• Pulled Elbow

    (Nursemaid’s Elbow; Radial Head Subluxation; Partially Dislocated Elbow)

    Definition

    Three bones come together at the elbow. One bone makes the upper arm and 2 make the lower arm. One of the lower arm bones may slip out of place at the elbow. This is called a pulled elbow. It is a common elbow injury in toddlers and preschoolers.
    A pulled elbow can be easily treated. It does not lead to long-term problems.
    The Elbow Joint
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    Causes

    Ligaments help to keep your bones in place. These ligaments are loose in young children. Bones are also not fully formed in young children. These factors make it easier for the bones to slip out of place.
    An pulled elbow happens with a sudden jerk, tug, or blow to the elbow. It is most likely when the arm is extended and twisted. In children, even a small amount of force may cause the injury.

    Risk Factors

    These types of injuries are most common in children 1-6 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 may include:
    • Pain at 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

    Diagnosis

    Your doctor will ask about your child’s symptoms. A physical exam will be done.
    The diagnosis will most likely be made during the physical exam.
    Your doctor may also look for signs of broken bone such as swelling and tenderness. An x-ray may be done if this is suspected.

    Treatment

    The doctor will be able to move the bone back in place.
    For some children the pain will go away once the bone is back in place. A child may also be able to easily 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 also be delayed in younger children with mild pain. In these cases, discomfort may continue after the bone is moved back into place. The doctor may advise:
    • Medications such as acetaminophen or ibuprofen.
    • Sling to rest the elbow for a few days
    • Applying ice to the elbow

    Prevention

    Some dislocations can be prevented. To help reduce your child’s chance of a partial dislocation:
    • Avoid jerking or tugging your child’s arm
    • Avoid swinging your child by their arms or wrists
    • Lift young children from under their arms

    RESOURCES

    Health Children http://www.healthychildren.org

    Kids Health—Nemours Foundation http://kidshealth.org

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Nursemaid’s elbow. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/az/Site1082/mainpageS1082P0.html. Accessed August 23, 2017.

    Nursemaid’s elbow. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/health-issues/conditions/orthopedic/Pages/Nursemaids-Elbow.aspx. Updated November 21, 2015. Accessed August 23, 2017.

    Nursemaid’s elbow. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/medical/bones/nursemaid.html. Updated January 2017. Accessed August 23, 2017.

    Radial head subluxation (nursemaid elbow)—emergency management. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T903394/Radial-head-subluxation-nursemaid-elbow-emergency-management. Accessed August 23, 2017.

    Revision Information

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