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Help Doc, my kid’s not moving this arm! – Nursemaid’s elbow (radial head subluxation)

Maria BARO, Physical Therapist

Nursemaid’s elbow is the most common cause of elbow injury in children ages 1-4 years. It usually happens when the kid’s forearm, wrist or hand is pulled hard by someone else, and sometimes it happens when the kid rolls on the bed with one arm stuck under the body. For example, Tom is crouching on the ground not willing to move, and his left wrist is pulled by his father to grab him. Following a big cry, Tom’s not moving his left arm because of pain. Another case could be, Jerry‘s right hand is also pulled up strongly by his mum when he misses a step. Following another big cry, Jerry’s not moving his right arm.

What’s going on?

The medical term for Nursemaid’s elbow is radial head subluxation. The tissue holding the elbow joint is not strong enough in younger child. As a result, the ligament will be trapped when the upper limb is pulled hard suddenly, causing pain during elbow movements. The kids will cry for a little while, and presents with a specific posture — the injured arm is kept straight or slightly bent just next to the body. Also the kid will be not willing to move the arm and not grasping objects that he/she used to be interested in.

What should I do?

Avoid forcing the kids to move the injured arm and bringing the kid to a doctor ASAP is recommended. According to the mechanism of the injury, as well as a good physical exam, nursemaid’s elbow can be diagnosed without doing additional tests or exams. But some kids still need an X-ray if a fracture or other dislocation is suspected, or if an initial reduction to fix the injury does not work.

Reduction?

The treatment of nursemaid’s elbow is reduction, a very quick procedure to move the tissue and bones back into place. Usually no pain medication is needed though the kid may feel some pain during the procedure. After reduction, the kid will feel much better 5-10 minutes later.

Any long term problems? How to prevent it happening?

These might be the most frequently asked questions. Nursemaid’s elbow rarely has any long term problems. The ligament usually becomes strong enough to hold the radial head steadily when kids are over 5 years old. To prevent this injury, avoid pulling hard on kids’ arm or lifting them up by the hand, wrist, or forearm. Instead, of lifting a child up, hold him or her by the upper arms or under the arms.

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