Nursemaid's Elbow

Many children squeal with delight when you swing them around or back and forth by the arms. But did you know that this fun activity can lead to one of the most common injuries in young kids?

It is called nursemaid's elbow, and it can be quite painful for your little one.

Nursemaid's elbow means the elbow has slipped out of its normal place at the joint.

The elbow bone (radius) is connected to the elbow joint (humerus) by elastic bands called ligaments. These ligaments grow stronger and tighter as a child grows older. In little kids and babies, the ligaments are still loose. This makes it easy for the elbow to slip out of place.

Your doctor or nurse may use other terms for nursemaid's elbow, such as:

  • Pulled elbow
  • Radial head subluxation

 

Who Gets Nursemaid's Elbow?

Nursemaid's elbow is a common injury among toddlers and preschoolers

The injury is not often seen in kids older than 5 or 6. That's because as children grow, their bones harden and the ligaments get tighter and thicker. This helps keep the elbow firmly in place.

Girls are slightly more likely than boys to have nursemaid's elbow.

Causes of Nursemaid's Elbow

Nursemaid's elbow can happen if you tug or pull on a child's lower arm or hand, especially if the arm is twisted. It doesn't take much force for the injury to happen. The most common cause of nursemaid's elbow is a pulling-type injury.

Nursemaid's elbow may happen if you:

  • Catch a child by the hand to stop a fall
  • Lift a child up by the hands or wrists
  • Pull a child's arm through a jacket sleeve
  • Swing a child by the arms or hands
  • Yank on a child's arm to make him or her walk faster

Sometimes nursemaid's elbow may happen if:

  • An infant rolls over onto the arm
  • A child uses the hands to brace himself or herself during a fall

Symptoms of Nursemaid's Elbow

The main symptom of a pulled elbow is pain when the child moves the arm. In fact, nursemaid's elbow can be quite painful. There is, though, no swelling, bruising, or other sign of a serious injury.

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To reduce the pain, the child typically refuses to use the arm and holds it still at her side, The elbow may be slightly bent and the palm may by turned towards the body. You should not try to straighten the arm or move the elbow back into place. If you do, the child will resist, and you could cause more serious damage.

Severe pain, even without swelling, can be the sign of a broken bone. Call your doctor if your child injures her elbow.

Treatment of Nursemaid's Elbow

Treatment depends on your child's age and overall health. The doctor will examine the child and make sure the bone is not broken. X-rays are not usually necessary to diagnose this.

Over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), may be given. Make sure you ask your health care provider for the correct dose for your child. Never give aspirin to a child under age 12.

The doctor will use a method called a "reduction maneuver" to put the elbow back into the correct position. This method is also called a "reduction."

In this method, the doctor holds the child's wrist and elbow. The doctor then carefully moves the arm in a specific way until the elbow pops back into place. You may hear a "click" when this happens.

A reduction maneuver only takes a few seconds. It may be done in the doctor's office.

The procedure can be briefly painful. The child will probably cry for a few seconds.

Most kids can use the arm without pain within 10 to 15 minutes. But some kids may be afraid to use the arm because they remember that it hurt before. If this happens, your doctor may recommend pain medicine and then observation for the next hour to make sure the child moves the arm.

X-rays are usually not needed. X-ray results are normal in someone with nursemaid's elbow. But X-rays may be taken if the child does not move the arm after a reduction.

Sometimes, the first attempt at reduction does not work. It may take two or more times to put the elbow back into the correct position. Surgery is rarely needed.

Nursemaid's elbow may sometimes be the result of child abuse. A child abuse investigation may be done if there are other signs that the child is being abused or if it occurs in an older child.

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Preventing Nursemaid's Elbow

As your child grows, his or her 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.

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on October 13, 2015

Sources

SOURCES:

KidsHealth web site: "Nursemaid's Elbow."

Boston Children's Hospital web site: "Nursemaid's Elbow."

Kliegman, R.M., Behrman, R.E., Jenson, H.B., Stanton, B.F., editors, Nelson Textbook of Pediatrics, 19th edition, Saunders Elsevier, 2011.

Roberts J.R., Hedges, J.R., editors, Clinical Procedures in Emergency Medicine, 5th edition, Saunders Elsevier, 2009.

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