Nursemaid’s elbow

  • Definition
    • 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.

      The injury is also called radial head dislocation.

  • Alternative Names
    • Radial head dislocation; Pulled elbow; Dislocated elbow - children; Elbow - nursemaid's; Elbow - pulled; Elbow subluxation; Dislocation - elbow - partial; Dislocation - radial head

  • Causes
    • 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 their 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:

      • Stopping a fall with the arm
      • Rolling over in an unusual way
      • Swinging a young child from their 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. In some cases, the injury can happen in older children or adults, but it usually occurs with a fracture of the forearm.

  • Symptoms
    • 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 their 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 their elbow.
  • Exams and Tests
    • The health care provider will examine the child.

      The child will be unable to rotate the arm at the elbow. The palm will be up, and the child will have trouble bending (flexing) the elbow all the way.

  • Treatment
    • 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 your health care provider's office or an emergency room.

      Your provider will fix the dislocation by gently flexing the elbow and rotating the forearm so that the palm faces upward. DO NOT try to do this yourself because you may harm the child.

      When nursemaid's elbow returns several times, your provider may teach you how to correct the problem yourself. See your provider for help.

  • Outlook (Prognosis)
    • 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.

  • Possible Complications
    • In some cases, children may have problems that limit movement of their arm.

  • When to Contact a Medical Professional
    • Call your provider if you suspect your child has a dislocated elbow or refuses to use an arm.

  • Prevention
    • DO NOT lift a child by a single arm, such as from their wrist or hand. Lift from under the arms, from the upper arm, or from both arms.

      DO NOT swing children by their hands or forearms. To swing a young child in circles, provide support under their arms and hold their upper body next to yours.

  • References
    • White DR, Adams CF. Nursemaid's elbow: radial head subluxation. In: Pfenninger JL, Fowler GC, eds. Pfenninger & Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 194.