Nursemaid’s elbow is a common painful injury of early childhood. It is sometimes referred to as “pulled elbow” because it occurs when a child’s elbow is pulled and partially dislocates. It occurs most often in children ages 1 to 4, but can happen any time from birth up to age 6 or 7 years old. As children grow, their bones become larger and more defined. In addition, ligaments become stronger and thus provide a better support system.
Mechanism of injury
Although a traction force is the most common mechanism of this injury, often no definite history of a typical pull or fall can be obtained.
- Lifting the child up from the ground by the hand or wrist,(Pulling a child up by the hands can put stress on the elbows. Never pick up a toddler or infant by the hands or wrists, but lift under the armpits)
- Swinging the child while holding the child by the hands or wrists
- Pulling arms through the sleeves of jackets
- Catching a child by the hand to prevent a fall
- Pulling a child along when in a hurry or the child suddenly collapsing to the ground in an effort to avoid going with their parent
- Rolling over in an awkward way in a crib, bed or on the floor can cause nursemaid’s elbow in infants and very young children
A nursemaid’s elbow injury usually doesn’t cause swelling, but the child will complain that the elbow hurts, or cry when her arm is moved. A child will typically hold her arm close to the side, with the elbow slightly bent and the palm turned toward the body. If someone tries to straighten the elbow or turn the palm upward, the child will resist because of the pain.
- Immediate pain in the injured arm
- Refusal or inability to move the injured arm
- Holds the elbow in slight flexion and the forearm pronated
Treating Nursemaid’s Elbow
This injury should be treated by a pediatrician or other trained health care provider. Since elbow pain can also be due to a fracture, your pediatrician may need to consider this before the elbow is “reduced” or put back into place.
Your doctor will check the injured area for swelling and tenderness and any limitation of motion. If an injury other than nursemaid’s elbow is suspected, X-rays may be taken. If no fracture is noted, the doctor will use a method called a “reduction maneuver” to put the elbow back into the correct position. Will move and twist and flex the arm gently to release the trapped tissue and allow the elbow to return to its normal position. Once he has moved the elbow back in place, the child will generally feel immediate relief and within a few minutes should be using her arm normally without any discomfort. Occasionally, the doctor may recommend a sling for comfort for two or three days, particularly if several hours have passed before the injury is treated successfully. If the injury occurred several days earlier, a hard splint or cast may be used to protect the joint for one to two weeks.
Nursemaid’s elbow can be prevented by not pulling or lifting your child by the hands or wrists, or swinging her by the arms. Instead, lift your child by grasping her body under the arms. While nursemaid elbow is usually a temporary condition without permanent consequences, it can be quite frightening to parents who find their child suddenly lacking the ability to use his or her arm.