Nursemaid's Elbow: A common injury to babies and young kids

Have you ever heard of this expression? Maybe not. It's not exactly the best name for a condition that affects young children. First of all, nobody has a nursemaid any more (although many of us wish we had one). Secondly, it sounds like the term refers to a problem with your baby's nursemaid, not the baby himself.

Actually, nursemaid's elbow refers to a condition usually seen in young children between one and four years old, and is more common in girls. The condition, known medically as radial head subluxation, peaks at ages two to three years old.

There are two large bones in the lower arm: the radius (leading to the thumb side) and the ulna (which forms the angle of the elbow). Radial head subluxation, which is quite common, occurs when a child's arm is extended out straight and somebody pulls on it. It is called nursemaid's elbow because it is often seen when a child runs into a street or jumps off a curb and someone (in yesteryear, the nursemaid) pulls the child's arm back suddenly. Of course, this can happen in many other situations where a sudden force is applied to a small child's arm. It can even occur in infants if they roll over in an awkward way. Commonly, we see subluxed radial head injuries when a parent or caretaker is roughhousing with a child and whirling them around at arm's length.

The reason we see this almost exclusively in young children is that the injury occurs when a small band of tissue called the annular ligament slips over the radius and wedges itself in the radial/ulnar joint space in the elbow. When a child is over five years, this ligament is thicker and tougher and is unlikely to be as easily displaced.

When this slippage occurs, the child is in pain and will probably refuse to use the arm in question. He may hang the arm against his body, and not want to bend it. Often it is not clear what has happened.   

Your child's physician can reduce or fix this problem by one or two simple maneuvers. She will examine the child's arm first to be sure there are no broken bones or bruises. She may even get an x-ray first. If there are no obvious injuries, the child can sit in a parent's lap while the doctor supinates (turns the arm palm up) and flexes the elbow in a simultaneous, smooth motion. She will stabilize the elbow with one hand and move the arm with his other. She may also hyperpronate the arm (really turn the arm palm down).

During this maneuver you may hear a small pop as the ligament slips out of the joint and back into place, or you may not hear anything. The doctor may also feel a popping sensation.

Once this injury has happened to your child, there is a 27%-39% chance it could happen again. I often show parents how to maneuver the arm to pop the elbow back in place. If they are uncomfortable doing it, they can always come into the office if nursemaid's elbow strikes again. But the better plan is to warn all caretakers not to put too much traction on these vulnerable body parts!

Has this ever happened to your child? Did it occur again? Were you able to reduce it on your own after a demonstration in the office?

Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS. She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons.

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