Nursemaid’s elbow
Radial head dislocation; Pulled elbow; Dislocated elbow - children; Elbow - nursemaid's; Elbow - pulled; Elbow subluxation; Dislocation - elbow - partial; Dislocation - radial head; Elbow pain - nursemaid's elbow
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.
Radial dislocation may be caused by a sudden pull on a child's arm or hand. For first aid, immobilize the arm and take the child to the doctor's office or emergency room.
Causes
Nursemaid's elbow is a common condition in young children, especially 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. This might occur, 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 them are stronger. Also, 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, usually 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 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 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.
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 the arm.
When to Contact a Medical Professional
Contact 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
Carrigan RB. The upper limb. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 701.
McClincy MP, Olgun ZD, Dede O. Orthopedics. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 22.
Version Info
Last reviewed on: 10/31/2022
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
