Nursemaid's elbow, also known as radial head subluxation, is a common injury among young children, typically occurring between the ages of 1 and 4 years old. This injury happens when the ligaments that hold the radius (one of the bones in the forearm) in place at the elbow joint are stretched or pulled out of their normal position. It often occurs when a child's forearm is pulled with a sudden, strong force while the arm is extended and pronated (turned so the palm faces down). Common scenarios include pulling a child up by the hands, swinging a child by the arms, or when a child tries to prevent a fall by reaching out.

Symptoms

The main symptoms of nursemaid's elbow include:

• Immediate pain in the affected arm immediately after the injury.

• Refusal or inability to use the injured arm, often holding it slightly bent at the elbow and close to the body.

• Pain or discomfort when trying to move the elbow, wrist, or hand of the affected arm.

Diagnosis

Diagnosis of nursemaid's elbow is typically based on the history of how the injury occurred and a physical examination. X-rays are not usually necessary unless there is concern about a possible fracture or if the diagnosis is uncertain.

Treatment

The treatment for nursemaid's elbow involves a quick and simple procedure called a reduction, where a healthcare provider manipulates the forearm to slip the head of the radius back into its proper position. This procedure can often be performed without sedation in a healthcare provider's office and usually provides immediate relief from pain. The child is typically able to use their arm normally within a short period after the procedure.

Prevention

Prevention of nursemaid's elbow involves avoiding pulling or swinging children by their arms and educating caregivers on safe ways to hold and play with young children. Teaching children to be cautious when playing and avoiding falls can also help, though it can be challenging due to the spontaneous and active nature of children's play.

Prognosis

The prognosis for nursemaid's elbow is excellent, with most children regaining full use of their arm shortly after the reduction procedure. However, some children may be more prone to repeat episodes, especially if they have experienced nursemaid's elbow before. With growth and strengthening of the ligaments around the elbow, the risk of recurrence decreases, typically ceasing around the age of 5 or 6.