Elbow subluxation

Alternative names

Nursemaid's elbow; Pulled elbow; Partial elbow dislocation; Radial head dislocation

Definition

A dislocation means the displacement of a body part (usually a joint) from its normal location. In a radial head dislocation, the forearm slips out of position at the elbow joint.

Considerations

This is a common but easily preventable injury in 1- to 3-year-old children.

Once the elbow dislocates, it is likely to do so again, especially in the three or four weeks following the injury.

Causes

This injury occurs frequently among toddlers. It is caused by a sudden pull on the child's arm or hand. It typically occurs when an adult pulls the child up from the hand, often to prevent a fall, to assist the child up a curb or step, or to hurry the child along. Swinging toddlers from the arms while playing can also cause this injury.

This injury, also commonly called a "nursemaid's elbow" does not usually occur after age 5. By this time, children's joints and ligaments are stronger, and they are less likely to be in a situation where this injury might occur.

Symptoms

• Immediate pain anywhere between the hand and the elbow
  
• Persistent crying after incident
  
• Inability or refusal to move affected limb (may clutch the arm next to body)
  
• Refusal to play
  
• Palm of hand faces down on the injured arm
  
• Swelling may occur several hours after the injury
  

First Aid

1. Apply an ice pack to the elbow.

2. Splint the injured arm in the position in which you found it. Immobilize the area both above and below the injured joint, including the shoulder and the wrist if possible.

3. Take the child to the doctor's office or emergency room. In some cases of frequently recurring nursemaid's elbow, your physician may teach you how to attempt to relocate the elbow yourself. This is done by supinating (externally rotating) the forearm (in other words, turning the thumb out with palm up), then gently flexing the arm at the elbow (pushing the forearm up into the biceps).

Do Not

• DO NOT Move the child without first splinting the arm.
  
• DO NOT Attempt to straighten the arm or change its position.
  
• DO NOT Make this diagnosis without a clear history of someone pulling on the arm