Pulled Elbow(Nursemaid's Elbow)

A pulled elbow(also known as nursemaid's elbow) is a common injury in toddlers and preschoolers. Children with this injury will typically hold their arm in a straight position not wanting to bend the elbow nor use it due to pain. There are usually no other signs such as swelling or redness of the elbow.

In young children the elastic-like ligaments around the elbow are loose. As a result, the upper forearm bones can move into the elbow joint area where they can get stuck and cause symptoms. As these ligaments tighten with age, children older than 5 years old are much less prone to a pulled elbow.

Causes of a pulled elbow:

While any fall or landing in an awkward position may pull or cause the forearm bone to get stuck in the elbow, the following are the most common causes of a pulled elbow:

  • Pulling a child up by the hand(s)
  • Swinging a young child by the hands or wrists
  • Jerking the arm when pulling a young child along

Diagnosis and treatment

The diagnosis can usually be made by confirming a history of a pulling action on the arms and on physical examination which reveals a child holding his/her arm in a very typical and recognizable position. X rays are usually not needed unless there is a suspicion of a bone fracture.

The treatment will require to manually move the elbow bones and ligaments into their normal position. This is achieved by a gentle maneuver called a reduction performed by an experienced doctor. While the child is sitting on a parent's or caregiver's lap, the affected arm is gently bent upwards and then straightened while the hand is turned downwards. The reduction procedure, takes a few seconds and will almost immediately relieve the pain and the child will be able to move and use the arm fully within 10 minutes.

Prevention

Because we know that this injury is caused by pulling or tugging  young children by their arms, the following are important in preventing a pulled elbow:

  • Never pick up a toddler or infant by the hands or wrists
  • Do not swing a child by the arms
  • Do not pull or tug a child's arm; Always be gentle when taking a child by the hand;

Fortunately in most situations a pulled elbow does not result  in long-term damage. Although in most cases the injury does not re-occur, a very small number of children may tend to experience a pulled elbow repeatedly. In such rare cases, the doctor may place a splint (a partial cast) to protect the elbow area and refer the child to a specialist.