Nursemaid Elbow: Everything You Need to Know

Nursemaid's elbow can cause intense pain, but fortunately, the treatment is simple. We'll tell you everything you need to know below.
Nursemaid Elbow: Everything You Need to Know
Diego Pereira

Written and verified by the doctor Diego Pereira.

Last update: 12 November, 2022

Nursemaid elbow is a traumatic event in which the radius is disarticulated from the rest of the structures that form the elbow. Technically, it’s known as radial head subluxation and is a very common condition in young children that we’ll discuss in more depth in the following article.

It usually occurs accidentally when an adult walks hand in hand with a child, at which point the difference in height and strength can take its toll. By going to an emergency department as soon as possible, a pediatrician or traumatologist will be able to resolve the situation with a few small maneuvers that will make the pain disappear in a matter of seconds.

How does nursemaid elbow occur?

This injury is as easy to resolve as it’s common. It’s called “nursemaid elbow” because it’s usually caused by pulling or lifting either of the child’s arms, something that can happen suddenly and involuntarily when an adult walks hand in hand with a child.

When this happens, the head of the radius (one of the bones of the forearm) is disarticulated from the elbow, revealing a significant laxity in that area. For this reason, it’s more frequent in preschoolers, that is, before the age of 6 years, according to some studies, and in some areas, it may be more frequent on the left side, although this is indifferent.

Although traction is the most common mechanism of production, nursemaid elbow can also appear after a fall. In addition, this dislocation is very frequent in mattresses or bouncy castles when the child makes a clumsy move.

How to spot it?

A doctor looking at an X-ray.

Like any type of subluxation (or dislocation), nursemaid elbow tends to produce intense pain, which will lead to crying and nervousness. While some children can’t locate the pain well (which is highly age-dependent), they’ll most likely adopt a specific position to avoid this sensation.

The most common is with the affected arm close to the torso of the body, with the palm facing inward and elbow flexion of up to 90 degrees. As this can be an uncomfortable position, it’s normal to support the affected limb with the other arm to prevent it from falling by gravity and worsening the pain.

The pain won’t allow the child to make prone-supination movements of the forearm. In this regard, the child won’t be able to turn the hand so that the palm or the back of the hand is facing upwards. It’s also possible to notice a crunching sound when the subluxation occurs.

All this usually happens right after some event, as mentioned in the previous section, i.e., walking and suddenly pulling the child to one side, although in some circumstances, it may occur on its own. It’s logical that in these cases, the concern of the parents increases, but if it happens, you must remain calm at all times.

Does nursemaid elbow have treatment?

Yes, nursemaid elbow has a treatment and, in fact, it’s very simple. A subluxation is characterized as being reversible, so an experienced professional can bring the joint back to its original place by a maneuver known as “reduction”. This is also used in fractures, but depending on the area involved and the injury, the technique will be different.

Before proceeding, the physician may request an x-ray of the involved joint to verify that there are no associated fractures. In many cases, this may not be necessary, especially when the medical history referred by the parents is very indicative that the child suffers from nursemaid elbow.

The process is very fast: In a matter of seconds, everything will be solved and the pain will disappear almost instantly. In some cases, the doctor may indicate the use of a sling to immobilize the joint for a few hours, although if the mobility is completely recovered and the pain stops after the intervention, this may be unnecessary.

If you have doubts about which doctor to go to, it’s best to go to the emergency department. Both pediatricians and orthopedic surgeons are trained to treat this trauma, but the latter are usually only required in exceptional cases.

What to do after suffering from nursemaid elbow?

A mother helping her toddler walk by holding onto both of his hands.

In general, no treatment or follow-up is recommended after one of these events. The doctor will probably give parents some guidance as to the mechanisms that cause the injury; a simple and effective way to prevent it is to lift the child by both arms when they need help.

While there’s always a risk of remission (i.e., re-injury), this doesn’t happen in most cases. If it occurs on several occasions and within a short period of time, an evaluation by the orthopedic surgeon is likely to be necessary.

Rarely, these types of events may signify the existence of a joint instability syndrome or some connective tissue diseases. Among other things, these conditions produce increased mobility in the joints that can increase the frequency of traumatic events such as nursemaid elbow.

How to prevent nursemaid elbow?

The most effective measure to prevent this injury is to avoid reproducing the mechanism at all costs. In this regard, it’s important not to pull the child by the arm suddenly or twist the child while grasping the forearm. Sometimes, the force used in these movements is so abrupt that it produces the injury, even unintentionally.

At the same time, it’s important to walk slowly when the child’s held by the arm. In some cases, it’s possible to forget that the child’s steps are shorter and slower than those of adults, so it’s possible to make sudden pulling movements without even noticing it.

If pulling on the child’s forearm is inevitable, it’s best to pull on both limbs simultaneously and apply the same force. However, this is only recommended in emergency cases, where you need to move the child abruptly to avoid danger.

In case it happens to you, don’t despair!

Nursemaid elbow is a common condition that can lead parents to despair, especially when the child has little ability to convey their sensations. Fortunately, as we’ve mentioned, it’s a condition that can be solved easily and almost immediately.

In case it happens to a small member of your family, we recommend you to keep calm, identify the injury as we’ve mentioned, and go as soon as possible to a pediatric emergency department. Leave the rest to the specialists.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

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This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.