Nursemaid Elbow

What is nursemaid elbow?

Nursemaid elbow, or nursemaid’s elbow, is a common injury in children younger than 5. Also called a pulled elbow, it occurs when a pulling motion partially dislocates the tiny radial bone in your child’s elbow joint. Because the joints and ligaments in young children are still growing and are relatively loose, it doesn’t take a lot of force to pull the radial bone out of place. It usually happens when well-meaning adults swing a child around by the arms or yank on their hand to pull them out of the street.

The name “nursemaid elbow” comes from the era when nursemaids or nannies commonly looked after children and were blamed for causing the injury. The medical term is radial head subluxation. Technically, it’s not a fully dislocated elbow. It means that the radial bone has started moving out of its socket and gotten caught between the ligaments — bands of connective tissue in the elbow — just short of popping out.

How common is this condition?

Nursemaid elbow is a common injury that makes up more than 20% of upper arm injuries in children. The condition affects children assigned female at birth (AFAB) slightly more than children assigned male at birth (AMAB). The left arm is more commonly affected than the right arm. The condition returns about 20% of the time.

What causes nursemaid’s elbow?

Nursemaid’s elbow occurs when the ligament that holds your child’s radius in place at their elbow joint slips and the end of their radius shifts out of position, leading to their elbow becoming partially dislocated.

Even a little force can be enough to pull a young child’s elbow joint out of place. Common nursemaid elbow causes include:

• Swinging your child around by the hands or arms.
• Lifting your child up by the hands.
• Pulling your child’s arm through a jacket sleeve.
• Catching your child from falling by the hand.
• Pulling your child suddenly by the hand to avoid danger.

What are the symptoms of nursemaid’s elbow?

If you didn’t witness the injury, nursemaid’s elbow symptoms might not be obvious. Children will cry from the pain at first, but they might not complain much afterward. It won’t cause swelling. Pay attention if your child:

• Cries or expresses pain immediately after being pulled by the arms or hands.
• Has pain in their wrist and/or shoulder.
• Avoids moving or refuses to move their arm below their shoulder.
• Supports one arm with their other hand.
• Holds their arm straight or slightly bent and close to their body.
• Refuses to rotate their palm.

How is nursemaid elbow diagnosed?

Your child’s healthcare provider will perform a physical exam and ask about what happened at the time of injury. The physical exam will test your child’s range of motion and gently feel for tenderness at the elbow. Imaging tests aren’t required and often won’t show evidence of nursemaid elbow. However, an X-ray may rule out a fracture or break.

How do you fix nursemaid elbow?

Treatment is a simple physical maneuver called a reduction of the elbow that moves the radius back into its correct position. It only takes a few seconds. Your child’s healthcare provider will perform the reduction by gently flexing and rotating the arm. You might hear a “pop” as the joint moves back into place, and your child might feel pain, but it shouldn’t last. That's usually all it takes. Occasionally, it might take a couple of attempts.

Can I treat nursemaid elbow at home?

You can apply ice and give your child over-the-counter (OTC) pain medications to manage the pain. Then, seek professional medical attention. The dislocated joint must be corrected by a skilled healthcare provider.

While some adults have attempted to learn the correction maneuver themselves, this isn’t generally advised. Healthcare providers caution that correction isn’t safe until the diagnosis is clear and fractures have been ruled out.

How can I prevent nursemaid elbow?

Take care not to forcefully pull or jerk your child by the arm or hand.

• Use verbal cues instead of physical actions to get your child’s attention.
• Be patient with young children putting their arms through jackets and climbing into car seats.
• Don’t swing your child around by the hands or arms for fun.

How long does it take to recover from nursemaid elbow?

Recovery time begins immediately after a healthcare provider reduces your child’s elbow. Your child might feel pain for a few seconds during the reduction but will begin to feel better right away. Within minutes, they’ll behave as though nothing ever happened.

Can nursemaid elbow come back?

If it’s been successfully corrected, the original injury shouldn’t return. However, a child who had nursemaid elbow once is more likely to have it again. The original injury stretches the ligaments, which makes it harder for them to hold the bone in place. Children who get nursemaid elbow also may have looser ligaments in general. The good news is that as children grow, their bones and ligaments will fit together more tightly. Nursemaid elbow is much less likely to occur after the age of 5.

Is nursemaid elbow an emergency?

Yes. Even if your child doesn’t show obvious signs of pain — children of this age might not be very verbal yet — normal use of their arm will be painful and limited until a healthcare provider corrects their injury. Seek medical attention right away.

Your child’s healthcare provider will want to examine your child to rule out any fractures before attempting to fix their elbow. Attempting to correct a fractured elbow could cause further damage. Once the diagnosis is clear, a trained practitioner can safely correct nursemaid elbow.

Don’t leave nursemaid elbow untreated. While it’s been known to correct itself, it’s not a safe bet. It usually won’t, and if it does, it might not correct itself completely. Your child will still need an examination to make sure the elbow healed well.

Don’t wait and see. Delay can make the injury harder to fix because the misplaced radial bone stretches the ligaments, making them less fit to snap back into place. In the meantime, it’s painful. Failing to correct the elbow could leave your child permanently disabled.

A note from Cleveland Clinic

Nursemaid elbow is very common among young children, whose joints and ligaments are still developing. Many caring adults have accidentally caused the injury through play or other normal activities. Sometimes, adults won’t recognize the injury right away, especially if they weren't present at the time. Pay close attention if you notice your child is guarding their arm and unwilling to use it. If you do suspect the injury, seek medical attention right away. Nursemaid elbow is easily fixed by a trained healthcare provider. Correctly performed, a nursemaid elbow reduction will bring immediate relief.