Lewis Gale Physicians June 13, 2018

There are 3 bones that come together at the elbow. The first one makes the upper arm (humerus) and the other two make the lower arm (radius and ulna). When one of the lower arm bones slips out of place at the elbow, it is called a nursemaid’s elbow. It is a common injury in toddlers and preschoolers.

 

Causes

The term nursemaid’s elbow is given because the injury often occurs when a caregiver suddenly jerks on a child’s arm to keep them away from a harmful situation, or when lifting or swinging them by the arms. Ligaments help to keep your bones in place. In young children, these ligaments are loose and the bones are also not fully formed. This makes it easy for the elbow joint to separate and for the bones to slip out of place, with very little force. Nursemaid’s elbow is seen most often in 2 to 5 year olds, but may occur until about age 7.

 A pulled elbow happens with a sudden jerk, tug, or blow to the elbow. It is most likely to happen when the arm is extended and twisted. In children, even a small amount of upward force may cause the injury. Nursemaid’s elbow usually is not caused by a fall.

 

Risk Factors

A risk factor is something that increases your chances of getting a certain disease or condition. A nursemaid’s elbow injury is most common in children 2-5 years of age. Actions that may increase the risk of dislocation include: 

  • Pulling a child up by the hands
  • Swinging a child by their arms
  • Jerking a child’s arm
  • Breaking a fall with the arm
  • Rolling over in an awkward way 

Children that have had a pulled elbow are more likely to dislocate their elbow again. 

Symptoms

Symptoms of a pulled elbow may include one or more of the following: 

  • Pain at the elbow right after pulling or trauma to elbow
  • Child refuses to use arm
  • Arm is kept close to child’s side
  • Child resists moving the arm

 

Diagnosing a Pulled Elbow

Diagnosing a pulled elbow usually is possible during the physical exam. Your doctor will ask about your child’s symptoms and a physical examination of the elbow will be done. They also will look for signs of a broken bone, such as swelling and tenderness. If a break is suspected, a x-ray may be done.

 

Treating a Pulled Elbow

A pulled elbow is easily treated and does not lead to long-term problems. The doctor will quickly and gently move the bone back into place. A small pop or clicking sound may be heard as the joint is put into proper position. This process is called a closed reduction.

 

For some children the pain will go away once the bone is back in place, and they may be able to move their arm within a few minutes. For other children, it may take a few tries to move the bone back into position. Treatment may be delayed in younger children who have only mild pain. In these cases, discomfort can continue after the bone is moved back into place. The doctor may advise: 

 

  • Pain relief medications like acetaminophen or ibuprofen.
  • Using a sling to rest the elbow for a few days
  • Applying ice to the elbow

 

Prevention

Some children are more prone to dislocations, but many can be prevented. To help reduce your child’s chance of getting nursemaid’s elbow, the American Association of Orthopaedic Surgeons (AAOS) recommends: 

  • Avoid jerking or tugging your child’s hands or arms
  • Avoid swinging your child by their arms or wrists
  • Lift young children from under their armpits, not by their hands or arms. 

 

Dr. William Thomas of Christiansburg Family Medicine is available for diagnosis of nursemaid’s elbow and other pediatric concerns. To schedule an appointment, call the office at (540) 382-6148 or click the button to schedule an appointment online.

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