Nursemaid's Elbow: A Common Childhood Injury

The elbow joins the upper arm bone, the humerus, with the two bones in the forearm, the ulna and the radius. Strong ligaments on either side hold everything together. The elbow has two joints; one between the ulna and the humerus that allows the elbow to bend and one between the radius and the humerus that allows the forearm to rotate.

The joint between the radius and the humerus is the one affected by nursemaid's elbow. This injury is not a fully dislocated elbow; rather, the radial bone moves out of its socket and gets caught between the ligaments.

It does not take a lot of force to cause nursemaid's elbow; often, it occurs from a seemingly harmless action like lifting or swinging a child by the hands or pulling a child by the hand to avoid danger or a fall.

Even pulling a child's arm through a jacket or coat sleeve can cause nursemaid's elbow.

This type of injury does not usually cause swelling, bruising, or signs of trauma, and it might not be obvious that anything is wrong just by looking at the elbow.

A child with nursemaid's elbow may hold their arm close to their side, with the elbow bent and the palm against their body. They will avoid lifting their arm above their shoulder and refuse to rotate their palm. Children with this type of injury usually only experience pain when pulled by the hand.

Although this injury is common and may not be obvious, nursemaid's elbow should be treated as soon as possible. The child will experience pain when trying to use their arm normally, and delaying treatment can make the injury more difficult to fix.

Caregivers may quickly realize the injury has occurred after swinging the child by the arms or pulling them by the wrist, or they may be unaware of what happened.

During a physical exam, the child may refuse to move the arm. In addition to obtaining a history of the injury and observing the child's behavior, the doctor examines the entire arm, looking for areas of pain or tenderness.

Doctors can usually diagnose nursemaid's elbow from the physical exam. Imaging or diagnostic testing isn't generally necessary unless the doctor suspects further injury, like a fracture or complete elbow dislocation.

Doctors may also investigate further if they feel the injury resulted from some other mechanism or if they suspect trauma or abuse.

Nursemaid's elbow can resolve on its own, which can be confusing for caretakers, especially when they take the child to the doctor and the symptoms seem to spontaneously disappear.

In most cases, the doctor gently moves the bones back into place without any pain medication. A pop or click may occur when the joint goes back into place. The child may experience some pain during the procedure, but it resolves quickly as soon as the joint is realigned.

After the doctor adjusts the joint, recovery is usually pretty quick, though some children take a few minutes to realize that the pain is gone.

Most children start to use their arms again within ten minutes, and 90 percent are asymptomatic within a half hour. If the child does not regain full use of their arm quickly, they may require additional imaging and a visit to an orthopedic surgeon.

Though a properly treated nursemaid's elbow injury should heal completely, children who have had a pulled elbow injury once are prone to it happening again.

Though the original injury stretches the ligaments, making the joint more likely to slip out of place again, bone and ligament development over the next years means these parts will fit together more tightly, making the injury less likely to recur over time.

Because nursemaid's elbow is more likely to occur in children who have already had the injury, parents and caregivers must be very careful to avoid certain behaviors that can reinjure the joint.

Lift children from under the arms instead of pulling them by the hands, and avoid swinging, holding, or pulling by the arms and hands.