Nursemaid Elbow: Symptoms, Causes, Treatment

What are the symptoms of nursemaid elbow?

Nursemaid’s elbow, also known as radial head subluxation, is a common elbow injury in young children, typically occurring when the child’s arm is pulled or yanked suddenly. This condition is characterized by partial dislocation of the radial head, and the symptoms can include:

1. Elbow Pain

• The child may exhibit immediate pain in the elbow area. The pain may be localized around the outside of the elbow.

2. Inability to Use the Arm

• The injured child may be unable or reluctant to use the affected arm. They may hold the arm close to their body and avoid movement, which can indicate discomfort or pain.

3. Reduced Range of Motion

• The child may resist bending or extending the elbow, showing limited movement as they may fear pain when attempting to move it.

4. Visible Deformity

• While the elbow usually doesn’t appear visibly deformed, in some cases, a subtle change in the position of the arm may be noticeable, such as the child holding the arm in a specific position (e.g., flexed at the elbow and held against their body).

5. Swelling or Tenderness

• There may be some swelling or tenderness around the elbow joint, although significant swelling is less common.

6. Behavior Changes

• The child may exhibit signs of distress or discomfort, such as crying, increased irritability, or reluctance to engage in activities that require the use of the affected arm.

Conclusion

If a child shows symptoms of nursemaid’s elbow following an incident where they were pulled by the arm or fell awkwardly, it is crucial to seek medical attention. Typically, this condition is diagnosed through a physical examination, and it is often effectively treated with a simple maneuver to reposition the radial head. Most children recover quickly with appropriate care and can return to normal activities shortly after treatment.

What are the causes of nursemaid elbow?

Nursemaid’s elbow, also known as radial head subluxation, is a common injury in young children, particularly those under the age of 5. The condition occurs when the radial head (the round part of the radius bone near the elbow) becomes partially dislocated from its normal position in the elbow joint. Here are the primary causes and risk factors associated with nursemaid’s elbow:

1. Pulling or Yanking of the Arm

• Common Mechanism: Nursemaid’s elbow typically occurs when a child’s arm is suddenly pulled or yanked. This might happen during activities such as:
• An adult quickly lifting or pulling a child by the arm, often when the child is falling or jumping.
• Tugging on a child’s arm during play or in an attempt to get their attention.

2. Falls

• Injuries from Falling: If a child falls while holding onto something (like a railing or another person’s arm), it may lead to an injury that results in nursemaid’s elbow.

3. Swinging or Twisting Movements

• Excessive Rotation: Activities that involve swinging or twisting the arm can place stress on the elbow joint and potentially lead to subluxation.

4. Age and Developmental Factors

• Young Age: Nursemaid’s elbow primarily affects younger children (typically children aged 1 to 4 years) because their ligaments are still developing and are less stable than in older children.
• Anatomy: The anatomical structure of a child’s elbow joint makes it more susceptible to this type of injury. The radial head is relatively loose in young children, making it easier for it to slip out of place when force is applied.

Conclusion

Nursemaid’s elbow is most often caused by sudden forces applied to a child’s arm, either from pulling, twisting, or falling. Educating caregivers about how to safely handle young children is essential for preventing this common injury. If a child shows symptoms of nursemaid’s elbow, such as pain and inability to use the affected arm after an incident, it’s important to seek medical attention for appropriate diagnosis and treatment. The condition is usually easily treated with a simple reduction maneuver performed by a healthcare professional.

How is the diagnosis of nursemaid elbow made?

The diagnosis of nursemaid’s elbow (radial head subluxation) is primarily clinical, meaning that it is based on the child’s history of the event leading to the injury and the physical examination findings. Here are the key steps involved in diagnosing nursemaid’s elbow:

1. Medical History

• Incident Description: The healthcare provider will inquire about the circumstances leading to the injury. This often includes:
• Details of how the arm was pulled or yanked (e.g., whether the child was lifted, fell, or twisted their arm).
• The age of the child, as nursemaid’s elbow most commonly occurs in children under the age of 5.
• Symptoms: The provider will ask about the symptoms, including:
• Onset of pain, reluctance to move the arm, or inability to use the affected arm.

2. Physical Examination

• Visual Inspection: The provider will visually inspect the affected arm and elbow for any swelling or deformity. However, there is usually no visible deformity in cases of nursemaid’s elbow.
• Palpation: Gentle palpation of the elbow joint may be performed to assess for tenderness, but the focus is often on eliciting the child’s response to movement.
• Range of Motion Assessment: The provider will typically evaluate the degree of motion in the elbow. Affected children will usually resist any attempts to move the affected arm or will hold it in a specific position (usually flexed and close to the body).
• Tests for Pain: In an affected child, movement such as supination (turning the palm up) may elicit pain.

3. Diagnostic Imaging (If Necessary)

• X-rays: While usually not required for a definitive diagnosis of nursemaid’s elbow, X-rays may be performed to rule out other injuries, such as fractures. In most cases, X-rays will be normal, as there is no structural abnormality in nursemaid’s elbow.

Conclusion

The diagnosis of nursemaid’s elbow is primarily based on the child’s history and clinical examination rather than imaging studies. If a child demonstrates classic signs of the condition following a pulling or twisting injury, a healthcare provider can typically confirm the diagnosis and proceed with appropriate treatment, which usually involves a simple manipulation to reduce the dislocation. Prompt diagnosis and treatment are essential for the quick recovery of the child and restoration of normal arm function.

What is the treatment for nursemaid elbow?

The treatment for nursemaid’s elbow (radial head subluxation) is generally straightforward and typically involves a simple reduction procedure performed by a healthcare professional. Here’s a breakdown of the treatment approach:

1. Reduction Maneuver

• Clinical Technique: The primary treatment for nursemaid’s elbow is a closed reduction, which is a manual manipulation to reposition the radial head back into its proper place. This is typically done in a healthcare setting.
• Procedure: A common technique involves:
  • Holding the child’s elbow at a 90-degree angle.
  • Applying gentle pressure to the radial head (at the outer part of the elbow) while simultaneously turning the forearm from a pronated (palm down) to a supinated (palm up) position.
• Confirmation: The provider will assess for relief of pain and restoration of function following the reduction.

2. Pain Management

• Discomfort Relief: After the reduction, mild analgesics may be recommended if there is residual discomfort. Over-the-counter medications like acetaminophen or ibuprofen can be used, following appropriate dosing guidelines for children.

3. Observation

• Monitoring: After the procedure, the healthcare provider may monitor the child briefly to ensure that the arm functions normally and that pain has resolved.
• Return of Function: Most children will start to use the arm again immediately after the reduction, although some may be hesitant to move it right away. Usually, they regain full use of the arm within a short time after the procedure.

4. Parent Education and Prevention

• Guidance for Caregivers: Parents or caregivers will be educated on how to avoid future incidents of nursemaid’s elbow. This may include advice on handling children:
• Avoiding pulling or yanking on a child’s arms.
• Lifting children by the body rather than the arms.
• Using age-appropriate methods to engage with children during play.

5. Follow-Up

• Monitoring Recovery: In most cases, no formal follow-up is needed if the child recovers well and is using the arm normally. However, if problems persist or if there are recurrent episodes, further evaluation by a healthcare provider may be warranted.

Conclusion

Nursemaid’s elbow is a common injury in young children that can be treated effectively through a simple reduction maneuver. The prognosis is excellent, with most children fully recovering without any long-term effects. If a child exhibits symptoms suggestive of nursemaid’s elbow after an incident of arm pulling or injury, seeking prompt medical attention can facilitate quick and effective treatment.