Nursemaid’s elbow

What is it?

Nursemaid’s elbow (also called "radial head subluxation" or "annular ligament displacement") is a common injury in toddlers and young children. It usually happens when someone pulls or catches the child by the arm. Since children at this age are constantly running to look at things, it often happens when a parent or caregiver tries to stop the child from getting hurt. Nursemaid’s elbow is not a broken bone or a fracture. Young children’s bones and ligaments are flexible, and when someone pulls a child’s arm, the elbow joint stretches a bit. While it is stretched, a tiny piece of the ligament around the joint can get caught in the joint. This causes pain, and may prevent the child from using the arm normally. Older children will usually show you that their elbow hurts, but younger toddlers may just cry whenever you touch the arm. Sometimes the wrist seems to be sore. No matter where the pain seems to be coming from, the child will refuse to use the arm until it is fixed. Nursemaid’s elbow is not a sign of child abuse unless there are other injuries as well.

Pain is the biggest concern right away. It always hurts to move the joint, though some children may not seem to be in much pain if they don’t have to move their elbow. Because of the flexibility of the tissues at this age, there is almost never any long-term damage, even if the condition continues for several hours. Of course, the other concern is to be sure that there is not an actual broken bone or other more serious injury. Your doctor has determined that by examining your child. Sometimes an X-ray is necessary but in most cases the doctor can make the diagnosis just by listening to you and examining your child.

Your doctor has done one of several maneuvers to fix the elbow. These always hurt for just a second, but they also work very well, and the elbow is back to normal after the first or second try in more than three-quarters of the cases. After two or three tries, many doctors will check an X-ray if the elbow still seems painful, to make sure there’s no fracture. There is usually no need for a cast, splint, or sling after the elbow is fixed. Give your child acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) as directed for the next 24 hours to help relieve any pain.

Most of the time the child is using his or her arm normally by the time you leave the office or emergency room. Younger children (under 18 months or so) seem to take a little longer to get over the pain than older children. It is normal for your child to have a little soreness in the elbow for a day or so after the injury. If your child complains of continued or worsening pain, however, that is not normal. Continued pain can mean that the injury was not actually fixed, that it has recurred, or that there is another injury, such as a broken bone. It is also not normal for a child to have numbness, tingling, or paleness in the arm or hand. If any of these occur, or if your child is not using her or his arm more or less normally, please be sure to call your doctor’s office right away.

Children who have had nursemaid’s elbow once have a higher than normal risk for having it again, especially within the first few days after the injury. Avoid pulling your child by the forearm or hand, and avoid games that involve picking up or swinging the child from the arms below the elbow. Be sure you mention this to babysitters and others who might be taking care of your child. Some children just seem to have nursemaid’s elbow repeatedly, even with the best of care. Your doctor may choose to teach you how to recognize a nursemaid’s elbow and fix it yourself after talking with a physician on the telephone.

A broken bone is the most likely condition that a child might have instead of a nursemaid’s elbow. Nursemaid’s elbow can happen from falling down on an arm, but it is much more unusual to happen this way. Falls are much more likely to result in a broken bone if there is any injury at all. Be concerned about a broken arm if there is more than just a little swelling at the elbow or wrist, if the arm or hand seem pale, or if the child complains of numbness or tingling. Sometimes the broken bone can be somewhere other than the arm. A broken clavicle (collarbone) can often cause a young child to complain of arm pain and to avoid using the arm.