Summary about Disease
Nursemaid's elbow, also known as radial head subluxation, is a common injury in young children where the radial head (a bone in the forearm) slips out of the annular ligament (a band of tissue that holds the radial head in place). It typically happens when a child's arm is pulled straight and the forearm is twisted.
Symptoms
Child refuses to use the affected arm.
Child holds the arm slightly flexed (bent) at the elbow.
Pain, especially when the arm is moved.
Tenderness around the elbow.
The child may cry or appear distressed when the arm is touched.
Causes
Sudden pull on the arm, such as lifting a child by the hands or wrists.
Swinging a child by the arms.
A fall on an outstretched arm.
Tugging on the arm while dressing or undressing the child.
Medicine Used
Nursemaid's elbow is not typically treated with medication. The primary treatment involves a maneuver to reduce (put back into place) the radial head. Pain relief medication like ibuprofen or acetaminophen may be given after reduction if needed, but are not part of the initial treatment.
Is Communicable
No, nursemaid's elbow is not a communicable disease. It is a mechanical injury.
Precautions
Avoid lifting or swinging children by their hands or forearms.
When lifting a child, support them under their armpits.
Be careful when dressing or undressing a child, avoiding pulling on their arms.
Educate caregivers about the risk of nursemaid's elbow.
How long does an outbreak last?
There is no "outbreak" associated with nursemaid's elbow. It is an acute injury. Once reduced, the pain typically subsides quickly. If untreated, the child will continue to experience pain and limited use of the arm until the radial head is reduced.
How is it diagnosed?
Physical examination: A doctor will examine the child's arm, looking for signs of pain, limited movement, and tenderness around the elbow.
History: The doctor will ask about how the injury occurred.
X-rays are usually not necessary unless there is suspicion of a fracture. The diagnosis is typically clinical, based on the history and physical exam.
Timeline of Symptoms
Immediate: Sudden onset of pain and refusal to use the arm after the injury.
Within minutes to hours: The child will keep the arm still, often slightly bent, and avoid using it. Crying or fussiness is common.
Without reduction: The symptoms will persist until the radial head is reduced.
After reduction: Pain typically resolves quickly (within minutes), and the child will start to use the arm again.
Important Considerations
Nursemaid's elbow is most common in children between the ages of 1 and 4 years.
Recurrence is possible, especially if proper precautions are not taken.
If the radial head cannot be reduced in the office, or if there is suspicion of a fracture, referral to an orthopedic specialist may be necessary.
Even after successful reduction, some children may be hesitant to use the arm immediately. Reassurance and gentle encouragement are helpful.