Nursemaid’s Elbow

Overview

In young children, the bones and joints are still undergoing development and have not as yet attained a state of full stability. The ligaments are still loose and the muscles weak. Hence, children are more prone than adults to certain kinds of injury. “Nursemaid’s elbow” is one such form of injury commonly seen in young children. It is the dislocation of the elbow that occurs when the arm is pulled or tugged forcefully at the wrist. This can also happen as a result of landing on the arms while falling. A small amount of force is sufficient since the joint is relatively weak. This can be painful for the child and should be handled with care in order to avoid causing further pain and injury.

What Is Nursemaid’s Elbow?

Radial head subluxation in children is better known by the more evocative phrase “nursemaid’s elbow” or simply ‘pulled elbow’. Certainly, this kind of injury can occur in adults as well, although it is far less common. Subluxation is the medical term for a partial dislocation. In this case, it is the partial dislocation of the elbow. Since a young child’s bones, muscles, and ligaments are not yet fully developed, it is possible for the upper end of the radius bone to slip out of position at the elbow. When such a dislocation takes place, the child experiences pain and may be unable to move the affected arm.

Fortunately, this can be easily and effectively remedied by resetting the elbow joint.  This relieves the child’s discomfort and fully restores normal use of the arm. Sometimes the dislocation is so minor that the ligament and bone return to their normal positions on their own soon after injury.

What Is Responsible For Nursemaid’s Elbow?

The human forearm is composed of two long bones known as the radius and the ulna. These bones run roughly parallel to each other along the length of the forearm. The radius extends from the elbow to the wrist on the side of the arm closer to the thumb. Both the radius and ulna meet the humerus bone of the upper arm to form the elbow joint.

The point where the radial head meets the humerus is known as the radiocapitellar joint and it is this joint that enables the palm to turn facing up or down. It is the radiocapitellar joint that gets dislocated when a person suffers from a pulled elbow. As a result of the slippage of the annular ligament at the elbow, the head of the radius gets dislocated. Hence, this condition is known in medical terms as ‘radial head subluxation’. Girls are more susceptible to such injury than boys.

This is usually found to occur until the age of 7 although it is most likely among children aged between 1 and 4 years. Beyond this age, the ligaments have tightened and firmed up. The bones are harder and sturdier as well.

The list below outlines some scenarios in which such an injury is likely to occur:

• A pulling force exerted on the extended and pronated forearm can cause such an injury. For instance, a parent tugging on the arm of an uncooperative child can cause a pulled elbow.
• Lifting a child up by the wrist.
• Swinging the child by the hands.
• Forcefully pulling the wrist through a sleeve while dressing the child.
• The child himself or herself may yank on a support with the hand while falling.
• An infant can develop a pulled elbow by rolling over onto the arm in an awkward position.

How Does It Feel?

Once the injury has occurred, the patient experiences some pain. Because of this pain, children will avoid using the injured arm and keep it in a fixed position with the palm facing the body. It may be slightly bent at the elbow to keep pain to a minimum. If there is severe pain, possibly accompanied by some swelling, then it is more likely to be a fracture rather than a simple partial dislocation.

Can There Be Any Complications?

Once such a dislocation has occurred, there is an increased likelihood of it happening again in the weeks immediately following the initial injury. In severe cases, the ligament may even tear.

How Does One Diagnose Nursemaid’s Elbow?

The circumstances leading to injury may be described to the physician. The child will typically hold the arm carefully and in an awkward position which indicates dislocation of the elbow. No further tests may be required for confirmation of this diagnosis, however, X-rays may be recommended in order to rule out fractures in case there is swelling, bruising or severe pain.

Treatment and Prevention

The specific way of treating a case of nursemaid’s elbow depends on the age of the child. The doctor has to diagnose the extent of damage and also whether there is a fracture or not.

In order to relocate the elbow in its correct position, the doctor will perform a “reduction maneuver”. This involves moving the arm in a definite manner so that it returns to its normal place.

Usually, a clicking sound at this stage indicates that the elbow is relocated. This could be painful for the child.  In the off-chance that this procedure fails, a surgery might be required. Depending on the age of the kid, painkiller medications could be prescribed.

Nursemaid’s elbow is a highly preventable injury. One needs to keep in mind these precautionary measures:

• NEVER lift a child with his/her arms, elbows, or wrists. Always lift them from under the arms.
• NEVER pull or suddenly jerk a child’s arms or elbows.
• It is a common habit of many to swing a child from his/her elbows. This should never be practiced.
• If a child has already suffered from an episode of nursemaid’s elbow, it is advisable to follow the above three practices strictly.

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