Arm (Elbow) Dislocations in Children: Understanding "Nursemaid’s Elbow". Dr. Narmin Azizova
Dr. Narmin Azizova
Neonatologist, Department of Neonatal Resuscitation and Intensive Therapy, Scientific Research Institute of Pediatrics named after K.Y. Farajova; Department of Pediatrics I, Azerbaijan Medical University; Founder, Pediatriya.az.
What is Nursemaid’s Elbow?
One of the most common reasons parents bring their children to the hospital is because their child suddenly cannot move their arm. This condition, called “nursemaid’s elbow” or “caretaker’s elbow,” happens most often in children between 1 and 4 years old. It is more common in girls and usually affects the left arm. As children grow older, their joints and ligaments get stronger, and this problem becomes less common after age 5.
Why Does It Happen?
Young children’s bones and ligaments are still developing, making them more flexible. The annular ligament, which holds part of the elbow in place, is loose in small children. This means the bone can slip out of place more easily.
Common Causes
Nursemaid’s elbow usually happens when a child’s arm is pulled suddenly. Common situations include:
- Babies (<1 year old): Rolling over in bed or getting an arm stuck while crawling.
- Toddlers (1–4 years old): Being lifted, pulled, or swung by the wrist or hand.
- Accidents: A child falling while holding an adult’s hand.
Symptoms of Nursemaid’s Elbow
- The child starts crying suddenly after their arm is pulled.
- They do not want to move the affected arm.
- The child holds the arm close to their body, with the elbow slightly bent.
- There is little or no swelling, which helps doctors tell it apart from a fracture.
How Is It Diagnosed?
Doctors usually diagnose nursemaid’s elbow based on symptoms and physical examination. X-rays are rarely needed unless a fracture is suspected. Studies show that less than 5% of cases require X-rays (Schunk et al., 1990).
Treatment and Recovery
Doctors use a simple maneuver to put the bone back in place. The most common methods are:
- Supination-flexion method: The doctor turns the forearm and bends the elbow to move the bone back.
- Hyperpronation method: The doctor rotates the forearm forcefully to realign the bone. Research (McDonald et al., 1999) suggests this method works better.
Children usually feel better within 5–10 minutes after treatment and start using their arm normally again.
Can It Happen Again?
Yes, it can. 12–27% of children may experience nursemaid’s elbow again, especially within a year (Illingworth, 1975). To prevent this, caregivers should:
- Avoid pulling or swinging a child by their arms.
- Be careful when helping a child up.
- Educate family members and caregivers on safe handling.
Conclusion
Nursemaid’s elbow is common in young children but is easy to treat. A quick and simple procedure helps the child recover almost immediately. However, since it can happen again, parents and caregivers should be careful when handling young children.
References:
- Schunk, J. E. (1990). “Radial Head Subluxation: A Review of 100 Cases.” Pediatric Emergency Care, 6 (2), 98–100.
- McDonald, J., & Clegg, J. (1999). “Hyperpronation vs. Supination-Flexion for Reduction of Radial Head Subluxation.” Journal of Pediatric Orthopedics, 19 (1), 50–52.
- Illingworth, R. S. (1975). “Recurring Pulled Elbow in Young Children.” British Medical Journal, 4 (1), 796–797.
