Nursemaid Elbow

Nursemaid elbow is a common injury among young children. Also called a “pulled elbow,” it's a partial dislocation of the elbow joint caused by pulling on the arm or hand. Nursemaid elbow is an emergency, but it is easily fixed by a trained healthcare provider. The treatment is a simple correction technique called a nursemaid elbow reduction.


What is nursemaid elbow?

Nursemaid elbow is a common injury in children under the age of 5. Also called a “pulled elbow,” it occurs when pulling on the arm partially dislocates the tiny radial bone in the 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’s often caused by well-meaning adults swinging a child around by the arms or yanking on their hand to pull them out of the street.


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Why is it called nursemaid elbow?

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 begun to move out of its socket and got caught between the ligaments — bands of connective tissue in the elbow — just short of popping out. This is an injury that little children are particularly prone to.

Symptoms and Causes

How does nursemaid elbow happen?

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

  • Swinging your child around by the hands.
  • 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 avert danger.

What are the signs and symptoms of nursemaid elbow?

If you didn’t witness the injury, it might not be obvious just looking at it. 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 after being pulled by the arms or hands.
  • Avoids moving their arm below the shoulder.
  • Supports one arm with the other hand.
  • Holds their arm straight or slightly bent and close to the body.
  • Refuses to rotate their palm.

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 the arm will be painful and inhibited until the injury is corrected. Seek medical attention right away.

Your healthcare provider will want to examine your child to rule out any fractures before attempting to fix the 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 has 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 to be examined 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.


Diagnosis and Tests

How is nursemaid elbow diagnosed?

Your 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 be used to rule out a fracture or break.

Management and Treatment

How do you fix nursemaid elbow?

The treatment is a simple physical maneuver called a nursemaid elbow reduction. It only takes a few seconds. Your 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. 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 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 is not 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 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.

Outlook / Prognosis

How long does it take to recover from nursemaid elbow?

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

Can nursemaid elbow come back?

If it has been successfully corrected, the original injury shouldn’t return. However, a child who has had nursemaid elbow once is more prone to have it again. The original injury stretches the ligaments, which makes it harder for them to hold the bone in place. Children who suffer from 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.

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.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 11/18/2021.

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