A child’s elbow can be injured when his or her arm is forcefully pulled. Nursemaid’s elbow results when the pull causes both a bone and a ligament in the elbow to pop out of place.
The ligament that slides out of place is the “annular ligament”. The part of the bone that is out of place is the end of the radius bone, also called the “radial head”. The annular ligament normally wraps around the radius, holding it in place. When the ligament slides out of place, it allows the radius to dislocate.
At first, the child may have elbow pain. However, pain will go away as the child naturally protects the arm by not using it. They will often hold the elbow slightly bent and close to their body. It will be painful if someone else tries to move the arm. It is important when your child is not moving their arm to see a doctor, as pain and not using the arm can also be signs of a fracture.
The doctor will examine and touch the elbow to see what hurts. He or she may also try to gently move the elbow.
Sometimes an x-ray is needed to make sure that the pain is not from a fracture.
The doctor will try and slide the elbow ligament and the bone back into place. He or she will hold the child’s hand palm up, and bend the elbow all the way, until the palm almost touches the shoulder. Often the doctor will notice a click, which is the ligament sliding back into place. Though the child will be uncomfortable at first, they should gradually start using the arm again.
After the radial head is “reduced” the child will typically resume using the arm. Casting, splinting or other immobilization is not typically needed after a single nursemaid’s elbow. A small percentage of children can have recurrent episodes of nursemaid’s elbow and may require a brief period of immobilization in a splint or cast. Children typically resume all activities without difficulty and long-term elbow problems are very uncommon after nursemaid’s elbow.
The best way to avoid a nursemaid’s elbow is to avoid pulling a child’s arm. Instead of lifting or swinging a child by grabbing their hands, place your hands under their armpits.
Q. How does a “pulled elbow” or nursemaid’s elbow occur?
A nursemaid’s elbow or “pulled elbow” occurs when the elbow is forcefully pulled. This can cause a ligament in the elbow to pop out of place. A ligament is similar to an elastic band that holds bones together. In children, these bands are fairly loose and can easily glide off the bone.
Q. How do I know my child has a nursemaid’s elbow?
He or she may have pain initially. This pain usually improves but the child will often resist movement of the elbow. They will often keep the elbow slightly bent and close to the body.
Q. Does my child need x-rays?
Not necessarily. X-rays aren’t always needed but your doctor may obtain them to make sure there is no broken bone.
Q. How is it treated?
Your doctor will gently manipulate the elbow which allows the ligament to move out of the joint and back over the bone. This is called “reducing” the joint and takes only a second or two. Your child will usually start using the arm normally again within a few moments. An X-ray is usually not needed afterwards, unless gentle manipulation fails to fix the problem.
Q. Will my child have long term problems?
These injuries usually occur in children between the ages of 6 months of 5 years of age. The injury can occur again with forcefully pulling. As your child grows older, the ligaments strengthen, and they will no longer be at risk.