A three-year-old child came into the office with apparent discomfort in her right arm. She had been playing in the back yard and began crying, saying that her right arm hurt. She held it close to her body and would not let Mom touch it.
Upon examination it was determined that she had “nursemaid elbow”. A clearer explanation was an incomplete or partial dislocation (subluxation) of one of the bones in the forearm at the elbow. When this dislocation occurred the surrounding soft tissue became trapped in the joint, leading to pain and decreased motion. It generally occurs in children less than four years of age.
Nursemaid’s elbow occurs when the elbow joint is stretched in a particular way. This stretching can be caused by pulling the child by the hands or wrists, or when she falls on an outstretched hand. The soft tissue stays in the elbow joint until it returns to its normal position, usually through a manipulation by the child’s doctor.
The area around the elbow hurts the child, although it usually is not swollen. She will want to keep her arm close to her chest, with the palm facing inward and the elbow bent. It will hurt her to move the arm to another position.
It is more comfortable to place the child’s elbow in a sling, for support and to ease the pain. Often an x-ray is taken to rule out the possibility of a fracture. If there is no fracture, her elbow will be manipulated until the joint is back in position. Generally, there is a return to normal function soon after the manipulation. Sometimes the continued temporary use of a sling eases the child’s mind.
The best prevention for nursemaid’s elbow is to be careful how a child is lifted and handled. Try to grasp her under the arms or around the body. Try to avoid pulling her by the wrists or hands, and do not swing her by the arms. These precautions will greatly decrease the incidence of nursemaid’s elbow.