Radial head dislocation; Pulled elbow; Dislocated elbow - children; Elbow - nursemaid's; Elbow - pulled; Elbow subluxation; Dislocation - elbow - partial; Dislocation - radial head; Elbow pain - nursemaid's elbow
Nursemaid's elbow is a dislocation of a bone in the elbow called the radius. Dislocation means the bone slips out of its normal position.
The injury is also called radial head dislocation.
Nursemaid's elbow is a common condition in young children, especially under age 5. The injury occurs when a child is pulled up too hard by their hand or wrist. It is often seen after someone lifts a child up by one arm. This might occur, for example when trying to lift the child over a curb or high step.
Other ways this injury may happen include:
Once the elbow dislocates, it is likely to do so again, especially in the 3 or 4 weeks after the injury.
Nursemaid's elbow does not usually occur after age 5. By this time, a child's joints and the structures around it are stronger. Also, the child is less likely to be in a situation where this injury might occur. In some cases, the injury can happen in older children or adults, usually with a fracture of the forearm.
When the injury occurs:
The health care provider will examine the child.
The child will be unable to rotate the arm at the elbow. The palm will be up, and the child will have trouble bending (flexing) the elbow all the way.
Sometimes the elbow will slip back into place on its own. Even then, it is best for the child to see a provider.
DO NOT try to straighten the arm or change its position. Apply an ice pack to the elbow. Keep the areas above and below the injured elbow (including the shoulder and wrist) from moving, if possible.
Take the child to your provider's office or an emergency room.
Your provider will fix the dislocation by gently flexing the elbow and rotating the forearm so that the palm faces upward. DO NOT try to do this yourself because you may harm the child.
When nursemaid's elbow returns several times, your provider may teach you how to correct the problem yourself.
If nursemaid's elbow is not treated, the child may be permanently unable to fully move the elbow. With treatment, there is usually no permanent damage.
In some cases, children may have problems that limit movement of the arm.
Call your provider if you suspect your child has a dislocated elbow or refuses to use an arm.
DO NOT lift a child by a single arm, such as from their wrist or hand. Lift from under the arms, from the upper arm, or from both arms.
DO NOT swing children by their hands or forearms. To swing a young child in circles, provide support under their arms and hold their upper body next to yours.
Carrigan RB. The upper limb. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 681.
Deeney VF, Arnold J. Orthopedics. In: Zitelli BJ, McIntire SC, Norwalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 22.BACK TO TOP
Review Date: 10/11/2018
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2020 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.