Nursemaid's elbow is an injury to the ligament (strong band of
tissue) that keeps the two bones of the forearm in the correct place.
The two bones in the forearm are the radius and the ulna. The radius is on
the thumb side of the forearm. The upper end of the radius is called the
radius head. The radial head is held in place by a ligament called the
annular ligament. When the annular ligament is torn, a part of it slides
upward and becomes trapped in the elbow joint, which is very painful
condition. The child holds the arm with the palm facing inward and the
elbow bent. This injury is uncommon after the ages of three to four, due
to stronger joints and ligaments. Also, youngsters are less likely to be
in situations where this injury might occur.
Nursemaid's elbow is also called subluxation of the radial head,
pulled elbow, slipped elbow, or toddler elbow.
Nursemaid's elbow is a common occurrence in children from the ages
of one to four or five. It is rarely seen after the age of six.
Causes and symptoms
Nursemaid's elbow is caused by a strong force on the elbow, such as
a sudden pulling or yanking on the hand or forearm. This can occur when a
child falls, when an adult pulls up a child's arm, to assist the
child up a curb or step or to hurry the child along, or when a child falls
away from an adult while being held by the arm. Swinging toddlers from the
arms while playing can cause this injury. It can also occur when an infant
rolls himself or herself over.
Symptoms of nursemaid's elbow include immediate
in the injured arm, refusal or inability to move the injured arm,
creating a condition called pseudo-paralysis, persistent crying, refusal
. However each child may experience symptoms differently. These symptoms
may also resemble other conditions or medical problems, so a physician
should be consulted for a diagnosis.
Swinging a young child by the arms can cause nursemaid's
(© Raoul Minsart/Corbis.)
The doctor should be called or the child should be taken to an emergency
room when a child does not use the arm that has been injured, when the
child seems to be in a lot of pain, or when there is a suspicion that
someone has deliberately harmed the child.
After treatment for nursemaid's elbow, the doctor should be called
if the child still refuses to use the arm six hours after it is put back
into place; the child still has pain after 24 hours; the child's
fingers get numb and tingly; or the child's elbow comes out of the
The diagnosis of nursemaid's elbow is made through a physical
examination by the child's physician. X rays of the elbow are
usually not necessary.
The child's arm should not be straightened or its position changed
before the doctor examines it. An ice pack can be used, and the arm
splinted in the position in which it is found. The area both above and
below the elbow should be immobilized, including the shoulder and wrist if
The physician or health care provider will move the bone and ligament back
to their correct positions. This is an easy procedure that can be done in
the office by supinating (externally rotating) the forearm (turning the
thumb out with palm up), and then gently flexing the arm at the elbow
(pushing the forearm up into the biceps). The ligament needs time to heal,
so the child's arm should be treated gently after the procedure.
The arm may be immobilized in a sling for one or two days, if desired.
Once the ligament and the radial head are returned to their proper
position, the child can usually begin to use his or her arm again within a
few minutes. Sometimes there is a short period of crying for a minute or
two after the release. The earlier after the injury that the child is
treated, the more rapid will be the recovery. Alternatively, if the
problem has existed for some days, then relief from pain may not be so
rapid. Bracing and
is usually not required if this is the first occurrence of this
condition. For repeat injuries, however, a posterior splint may be applied
for several days. A few children may have swelling or pain in the joint.
Regular doses of ibuprofen or other over-the-counter pain killers for a
few days will help with the swelling and the pain.
If the child fails to use the arm after 15 minutes, the elbow should be x
rayed to determine if it was fractured. If no fracture is found, the arm
should be splinted and put into a sling, and the condition re-evaluated
after 24 hours.
The child should be able to use the elbow after the injury has healed.
However, once an elbow has been injured, it is more likely that it will
happen again in the future if care is not taken to prevent further injury.
A child should not be lifted or swung by the arms or hands nor should a
child's arm be pulled hard. A small child should be lifted from
under the arms.
—Hinged joint between the forearm and upper arm.
—A type of tough, fibrous tissue that connects bones or cartilage
and provides support and strength to joints.
—An injury to the ligament (strong band of tissue) that keeps the
two bones of the forearm in the correct place.
—The bone of the forearm which joins the wrist on the same side
as the thumb.
—One of the two bones of the forearm. Two pivot joints join it to
the radius, one near the elbow, one near the wrist.
PM Medical Health News.
21st Century Complete Medical Guide to Elbow Injuries and Disorders:
Authoritative Government Documents, Clinical References, and Practical
Information for Patients and Physicians.
Washington, DC: Progressive Management, 2004.
"Nursemaid's Elbow." National Institutes of Health.
"Pediatrics, Nursemaid elbow." eMedicine.com, Inc.