What is Nursemaid's Elbow?

The name is old but the injury is still a common one seen in children less than 4 years of age. It occurs when one of the bones in the arm (the radius bone) slips out of place from the ligament or band of tissue that holds it near the elbow.

The medical name for this is Radial Head Subluxation. It is also called pulled elbow, slipped elbow or toddlers elbow.

Causes:

• A sudden pulling on the hand or forearm
• An infant rolling himself/herself over
• A fall
• Swinging or lifting a child by the hand or wrist

It most often occurs in children under 4 years of age.

Most common symptoms:

• Immediate pain in the arm
• Child refuses to move or use arm
• Anxiety

The diagnosis is made by physical examination and the child should be seen right away. Your child may or may not need an x-ray.

Treatment depends on the child's age, health and medical history and how severe the symptoms are. Usually the physician is able to reduce or fix the injury easily and provide immediate pain relief. Use of the arm usually returns within 10 to 15 minutes. If the diagnosis and reduction was delayed for several hours the pain may take longer to go away. Acetaminophen or Ibuprofen can be used for pain. Sometimes it may be suggested to use a splint to limit arm usage until injury heals. This may be hard to do, because the arm is now not painful and the child will want to use it. Once the elbow has had this type of injury, it is more likely to happen again. Most children, though, will outgrow this type of injury by the age of 4 years.

Tips for prevention:

• AVOID pulling or swinging a child by the arms or hands.
• AVOID lifting a child by the arms or hands.

If you would like to talk to a nurse about your child's symptoms, please call 314.454.KIDS when you are with your child.

Written by Ann Leonard, a pediatric nurse with the St. Louis Children’s Hospital Answer Line. For more information, call 314.454.KIDS