Pediatric Orthopedic Surgeons treating a Hammer Toe


Nursemaid’s elbow occurs when the radius (one of the bones in the forearm) slips out of place from where it normally attaches to the elbow joint. It appears as a common condition in children younger than 4 years of age. Doctors also refer to the condition as pulled elbow, slipped elbow, or toddler’s elbow.

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 Nursemaid Elbow

Injuries like nursemaid elbow occur frequently in young children. Nursemaid elbow is a disorder (medically known as radial head subluxation) where two of the three bones that make up the elbow joint are not aligned normally. The left arm occurs more frequently damaged than the right in girls.  It’s just the opposite in males. According to some experts, nursemaid elbow appears less common in right-handed parents who constantly tug their left-handed kids’ hands. When a small kid is swinging by the arms or being pulled by the arm in a rush, the injury may unintentionally happen. Parents can pull the elbow bones of a young infant out of position with comparatively little force.

Physiology of the Arm

  • Elbow dislocation is a common term
  • The rapid loss of an arm’s use due to nursemaid elbow can certainly worry parents, even though it is often a transient ailment with no long-term effects.
  • Radius and ulna, two forearm bones, as well as the upper arm bone, make up the elbow joint (Humerus, hence the name “funny bone”). The forearm bone on which the baby’s finger is located is called the ulna. On the thumb side, the radius spans the whole forearm. With the capitellum, the distal end of the Humerus, the radius connects specifically.
  • Humerus and Ulna have a strong connection. However, the radial head requires a rigid ligament (trochlear) to hold it in the correct area. Sudden or chronic pulls on the radial head can partially tear this ligament and cause it to become misaligned, causing the radius to lose its proper position in the socket at the end of the humerus.
  • This type of injury usually occurs in 1- to 4-year-old children, but has also occurred in infants aged 6-12 months. The highest incidence occurs at 27 months of age. As the child grows, the bones become larger and more defined. Ligaments also get stronger, which makes them a superior support system. Unless the child hangs by the hands a lot or lifts a lot of heavy things, nursemaid elbow is uncommon in children older than 6 years of age. (The term “nursemaid elbow” dates back to a time when nannies or nursemaids frequently looked after the children of upper-class households.)

What Are the Symptoms of Nursemaid Elbow?

  • The youngster often yells in agony and refuses to use the injured arm.
  • Typically, the arm appears snugly against the body, slightly bent (in flexion), with the forearm twisted with the thumb towards the body.
  • Frequently, a young child will use the other hand to support the hurt arm.
  • After the initial incident, the youngster will often relax and may resume playing, albeit without the use of the injured arm.
  • If you turn the forearm away from the body with the thumb up and the palm facing up (supination), the child will resist and cry in pain.
  • When a kid becomes old enough to speak, they may frequently mention discomfort in the wrist or shoulder instead of, or in addition to, any elbow pain.
  • With the exception of not using the wounded arm anymore, your youngster will often seem perfectly ok.

What Causes Nursemaid Elbow?

An abrupt tugging motion on a child’s outstretched arm will cause nursemaid elbow. The applied force might not appear severe to the parents and they might not know that an injury has occurred. However, due to the relative strength of the adult as compared to the fragility of the child’s, Nursemaid Elbow can occur.  Lifting a kid off the ground by the hand or wrist, or swinging a child while holding them by the hands or wrists, are two common methods that result in this injury. Pulling a kid along when in a hurry or when the youngster unexpectedly collapses to the ground in an effort to escape going with their parent is often the case for causing Nursemaid Elbow. In addition, pulling arms through jacket sleeves or catching a child by the hand to prevent a tumble will also cause the condition.

The physical characteristics of the bones and ligaments of young children make them particularly vulnerable to Nursemaid Elbow. Explaining the source of this damage requires understanding its mechanism.

The Mechanics of Causing a Nursemaid Elbow

The radial head refers to the portion of the radius that joins at the elbow joint. The radial head fits over a comparable convex prominence at the end of the humerus thanks to its shallow concave form (the capitellum). As the child gets older, the radial head widens — eventually surpassing the part of the radius next to the head (known as the radial neck). The radial head does not yet have a distinct lip at the end in a young child. As a result, the toddler’s radial neck and head are of comparable size.

Along with the ulna, the other forearm bone, and the annular ligament, the radius is held in place. The annular ligament stabilizes the joint between the radial head and the humerus.  In addition, it also allows the radius to rotate as a child’s hand moves from palm down (prone) to palm up (supine).

If traction is applied to the elbow while the forearm is rotated palm down slightly, the loose portion of the ring ligament can slip over the radial head. It can cause a partial tear. This can lead to the radial head, often known as the nursemaid elbow, subluxing, which occurs when the tissue of the annular ligament is wedged between the radial head and the capitellum.

How is this Condition Diagnosed?

Make an appointment with us if your child is gripping his or her arm strangely or are complaining of discomfort. As part of a physical examination of the damaged arm, their doctor will often diagnose a nursemaid’s elbow based on how the elbow was hurt and how the kid is holding their arm.

How Is Nursemaid’s Elbow Treated?

The course of treatment depends on the age and general health of your child. To diagnose this condition, our doctor will carefully examine the arm.  X-rays are typically not required as they do not show this injury. Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) are two examples of good over-the-counter painkillers for children. Make sure to consult our doctors about what dosage for your child. To return the elbow to its proper position, the doctor will employ a technique known as a “reduction maneuver.”

Our doctor performs this technique in his office while holding the child’s wrist and elbow. Our doctors will then gently move the arm in a certain way until the elbow returns to its original position. A click occurs when done successfully. A reduction move simply take 30 seconds by a skilled orthopedic children’s doctor.  The process could hurt for a moment. Most likely, the youngster will cry for a short while. Within 10 to 15 minutes, the majority of children can use their arms pain-free. However, some youngsters may appear afraid of using the arm because they recall how painful it was in the past. If this occurs, our doctor could suggest pain medication followed by an hour of monitoring to ensure everything is ok. 

Sometimes, a child’s maltreatment might lead to a nursemaid’s elbow. If the youngster exhibits other abuse indicators or the patient is an older child, an abuse investigation may be warranted.

Can You Prevent Nursemaid’s Elbow?

Your child’s ligaments will develop stronger as they grow. Certainly, after the age of 6, pulling on a child’s arm will normally not result in a nursemaid’s elbow. Until then, the following advice may help you avoid nursemaid’s elbow:

  • Never raise a child by the hands or arms. Instead, raise the infant by the arms.
  • Do not pull or jerk a child’s arm or hand.
  • Never swing a kid about by the arms or hands.

Nursemaid’s elbow will likely recur in children who have already experienced it.

Call 214-556-0590 to make an appointment.

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