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No matter how careful we may be, accidents still happen and arm injuries in young children (particularly preschool age group).
Child with nursemaid elbow may complain of pain when trying to use their arm, leading them to refuse its use altogether. Your physician will conduct a physical assessment as well as ordering an X-ray to rule out other injuries such as fractures.
Treatment of Nursemaid Elbow
Nursemaid’s elbow commonly affects children under 5, caused by partial elbow dislocation from sudden pulling. This happens when caregivers tug a child’s arm to avoid danger or assist on steps.
Treatment involves a simple maneuver, a reduction, to reposition the bone and ligament. A doctor holds the wrist, turns the hand palm up, applies pressure to the radius bone’s top, and slowly bends the elbow. A faint pop signals successful realignment.
Neglecting treatment risks permanent limited elbow movement. Applying ice and stabilizing the area above and below the injured elbow can ease pain.
Diagnosis
Radial Head Subluxation, more commonly referred to as Nursemaid Elbow, occurs when your child is pulled by their arm and their radial Head at their elbow joint partially dislocates.
This injury often happens when well-meaning parents or grandparents pick up or swing around young children without realizing this risk is higher among younger children as their socket and ligaments continue to form and develop.
When nursemaid elbow occurs, your child may refuse to move his/her arm, dangle by their side, and pronate slightly inward (pronate). They’ll cry because of pain. Health care professionals can diagnose nursemaid elbow with a physical exam and by asking about its cause; usually no x-rays are necessary unless there’s also evidence of fracture.
As part of an exam procedure called reduction (which fixes nursemaid elbow), your doctor will gently fold up your child’s arm upward from its straight position before supporting it at its elbow – an effective reduction process that fixes nursemaid elbow quickly!
Treatment
Nursemaid’s elbow, also known as radial head subluxation, occurs when the ligament that secures a small radial bone within an elbow joint (humerus) becomes pinched and buckles under pressure.
It most commonly affects children under five due to looser bones and ligaments; well-meaning adults often cause this by swinging their child through the air or pulling on their arms in an effort to pull them away from potential dangers.
Your child’s doctor will perform a physical exam and inquire as to the cause and circumstances surrounding their injury. He or she will assess range of motion and any tender spots on their body; typically x-rays aren’t necessary but may be performed just in case any broken bones exist.
Treatment requires moving the radial head back into its proper position within the elbow joint, so your child must remain still so their doctor can perform this procedure. Your physician will fold their arm upward from a straight position so their palm faces up before slowly bending their elbow until he/she hears a faint pop or click sound.
Prevention
Children’s ligaments–the strong tissues that connect bones–are not fully developed, making it easy for a forceful movement or pull to shift or partially dislocate an elbow bone (radial head subluxation). This injury usually happens between 1 and 4 years old but could happen up to age 6 or 7 years.
Health care professionals can quickly treat nursemaid elbow in children by holding the arm, rotating it palm up while exerting pressure near the top of the radius bone and applying gentle force near its endpoints. This technique, called reduction, usually relieves pain quickly and restores elbow movement within seconds; rarely are x-rays required.
Educators can prevent nursemaid elbow by seeking guidance on how to safely handle young children. For instance, avoid pulling or lifting them by their arms, wrists or hands; use verbal cues rather than pulling on hands and arms; and ensure all children wear helmets when riding bicycles or scooters.
Follow-Up
Nursemaid’s elbow, also known as radial head subluxation, occurs more often among preschool-aged children (ages 1-4) due to being pulled by hand or wrist and having the bones of their elbow joint slip slightly out of alignment. More girls than boys experience it; and it typically affects left sides of bodies.
Young children tend to have looser and less mature ligaments that make it easy for small forces to displace the bones from their normal positions in the elbow joint, so seeking guidance from healthcare providers on how to treat this injury is vital.
A healthcare provider will first examine and then x-ray their elbow in order to make sure there are no fractures or serious damage before quickly and gently returning it into its original state.
How to Prevent Nursemaid Elbow From Happening Again
To prevent nursemaid elbow recurrence, follow these steps:
- Avoid pulling/lifting by hands. Lift under armpits to reduce injury risk.
- Teach child not to yank arm/hand. Encourage communication if uncomfortable or wanting release.
- Be careful during play. Avoid arm/hand swinging to lessen elbow strain and risk.
By adhering to these measures, you can notably reduce nursemaid elbow reoccurrence.
What Are the Symptoms of Nursemaid Elbow
Symptoms of nursemaid elbow may involve:
- Immediate pain in the hurt arm and elbow. Pain may extend to the wrist or shoulder.
- Refusal or inability to move the injured arm.
- Arm held slightly bent at the elbow.
Additionally:
- Child might avoid using the hurt arm due to pain.
- Child could hold the arm straight or with a slight elbow bend.
- Discomfort might be expressed in wrist, forearm, or elbow.
Notably, nursemaid elbow doesn’t cause visible swelling or bruising. Seek medical attention if these symptoms arise for proper diagnosis and treatment.
Recovery Time for Nursemaid Elbow in Children
Children usually recover quickly from nursemaid elbow, often regaining full arm use within minutes after successful reduction.
Around 90% of children are symptom-free within 30 minutes. Note that after dislocation, recurrence is likely within 3-4 weeks, particularly in children under 5. Nursemaid’s elbow is rare beyond age 5 when joints are stronger and less prone to injury situations.
Occasionally, this injury occurs in older children or adults, often involving forearm fractures. For injuries a few days old, a hard splint or cast may protect the joint for 1-2 weeks. Lingering pain post-treatment warrants further evaluation. After reduction, pain medication might be needed, and recovery usually takes a few days.
