Nursemaid’s Elbow

Nursemaid's elbow (radial head subluxation) is an injury in which a bone of the elbow joint is pulled out of place and gets stuck in that position. This injury is common in young children. It often happens when you lift or pull the child by one or both arms. The injury commonly occurs when a parent or caregiver is trying to keep the child out of harm’s way. This might be grabbing a child who is about to step out into the street. Sometimes a playmate will tug hard enough on the arm to cause this injury.

This injury happens because the ligaments in the elbow can be weak in some young children. Your child’s healthcare provider can usually fix this easily by gently moving the bone back into place. But the injury can happen again if the arm is pulled again. Ligaments strengthen by 5 or 6 years of age. Nursemaid’s elbow will usually not occur after that.

The healthcare provider will hold the child's wrist or forearm and turn the hand so that it faces palm up. While putting pressure near the top of the radius bone (bone in the arm) with his or her thumb, the doctor will slowly bend the elbow. A faint pop or click may be heard when the joint goes back into place.

After the bone is put back into position, it usually takes about 30 to 60 minutes before the child will start using that arm normally again. In some cases, it may take up to 24 hours before the child starts using the arm again. If your child is not using the arm normally by 24 hours, he or she may have other injuries. Your child may need X-rays or other tests to find out what they are.

Home care

Follow these guidelines when caring for your child at home:

• If all symptoms get better before you leave this facility, your child doesn’t need any further treatment.
• If your child is still having arm pain, a splint and sling may be put on. Leave this in place until the next scheduled exam, or as advised by your child’s healthcare provider.
• Use acetaminophen for fussiness or discomfort. In babies older than 6 months of age, you may use ibuprofen instead of acetaminophen.

Prevention

Until your child is at least 5 years old, this injury may occur again with any type of lifting or pulling on the arm. To prevent it from happening again:

• Don’t lift or pull your child by the arm. Hold your child under the arms to lift.
• Don’t swing your child by holding his or her hands or arms.
• Teach siblings and playmates not to tug or pull on your child’s arms.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. If a splint was put on, follow up for a repeat exam within the next 24 hours, or as directed. 

© The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. This information has been modified by your health care provider with permission from the publisher.