Nursemaid’s elbow, also known as radial head subluxation, is a common injury among toddlers and preschoolers, typically occurring between ages 1-4 years old. It happens when a ligament slips out of place and gets caught between two bones in the elbow joint, partially dislocating the elbow.

Common Symptoms

• Arm pain and refusal to use or move the affected arm
• Holding the arm slightly bent and close to the body
• No visible swelling or bruising

Cause & Anatomy

The injury usually occurs when a child is pulled or lifted by the hand, wrist or forearm, causing the elbow to extend and the ligament to slip out of place. Common scenarios include:

• Pulling a child by the hand to prevent falling or running off
• Swinging a child around by the hands or arms
• Lifting a child up by the hands, wrists or forearms
• The child rolling over on the arm during sleep or play

Diagnosis

Diagnosis is typically based on the history and physical examination, with no need for X-rays unless a fracture is suspected. The healthcare provider will check for inability to rotate or fully flex the elbow.

Treatment

A gentle maneuver called a “reduction” is performed to slip the ligament back into place, often resulting in an audible “pop”. This provides immediate relief, with full use of the arm restored within 5-15 minutes. Occasionally, a splint or sling may be used for residual discomfort.

Prevention involves avoiding pulling, tugging or swinging a child by the arms or hands, and instead lifting under the armpits