Nursemaid’s elbow, also known as radial head subluxation, is a common injury in young children, typically between the ages of one and four. It occurs when the radius bone in the forearm slips out of its normal position at the elbow joint, often as a result of a sudden pull on the child’s arm. Although it can be alarming for parents, this condition is generally easy to treat with a simple procedure known as closed reduction. Understanding the nature of nursemaid’s elbow, the techniques for closed reduction, and post-procedure care is important for parents, caregivers, and healthcare providers to ensure a quick recovery and prevent recurrence.
Understanding Nursemaid’s Elbow
Nursemaid’s elbow happens when the ligament that holds the radius in place becomes stretched or slips, allowing the bone to partially dislocate from the elbow joint. This injury is common in young children because their ligaments are still developing and their joints are more flexible compared to adults. The condition can occur during everyday activities, such as swinging a child by the arms, lifting them abruptly, or when they trip and an adult instinctively pulls their arm to prevent a fall.
Common Causes
- Pulling a child up by the hand or wrist
- Playing games that involve swinging by the arms
- Sudden tug when walking hand-in-hand
- Rolling over awkwardly while sleeping
- Falls with an outstretched arm
Recognizing the Symptoms
The child may suddenly refuse to use the injured arm and will hold it close to their body with the elbow slightly bent. Pain is often present, but the injury may not cause significant swelling or bruising. Parents often notice the problem when their child avoids moving the arm and becomes upset if the arm is touched or rotated. Early recognition of nursemaid’s elbow is essential to prevent unnecessary distress and ensure prompt treatment.
What is Closed Reduction?
Closed reduction is a manual, non-surgical procedure used to restore the normal position of the radius in the elbow joint. The term closed means that the procedure is performed without making any incision or opening the skin. It is performed in a clinical setting by a trained healthcare professional and usually takes only a few seconds to complete. Once the joint is realigned, the child often regains full use of their arm within minutes.
Advantages of Closed Reduction
- Quick and minimally invasive
- Immediate relief of symptoms
- Does not require anesthesia in most cases
- High success rate
- Minimal recovery time
Techniques for Closed Reduction of Nursemaid’s Elbow
There are two primary techniques for performing closed reduction in cases of nursemaid’s elbow the supination-flexion method and the hyperpronation method. Both are safe and effective, and the choice depends on the clinician’s preference and the child’s comfort.
Supination-Flexion Method
This is the traditional approach and involves the following steps
- The child’s elbow is held at a 90-degree angle.
- The forearm is gently turned (supinated) so that the palm faces upward.
- The elbow is then slowly bent (flexed) toward the shoulder.
- A subtle click may be felt as the joint moves back into place.
Hyperpronation Method
This alternative method is often preferred because it may cause less discomfort and has a slightly higher success rate. It involves
- Holding the child’s elbow at about 90 degrees.
- Firmly rotating the forearm inward (pronation) so the palm faces downward.
- The ligament slips back into place, often producing a faint click.
After the Reduction
In most cases, the child begins using the arm again within 5 to 10 minutes after a successful closed reduction. Some children may take up to 30 minutes to regain confidence in moving the arm. It is rare for immobilization to be necessary, but if the injury recurs frequently, a sling or splint may be recommended for short-term protection.
Post-Procedure Care
- Encourage gentle use of the arm to restore normal motion.
- Observe for signs of ongoing pain or swelling, which may indicate a more serious injury.
- Reassure the child to reduce fear and anxiety about using the arm.
- Avoid activities that involve pulling or swinging the child by the arms.
Preventing Nursemaid’s Elbow
While this injury is often accidental, there are preventive measures that parents and caregivers can follow
- Lift young children by supporting them under the arms, not by their hands or wrists.
- Avoid swinging children by the arms during play.
- Be mindful when holding hands to prevent sudden tugs.
- Teach older siblings to handle younger children gently.
When to Seek Medical Attention
Although closed reduction is simple, it should always be performed by a trained healthcare provider to avoid complications. Parents should seek medical attention immediately if
- The child refuses to use the arm after a suspected injury.
- There is swelling, redness, or obvious deformity.
- Pain persists after the reduction attempt.
- The injury is accompanied by other symptoms such as fever or severe bruising.
Possible Complications
Nursemaid’s elbow rarely leads to long-term problems if treated promptly. However, repeated injuries may make the joint more susceptible to future dislocations. Misdiagnosis or improper reduction can result in ongoing pain, limited range of motion, or damage to surrounding tissues. This is why professional evaluation is essential before attempting any treatment.
The closed reduction of nursemaid’s elbow is a straightforward and highly effective procedure that brings rapid relief to children experiencing this common elbow injury. By understanding the signs, causes, and treatment options, parents and caregivers can respond quickly and appropriately when the injury occurs. Preventive measures, combined with prompt professional care, ensure that most children recover fully and return to normal activities within minutes. Awareness and education about nursemaid’s elbow can go a long way in reducing the anxiety and discomfort that often accompany such injuries in young children.