Nursemaid

Sir Joshua Reynolds - The Children of Edward Holden Cruttenden

Nursemaid's elbow is a common injury among young children and toddlers, typically involving the dislocation of the radial head subluxation. It occurs when a sudden pull on the extended arm of a child leads to the slipping of the radius bone out of its position at the elbow joint. This condition is also known as "pulled elbow" or "toddler's elbow."

Causes

Nursemaid's elbow is most commonly caused by a sudden pulling or tugging motion on a child's arm. This can happen when an adult pulls the child up too quickly by the hands or wrists, when swinging a child by the arms, or when the child falls away while being held by the hand. The ligaments in a child's elbow are still developing and are more elastic, allowing the radius to slip more easily out of place.

Symptoms

The primary symptom of nursemaid's elbow is immediate pain in the affected arm, leading to the child refusing to use the arm. The child may hold the arm slightly bent at the elbow and pressed against their body. Swelling and redness are not common, but the child may experience discomfort when the elbow is moved.

Diagnosis

Diagnosis of nursemaid's elbow is primarily based on the physical examination and the history of the injury. X-rays are not usually necessary unless there is concern about a possible fracture or if the elbow does not improve after treatment.

Treatment

Treatment for nursemaid's elbow involves a healthcare professional performing a gentle maneuver, known as a reduction, to move the radius back into its proper place. This procedure is quick and, although it may cause temporary discomfort, often relieves the pain immediately. After the reduction, most children are able to use their arm normally within a short period. No immobilization is usually necessary, and follow-up visits are only needed if the problem recurs or the child continues to experience pain or limited movement.

Prevention

Preventing nursemaid's elbow involves avoiding lifting or swinging children by their hands or arms. Instead, it is recommended to lift children by placing hands under their armpits or to hold them by their torso.

Epidemiology

Nursemaid's elbow is most common in children between the ages of 1 and 4 years, as their ligaments are more elastic and the bones of the elbow are not fully developed. The condition is less common as children grow older and their joints become stronger and more stable.