Toddlers and preschoolers are at risk for a common elbow injury called nursemaid's elbow. This happens when a ligament slips
out of place and gets caught between two bones of the elbow joint.
Sometimes it gets unstuck by itself. In most cases, a health care professional
gets the ligament back in place by doing a quick, gentle move of the arm.
A child with nursemaid's elbow has some arm pain when the injury happens, but it
doesn't cause long-term damage.
Nursemaid's elbow (also called pulled elbow) usually happens in kids 1 to 4 years
old. Their ligaments (the elastic-like bands that hold bones together) are a bit loose.
So it can be easy for a ligament in the elbow to slip into the joint and get stuck.
Nursemaid's elbow can happen with just a small amount of force. For example:
Pulling a child up by the hands can put stress on the elbows.
Never pick up a toddler or infant by the hands or wrists, but lift under the armpits.
Swinging a toddler by holding the hands or wrists can put stress
on the elbow joint and should be avoided.
Jerking an arm when pulling a toddler along or quickly grabbing
his or her hand can make the ligament slip. Always be gentle when taking a child by
Breaking a fall by reaching an arm out for protection can overextend
the elbow, causing the ligament to slip.
Rolling over in an awkward way in a crib, bed, or on the
floor can cause nursemaid's elbow in infants and very young children.
As kids get older, the ligaments tighten. Most won't get nursemaid's elbow after
they turn 5 years old, though it can happen up to age 6 or 7.
Signs and Symptoms
A child with nursemaid's elbow will not want to use the injured arm because
moving it is painful. He or she will keep the arm in a straight position or with a
slight bend in the elbow. The injury won't be obvious because nursemaid's elbow doesn't
cause deformity or swelling.
An arm or elbow injury that causes severe pain might be a sign of an elbow fracture
(broken bone) or a bad bruise. It can be hard for a parent to tell whether an injury
is nursemaid's elbow or a fracture, so it's important to call your doctor if your
child has injured an elbow.
At a doctor's office or an emergency room, a health care professional will examine
the child's arm and ask questions about how the injury happened. Usually, no special
tests are needed to diagnose nursemaid's elbow. X-rays
are done only if a fracture is suspected.
If there's no swelling or signs of another injury, the doctor will do a gentle
maneuver called a reduction. This procedure
takes only a few seconds. The child will sit on a parent's lap while the doctor gently
takes the arm from a straight position and bends it upwards or straightens the arm
while turning the palm to the floor.
Kids might have a brief moment of pain during the reduction, but quickly feel much
better. Most have full use of the arm within 5 to 10 minutes. Some cases may require
more than one reduction to successfully fix the injury.
Occasionally, a child may not want to use the arm after a reduction, fearing it
will be painful. If there is some discomfort, the doctor may put the arm in a sling
and say it's OK to give acetaminophen
or ibuprofen for
pain relief. In some cases, the doctor may place a splint (a partial cast) to protect
the arm until a specialist can check it after a few days of rest.
It's important to know that kids who get nursemaid's elbow might get it again.
So be mindful of the risks and don't pull, tug, or swing your child by the arms or
hands, and be sure to tell all caregivers to do the same.
Still, some kids are just more prone to getting nursemaid's elbow than others and
might get it again even when parents try hard to prevent it.