Doctronic

Understanding and Preventing Nursemaid's Elbow in Children

Abhijit Bhattacharyya | MD, PhD, MBA

Medically reviewed by Abhijit Bhattacharyya | MD, PhD, MBA, Tufts University School of Medicine - Miami, Florida on March 1st, 2024.

Key Takeaways

  • This injury occurs when the radius bone slips out of the annular ligament at the elbow joint, most commonly in children aged 1-4 years when ligaments are naturally looser and still developing.
  • Classic presentation includes a child who suddenly stops using one arm, holds it close to their body with the forearm turned inward, and cries when the area is touched or moved.
  • The injury typically happens from lifting a child by their hands or wrists, sudden tugging during falls, or swinging a child by their arms during play.
  • Reduction requires a trained medical professional to perform a specific maneuver where they flex the elbow to 90 degrees and rotate the forearm—most children resume normal arm use within 15-30 minutes.
  • Prevention is straightforward: always lift children under their armpits rather than by their hands, avoid pulling on arms during tantrums, and never swing children by their wrists or hands during play.

Nursemaid's elbow, also known as pulled elbow or radial head subluxation, is a common injury among toddlers and preschoolers. It occurs when the elbow joint slips out of its normal position, causing pain and discomfort for your child. In this article, we'll discuss the causes, symptoms, treatment, and prevention of nursemaid's elbow.

What Causes Nursemaid's Elbow?

Nursemaid's elbow can happen when a child's arm is pulled or tugged, especially if the arm is twisted. This injury is more common in young children because their ligaments, which connect the elbow bone to the joint, are still loose and developing. Some common causes include:

  • Catching a child by the hand to stop a fall

  • Lifting a child up by the hands or wrists

  • Pulling a child's arm through a jacket sleeve

  • Swinging a child by the arms or hands

  • Yanking on a child's arm to make them walk faster

Symptoms of Nursemaid's Elbow

If your child has nursemaid's elbow, they may experience the following symptoms:

  • Pain when moving the affected arm

  • Crying when the arm is moved or touched

  • Holding the arm close to their side or supporting it with the other arm

  • Refusing to use the affected arm

It's important to note that there is usually no swelling, bruising, or other visible signs of a serious injury.

Understanding and Preventing Nursemaid's Elbow in Children

Treatment for Nursemaid's Elbow

If you suspect your child has nursemaid's elbow, it's essential to seek medical attention. Your doctor will examine your child's arm and may perform a "reduction maneuver" to put the elbow back into its correct position. This procedure is quick and usually resolves the issue within minutes.

In some cases, over-the-counter pain medication, such as acetaminophen or ibuprofen, may be recommended to help manage any discomfort. Always consult your healthcare provider for the appropriate dosage for your child.

Preventing Nursemaid's Elbow

To reduce the risk of nursemaid's elbow, follow these tips:

  • Avoid lifting your child by their arms or hands; instead, lift them under their arms

  • Never tug or jerk your child's hand or arm

  • Refrain from swinging your child by their hands or arms

As your child grows, their ligaments will become stronger, making nursemaid's elbow less likely to occur. However, children who have experienced this injury are more prone to future occurrences, so it's crucial to take preventive measures.

For more information on nursemaid's elbow and other common childhood injuries, visit HealthyChildren.org, KidsHealth.org, or consult your pediatrician.

The Bottom Line

Quick medical attention can resolve this injury completely within minutes using a simple joint manipulation technique, and recurrence is uncommon once the child's ligaments mature around age 5. Always lift young children under their arms to prevent this painful but easily treatable condition. If your child suddenly stops using their arm after being pulled or tugged, Doctronic can help you assess the situation and determine if immediate medical care is needed.

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