OrthoConnecticut

By Dr. Jerome Barton, MD

Nursemaid’s elbow is a common injury occurring in preschool children usually between the ages of one and four. It is a partial dislocation (subluxation) of the upper end of the major forearm bone (radial head) when it slips partially out of the annular ligament which holds it in place.

It is frequently caused by an adult pulling on the child’s extended arm. The child is most often offering no resistance to the pull. The radial head is pulled downward out of its usual position where it is held by the annular ligament.

The child experiences pain and may later be relateively comfortable but will resist elbow motion. He or she will refuse to use the arm and will hold the arm against the body with the palm facing downward. It is usually evident that there has been an injury but it is sometimes hard to judge exactly where. There is usually no swelling associated with Nursemaid’s elbow.

A careful history including the pulling incident, the absence of a history of trauma, the absence of swelling and a gentle examination will usually make the diagnosis evident. X-rays are usually not necessary unless fracture is suspected.

The subluxation is reduced by the doctor by completely supinating the forearm by turning the palm upward. A click at the elbow can be felt as the radial head slips into place. After reduction the child is comfortable and returns to using the arm. No further treatment is necessary. If reduction was difficult or required several attempts or recurs, the elbow can be immobilized in a splint for a short time.

Nursemaid’s elbow may recur and parents should be careful to avoid traction on the arm and should so instruct other caregivers. It is very rare to have any residual problems from Nursemaid’s elbow even after recurrent episodes.

Nursemaid’s elbow is a relatively common problem in preschool children. It responds to gentle reduction, may recur but will respond to repeat reduction. It will stabilize with growth and usually has no long term effects.