Nursemaid’s Elbow or Radial Head Subluxation is a common physical disorder affecting children in the age group of 1-7 years. The injury is also known as Pulled Elbow and Toddler’s Elbow. As the bones and joints of children are tender and still in a formative stage, there is an increased likelihood of dislocations. The elbow joint is made up of the upper arm bone, humerus, and two lower arm bones; ulna and radius. These are held together by the ligaments, muscles and tendons. The elbow further comprises into two joints:
- Humeroulnar joint, where the humerus meets the ulna and enables the elbow to bend
- Radiocapitellar joint, the meeting point of radius and humerus that enables the forearm to rotate
In Nursemaid’s Elbow, the radiocapitellar joint gets dislocated. It is a temporary injury and may not lead to any long term damage to the joint. As the child grows, the ligaments and muscles become stronger as well as keep the joint stable, thereby, reducing the chances of suffering the injury.
- A sudden force to the child’s wrist or arm
- Yanking or swinging the child with the arm
- Lifting the child by holding his hands or arms
- Forcefully dragging a child by pulling his/her arm
- Loose ligaments
- Breaking a fall with an outstretched arm
- Rolling over in bed may lead to partial displacement of the bones
- Visible deformity in the form of a slightly bent arm
- Pain which may increase while moving the arm
- Inability to rotate the arm or palm
- The child may tend to hold his arm near the body and does not move it
- Clinical evaluation of the injured arm and the mode of injury
- The doctor may observe the way the child holds, moves or bends the arm
- X-ray imaging may be done to rule out fracture or damage to adjacent structures
- Physical Reduction– The orthopedic doctor may manually push the bone back in place. This procedure may cause some initial discomfort to the child but once the position of the bone is restored, he may be able to move the arm easily.
- Anti-inflammatory medicines may be prescribed to provide relief from pain and inflammation.
- Wearing a sling for a few days may be recommended to keep the arm in a stable position