Pulled Elbow (Nursemaid’s elbow) – A panic situation

Pulled elbow is a common injury in children under the age of five.  Pulled elbow is usually caused by a sudden pull on the child’s forearm or wrist like lifting the child up by one arm. It can also happen when a child falls. Pulled elbow also called nursemaid's elbow. It is unusual for children over five years old to get a pulled elbow, as their joints are a lot stronger.

Pathoanatomy -

There is strong, flexible band called annular ligament normally holds the radius head in place, but with fall or sudden pull, this ligament can be overstretched and bone partially slips out from underneath the ligament.

Clinical features -

In most cases, children with pulled elbow will cry immediately after the sudden pull, and after that child won't use the injured limb. Affected arm hang will lay by the side.

An X-ray is not necessary for the diagnosis, clear history and observation of the child is needed to make the diagnosis.

Treatment -

Pulled elbow will be reduced on manipulation by your Paediatric Orthopaedic Surgeon. This procedure is painful, but it lasts only for a short moment and radial head popping back into the normal place will be felt. With successful reduction, analgesia is rarely needed. Just observe the child for short period after the manipulation, to see return to the normal activities in the affected limb. If your child is not moving the arm fully by the next day, take them back to the doctor so that their arm can be evaluated again.

Prognosis and counselling -

A pulled elbow usually will not cause any long-term damage to your child if treated promptly and appropriately.

However some children are more prone, for instance in children who have particularly loose joints.

Prevention is better than cure, so make sure you don't pick your child up by the forearms or wrists and lift them up using their armpits instead. Teach others who care for your child, such as grandparents and child care workers, the correct way to pick up your child.