Nursemaid's Elbow
By Deanie Barth, MSPT, Physical Therapist
Have you ever been walking down the street with your toddler when he decides it’s a perfect time to throw a temper tantrum? You grasp his hand to pull him along and in defiance and anger he turns his palm down to the ground and tries to pull away from you by sitting down, or worse, lifting his feet in the air? You might respond by pulling even more firmly on his arm in an effort to get him moving before there’s a full-scale tantrum. While pulling harder usually won’t harm your child, once in a while these actions could result in what is known as “Nursemaid’s Elbow”.
Nursemaid’s elbow is a subluxation (incomplete dislocation) of a bone in the elbow (the radius). Children between the ages of 1-3 are most at risk for this injury. At this age, the ligaments are still developing, which is part of the reason babies and toddlers always seem so flexible. There is a small ligament in the elbow (annular ligament) which serves to stabilize the elbow and when a child’s arm is pulled by the hand with the palm turned downward (pronated), this ligament can be easily torn which results in the subluxation of the bone.
After subluxation, a child will usually start crying and hold his elbow bent at 90 degrees against his stomach with the palm turned downward. He may rub his elbow and some swelling or bruising may occur. Even after he stops crying, he will continue to hold his elbow in the protected position and may not be able to turn his palm up or bend and straighten his elbow all the way. If you suspect your child sustained this injury, do not attempt to diagnose it by moving it around – take him to the doctor immediately.
Once a diagnosis is made, the physician will reduce the elbow (pop it back into place) and may choose to sling the elbow. In the first 3-5 weeks following the injury, the elbow is more likely to sublux if pulled on, so it is very important to avoid doing so. Your doctor will most likely instruct you on exercises or refer you to a physical therapist to ensure the return of full range of motion.
To avoid dislocation injuries of the elbow and shoulder of your toddler, refrain from pulling him by the hands with any force. If you need to pick your child up, pick him up from under the armpits. If you choose to swing your child in circles, don’t hold him by the hands, once again, hold under his armpits and you should be able to avoid any unwanted injuries. Except in the case of extreme ligament laxity, risk of subluxation is minimal after the age of 7 when the ligaments have had a chance to fully develop. In the meantime, if you need help with dealing with your child’s tantrums, please refer to a previous article written by our special educator, Gopi Patel, Help! My Child Has Tantrums.
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