Nursemaid’s Elbow

Description

In nursemaid’s elbow, the head of the radius has slipped partly under a ligament near the elbow. It is very common in toddlers and happens when the arm is pulled or lifted by the hand or wrist. It is not a broken bone and does no lasting harm.

How it happens (the mechanism)

A toddler’s ligaments are loose, so a sudden lengthwise pull on the arm — lifting or swinging a child by the hand — lets the ring-shaped ligament around the radial head slip up and over it. The child then guards the arm. It tends to recur until around age five, when the ligament tightens with growth.

Symptoms

The child suddenly stops using the arm and holds it slightly bent and turned in, usually without much swelling, after the arm was pulled.

Doctor examination and imaging

The diagnosis is usually clear from the story and exam; X-rays are typically not needed unless an injury is suspected.

Treatment

The doctor gently guides the radius back into place with a quick maneuver in the office, usually followed by rapid relief and the child using the arm again within minutes to an hour. No cast or splint is needed.

Recovery and long-term outlook

Children recover completely. Because it can recur, families are shown how to avoid lifting or swinging a child by the hands or wrists — lifting under the arms instead.

When to call the doctor

Call if pain is severe or worsening, your child will not use the arm at all, the area becomes very swollen, red, or warm, your child develops a fever, or things are not improving as expected.

Learn more

OrthoInfo (AAOS) — Elbow Fractures in Children: orthoinfo.aaos.org

This information is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. For specific concerns about your child, consult a board-certified, fellowship-trained pediatric orthopaedic surgeon.