Nursemaid's elbow is a dislocation
of a bone in the elbow called the radius. Dislocation means the bone slips out of its normal position at the elbow joint.
The injury is also called radial head dislocation.
Radial head dislocation; Pulled elbow; Dislocated elbow - children; Elbow - nursemaid's; Elbow - pulled; Elbow subluxation; Dislocation - elbow - partial; Dislocation - radial head
Causes, incidence, and risk factors
Nursemaid's elbow is a common condition in young children. It generally affects children under age 5. The injury occurs when a child is pulled up too hard by the hand or wrist. It is often seen after someone lifts a child up by one arm. (For example, when trying to lift the child over a curb or high step.)
Other ways this injury may happen include:
Breaking a fall with the arm
Rolling over in an unusual way
Swinging a young child from the arms while playing
Once the elbow dislocates, it is likely to do so again, especially in the 3 or 4 weeks after the injury.
Nursemaid's elbow does not usually occur after age 5. By this time, a child's joints and the structures around it are stronger, and the child is less likely to be in a situation where this injury might occur. However, in some cases, the injury can occur in older children or adults, usually from a fracture of the forearm.
When the injury occurs, the child usually begins crying right away and refuses to use the arm because of elbow pain.
The child may hold the arm slightly bent (flexed) at the elbow and pressed up against the belly (abdominal) area.
The child will move the shoulder, but not the elbow. Some children stop crying as the first pain goes away, but continue to refuse to move the elbow.
Signs and tests
The health care provider will examine the child.
The child will be unable to rotate the arm at the elbow so that the palm is up and will have trouble bending (flexing) the elbow all the way.
Sometimes the elbow will slip back into place on its own. Even then, it is best for the child to see a health care provider.
DO NOT try to straighten the arm or change its position. Apply an ice pack to the elbow. Keep the areas above and below the injured elbow (including the shoulder and wrist) from moving, if possible.
Take the child to the doctor's office or emergency room.
The doctor will fix the dislocation by gently flexing the elbow and rotating the forearm so that the palm is facing upward. DO NOT try to do this yourself because you may harm the child.
When nursemaid's elbow returns several times, your health care provider may teach you how to correct the problem yourself. See your health care provider for help.
If nursemaid's elbow is not treated, the child may be permanently unable to fully move the elbow. With treatment, there is usually no permanent damage.
In some cases, the child may have problems that limit movement of the arm.
Calling your health care provider
Call your provider if you suspect your child has a dislocated elbow or refuses to use an arm.
Do not lift a child by one arm only such as from the wrist or hand. Lift from under the arms, from the upper arm, or from both arms.
Do not swing children by the hand or forearm. To swing a young child in circles, provide support under the arms and hold the upper body next to yours.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.