. Be careful not to move your child's arm from the most comfortable position.
A doctor will move your child's arm to free the trapped ligament and put the end of the radius back into its normal position. The doctor rotates your child's forearm. At the same time, the doctor gently bends your child's arm at the elbow up toward the shoulder. Usually, your child starts feeling better right away. Sometimes, though, the pain lingers for a bit. It may take from 30 minutes to a few hours for your child to move the arm normally.
The doctor may place a sling or splint on your child's arm to wear until all pain is gone. If your child can move the arm normally without pain soon after treatment, a sling or a splint is not needed.
How can you care for your child?
Although your child heals quickly, they have a greater chance of having nursemaid's elbow again, especially in the first few weeks after being injured.
- Be careful in how you hold or lift your child. When you lift or swing your child, hold them under the arms. This includes when you lift your child up onto a higher surface (such as a sidewalk or equipment at a playground).
- Use care when walking with your child as you hold their hand or lower arm (forearm). If a child pulls back or resists, stop. Don't pull your child. Wait until your child is ready to go with you without resistance. If this is not possible, pick up your child.
Be sure to follow your doctor's directions on how to care for your child after nursemaid's elbow.
Current as of: March 9, 2022
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine