How To Fix Nursemaid’s Elbow

As a parent, it’s only natural to want to lift your child into your arms, swing them around, and enjoy high-spirited playtime. However, the very activities you love to engage in can cause a painful condition known as nursemaid’s elbow. 

Nursemaid’s elbow is a common problem for young children. Though it’s not typically a cause for major concern, it’s not something you can afford to ignore, either. Learn how to recognize nursemaid’s elbow so you can take your child to their doctor when needed and have this condition treated promptly to relieve the pain and discomfort that it will cause.

What Is Nursemaid’s Elbow?

Image via Unsplash by @guillaumedegermain

Nursemaid’s elbow, also known as radial head subluxation or simply a pulled elbow, is a common injury that affects children five and under. Nursemaid’s elbow occurs when the elbow bone, or radius, becomes partially dislocated from the elbow joint or humerus. This is not a full dislocation. Instead, the radius stops just short of coming completely loose from the joint. This is what’s known as subluxation, where the bones are just slightly misaligned. 

Nursemaid’s elbow is most common among children between the ages of one and four, and it is slightly more common among girls than boys. Nursemaid’s elbow is rare at the age of five because the ligaments around the elbow are much stronger by this time. You won’t typically see this injury in anyone age six or older.

What Causes Nursemaid’s Elbow?

Nursemaid’s elbow was so named because it was historically common among children under the care of a nursemaid or nanny. The pulled elbow would occur when the nursemaid pulled insistently on the child’s hand. Today, nursemaid’s elbow is typically caused by exuberant parents. Lifting a child by the arms can easily cause nursemaid’s elbow, as this pulls at the outstretched joint. Swinging a child around by the arms increases the chances of nursemaid’s elbow, which exerts even more force on the joint.

It’s called nursemaid’s elbow because this condition happens when one:

• Pulls the child’s arm through a sleeve.
• Grabs the child’s hand to catch them from a fall.
• Pulls on the child’s hand to encourage them to walk faster.
• Braces oneself from a fall with an outstretched arm.

The easiest way to prevent nursemaid’s elbow is by avoiding roughhousing activities like swinging the child through the air by their hands. When lifting the child, place your hands under their arms and do not lift them by the hands. This will help you to keep from exerting unnecessary force on the weak, developing ligaments that hold the elbow joint in place. 

How Is Nursemaid’s Elbow Diagnosed?

Your child will typically alert you to nursemaid’s elbow by crying or complaining of discomfort and pain. The child will usually hold their arm down or out at the side and resist any movement. The elbow will be bent slightly, as the child won’t be able to extend their arm out fully. You won’t see swelling, bruising, or other signs of injury. You shouldn’t attempt to straighten the arm or force any movement.

Make an appointment with your physician as soon as possible to diagnose nursemaid’s elbow. This is a painful condition, and it can lead to a more serious injury if left untreated, so you should communicate with your doctor that the child needs to be seen quickly.

Most pediatricians can diagnose nursemaid’s elbow clinically by observing the way the child holds the elbow. If you know that the condition occurred just after you were swinging the child, pulling their hand, or lifting them by the arms, it’s important to let your doctor know as this will help in the diagnosis. In some cases, your physician may use an X-ray to rule out a fracture or other more serious injury. Nursemaid’s elbow itself will not show up on any kind of imaging.

What Is the Treatment for Nursemaid’s Elbow?

There is a quick and simple treatment for nursemaid’s elbow, but it’s best to have your child’s doctor perform it. The doctor will gently move the elbow bone and ligament back into place by folding the child’s arm upward so that the wrist pulls toward the shoulder. Though this is a simple procedure that takes only seconds, performing it wrong can cause more serious damage, so parents are discouraged from trying it at home.

Moving the elbow back into place may be painful initially, but the child typically feels better within 45 minutes. If the pain and discomfort are not gone within an hour, your doctor may recommend imaging if this was not performed earlier, or order additional tests to check for other possible diagnoses.

Are There Long-Term Complications From Nursemaid’s Elbow?

A child who has suffered from nursemaid’s elbow once is more likely to experience this type of dislocation again. If you’re dealing with repeated instances of nursemaid’s elbow, you might speak with your doctor about learning to relocate the elbow at home. Your physician can let you know whether an at-home treatment is appropriate for your child based on their age and medical history.

Nursemaid’s elbow should not cause any lifelong complications. By the time your child is six years old, their ligaments should be strong enough to resist this type of dislocation. The worst part of nursemaid’s elbow is the initial pain for the child. Moving more carefully in the future can help you reduce the risk of this dislocation happening again.

Children’s elbow injuries are fairly common, especially in active families or children who love to run, play, and roughhouse. If your child is complaining of pain in the arm or elbow, our team at The Hand and Wrist Institute can help. We offer prompt treatments for nursemaid’s elbow and other conditions like little league elbow and tennis elbow. Never ignore a complaint of ongoing discomfort or an inability to move the arm fully. Contact us today to make an appointment and diagnose any issues your child may be having.

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.