Nursemaid's Elbow

Nursemaid's Elbow

About Nursemaid's Elbow

It's easy for parents to sometimes forget that active preschoolers — who run, climb, jump, and quickly hop up after falling — aren't as rough and tumble as their older siblings.

Kids this age are prone to nursemaid's elbow, a partial dislocation of the elbow joint that happens when a ligament slips out of place near the elbow. The medical terms for this is "annular ligament displacement."

Nursemaid's elbow (also known as pulled elbow) is a common early childhood injury. It usually happens in kids 1 to 4 years years old because their ligaments (the elastic-like bands that hold bones together) are loose and bones are not yet fully formed. This makes it easier for some bones to slip in and out of place. As kids get older, their ligaments tighten and become thicker, bones enlarge and harden, and the risk of nursemaid's elbow decreases.

A child with nursemaid's elbow has some initial pain in the arm, but the injury does not cause long-term damage. At the doctor's office or in the emergency room, a medical professional can slip the ligament back into place (usually without the need for any pain medicines), ending the problem quickly.

Causes

The elbow joint connects the upper arm bone (humerus) to the lower arm bones (radius and ulna). The rounded tip of the radius (the radial head) is surrounded by a ligament (the annular ligament) that is sometimes loose in younger kids.

If it's not tight enough, this ligament may slip over the radial head and even tear. The ligament also can then get trapped in the elbow joint. In some kids, this can happen very easily with just a small amount of force.

nursemaids elbow illustration

Other actions can increase the risk of nursemaid's elbow, such as:

  • Pulling a child up by the hands. Pulling on hands or forearms can put stress on the elbows. Never pick up a toddler or infant by the hands or wrists. Lifting under the armpits is the safest way to lift a child.
  • Swinging a toddler by the arms. Any type of swinging that involves holding the hands or wrists can put stress on the elbow joint and should be avoided.
  • Jerking a child's arm. Pulling a toddler along while walking or quickly grabbing his or her hand can jerk the arm, causing the annular ligament to slip. Remember to be gentle when taking a child by the hand.
  • Breaking a fall with the arm. The natural response to falling is outstretching an arm for protection. The elbow can overextend during this action, resulting in a slip of the annular ligament.
  • Rolling over in an awkward way. Sometimes rolling over in a crib, bed, or on the floor can cause nursemaid's elbow in infants and very young children.

Signs and Symptoms

A child might have nursemaid's elbow if:

  • The child refuses to use an arm. A child won't be able to use the injured arm without pain. So the arm usually is kept in a fixed, straight position to the child's side or with a slight bend in the elbow. While the arm is in this fixed position, the child seems to have only mild pain or discomfort.
  • There's no swelling or deformity. A child with nursemaid's elbow probably won't look injured because the injury does not cause the arm to have an obvious deformity or swelling at the elbow.

An arm or elbow injury that causes severe pain may indicate an elbow fracture (broken bone) or contusion (bruise). It can be hard for a parent to tell whether an injury is nursemaid's elbow or a fracture, so it's important to call your doctor if your child has injured an elbow.

In some cases of nursemaid's elbow, the bone will move back into place on its own, such when a child does something that moves the joint, like putting on a coat. Even if you think the bone has moved back into place, it's still important to see a doctor to make sure that nothing else is wrong with the arm. Do not try to put the bone back into place yourself.

Treatment

Your doctor may be able to treat a nursemaid's elbow injury or might refer you to the emergency room for treatment.

The doctor will first see whether your child is likely to have nursemaid's elbow based on the cause of injury and the physical exam. The arm, hand, and shoulder will be felt to make sure there's no swelling, tenderness, or other abnormality, which could point to a fracture instead.

X-rays are only needed if a fracture is suspected. If there's no obvious swelling or other injury, the doctor will perform a gentle maneuver that allows the bone to go back into its normal place. The medical term for this is a reduction.

This procedure is very quick and takes only a few seconds. A child is usually asked to sit on a parent's lap while the doctor attempts to reduce the displacement of the ligament. During the procedure, the arm is taken from a straight position and bent upwards in a swift motion. The doctor will listen for a "pop" sound, indicating the bone is back in place.

The child may experience a moment of pain during the reduction, but soon after treatment the discomfort is gone. Most kids have full use of the arm within 5 to 10 minutes. Some cases may require more than one try to successfully reduce the elbow.

Occasionally, a child may avoid using the arm after the reduction for a brief time, fearing it will be painful. If discomfort continues, the doctor may put the arm in a sling and recommend acetaminophen or ibuprofen for pain relief.

Prevention

It's important to remember that sometimes nursemaid's elbow can happen for no obvious reason. Some kids are just more prone to the injury than others. And those who get nursemaid's elbow may get it again.

So be mindful of the risks and, whenever possible, avoid tugging, swinging, or jerking on your child's hands or arms, and be sure to tell caregivers to do the same.

Reviewed by: Rupal Christine Gupta, MD
Date reviewed: July 2014

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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