Nursemaid’s Elbow

“Nursemaid’s Elbow,” or radial head subluxation, is a frequent elbow injury occurring in more than 20,000 children a year in the United States.

Nursemaid’s Elbow occurs most often with sudden pulling and twisting of the wrist or hand. Due to the child still growing and developing, very little force may cause a ligament to slip out of place and become stuck between two bones in the elbow. It’s most commonly seen in kids between 1 and 4 years old.

Actions such as “swinging” the child by the arms, trying to keep a child from falling or running into the street,  or even trying to help a child onto a step can cause nursemaid’s elbow. While it may become unstuck by itself, it’s most commonly taken care of by a medical provider with a quick and gentle movement of the arm.

Symptoms

Most children who have Nursemaid’s Elbow will not want to use their arm. The most common presenting symptom will be pain when moving the arm.

Children may describe a generalized pain in their elbow, wrist, or arm. While a child might be able to move the shoulder, they will not move their elbow. They may hold their arm with the affected elbow bent and close to their body.

Treatment

Ibuprofen or acetaminophen may be used for pain.

If you suspect Nursemaid’s Elbow in a child, a provider will do a brief exam. X-rays are rarely needed, unless there’s a concern for a fracture.

The provider will use a method to reduce, or put the child’s elbow back into place. The provider will place one hand at the elbow and the other hand near the wrist, and maneuverer the arm in a specific way until the elbow pops back into place. Once the child begins to move the arm, it’s considered a success — with immediate pain relief for the child.

Within 5-10 minutes, the child should be using the arm as normal without pain.

Prevention

The best way to prevent Nursemaid’s Elbow is by never pulling, tugging, jerking, or yanking a child’s arm or hand. A caregiver should also never swing a child by their arms or hands. Lifting a child under their arms instead of by their hands, arms, or wrists will help prevent nursemaid’s elbow.

Dr. Amy Maddalena, a Kids Plus Provider since 2006, is the Medical Director of our Breastfeeding Center of Pittsburgh.

John Armbrust, PA-S, spent a rotation at Kids Plus as a PA Student from Slippery Rock University.