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Nursemaid's Elbow

A pulled elbow (also known as nursemaid's elbow) is a common, painful injury generally among children under four years old but occasionally older. It occurs when the outer part of the elbow becomes dislocated or slips out of its joint. This happens because the child's elbow joint is loose enough to separate slightly when her arm is pulled to full length (while being lifted, yanked, or swung by the hand or wrist, or if she falls on her outstretched arm). The nearby tissue slides into the space created by the stretching and becomes trapped after the joint returns to its normal position.

A nursemaid's elbow injury usually doesn't cause swelling, but the child will complain that the elbow hurts, or cry when her arm is moved. A child will typically hold her arm close to the side, with the elbow slightly bent and the palm turned toward the body. If someone tries to straighten the elbow or turn the palm upward, the child will resist because of the pain.

Treating Nursemaid's Elbow

This injury should be treated by a pediatrician or other trained health care provider. Since elbow pain can also be due to a fracture, your pediatrician may need to consider this before the elbow is "reduced" or put back into place.

Your doctor will check the injured area for swelling and tenderness and any limitation of motion. If an injury other than nursemaid's elbow is suspected, X-rays may be taken. If no fracture is noted, the doctor will move and twist and flex the arm gently to release the trapped tissue and allow the elbow to return to its normal position. Once he has moved the elbow back in place, the child will generally feel immediate relief and within a few minutes should be using her arm normally without any discomfort.

Occasionally, the doctor may recommend a sling for comfort for two or three days, particularly if several hours have passed before the injury is treated successfully. If the injury occurred several days earlier, a hard splint or cast may be used to protect the joint for one to two weeks.

Persisting pain after a "reduction" may mean that a fracture occurred that may not have been apparent at the time of initial X-rays.

Prevention

Nursemaid's elbow can be prevented by not pulling or lifting your child by the hands or wrists, or swinging her by the arms. Instead, lift your child by grasping her body under the arms.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.