You are walking hand-in-hand with your four-year-old when a skateboarder comes charging around the corner. You yank your child out of harm’s way, but she instantly howls in pain, clutches her arm and seems unable to bend it.
She may have incurred “nursemaid’s elbow.”
What is Nursemaid’s Elbow?
Nursemaid’s elbow, also known as radial head subluxation, is a dislocation of the joint commonly seen in children under six years old, particularly young girls.
This injury occurs when there is a sudden pull on a child’s hand while her arm is in a specific position, causing the radius bone at the elbow joint to slip partially out of place.
The name “nursemaid’s elbow” originates from incidents where caretakers or babysitters inadvertently cause the injury while playing with the child or trying to pull the child to safety.
Symptoms and Diagnosis
Symptoms of nursemaid’s elbow typically include:
- Pain: Sudden onset of pain around the elbow joint, which may cause the child to hold their arm in a guarded position.
- Limited Movement: Reluctance or inability to bend or rotate the affected arm.
- Tenderness: The elbow area may be tender to touch.
- Visible Signs: Swelling and slight discoloration around the elbow may also be present.
Typically, a physician can diagnose this condition through a thorough physical examination. The doctor will assess the child’s ability to move the arm and check for tenderness and swelling around the elbow.
While generally not needed to diagnose nursemaid’s elbow, x-rays may be conducted to rule out any fractures or other potential injuries.
Preventive Measures
Preventing future episodes of nursemaid’s elbow involves educating caregivers and babysitters about safe handling practices:
- Proper Lifting Techniques: Caregivers should be instructed to avoid forcefully pulling on a child’s hand or lifting the child by the arms. Instead, they should support the child under the armpits or trunk to minimize strain on the elbow joint.
- Activity Modification: Activities that stress the elbow joint, such as swinging on monkey bars, should be restricted for children at risk. Encourage children to participate in activities that are age-appropriate and avoid activities that involve sudden pulling or jerking motions.
Treatment For Nursemaids Elbow
Fortunately, treatment is simple and effective.
Immediate At-Home Treatment Steps
Prompt treatment is essential to alleviate pain and restore normal function:
1. The Gentle Reset
One of the most effective ways to treat nursemaid’s elbow is through a gentle reduction maneuver. Before you attempt anything, it’s important to stay calm—children often pick up on our emotions. Here’s how you can do it:
- Positioning: Sit down and place your child on your lap facing you. Keep them relaxed and distracted if possible (a favorite toy or a cartoon can help).
- Maneuver: With their palm facing up, gently bend their elbow to a 90-degree angle. Then, turn their palm so it’s facing down while maintaining the bend. Finally, slowly straighten their arm out. You may hear a slight click or pop—this is normal and usually indicates the joint has moved back into place.
- Comfort: After the maneuver, reassure your child with calm words and cuddles. They might be a bit wary of using their arm at first, but it should start feeling better soon.
2. Ice and Rest
After resetting the elbow, apply a cold compress or ice pack wrapped in a cloth to reduce swelling and ease any discomfort. Use it for about 15-20 minutes at a time, several times a day, especially within the first 24 hours.
3. Avoiding Recurrence
Once the elbow is back in place, try to prevent it from happening again. Avoid pulling your child up by their hands or swinging them by their arms. Instead, lift them under their armpits to minimize any strain on their elbows.
4. When to Seek Medical Help
While most cases of nursemaid’s elbow can be managed at home, there are times when medical attention is necessary.
If your child continues to experience pain, swelling, or if they resist using their arm, it’s best to consult a healthcare professional. They can rule out any other potential issues and provide further guidance.
Medical Intervention
Seek professional medical help from a healthcare provider experienced in pediatric care. They will perform a technique known as nurse elbow reduction, where the physician gently manipulates the arm to “pop” the bone back in place.
These gentle maneuvers are used to guide the dislocated bone back into its correct position within the elbow joint and the procedure is typically quick and effective, often providing immediate relief to the child.
Although the child may feel some discomfort during the procedure, she will likely feel immediate pain relief and regain full use of her arm in about half an hour.
Additional Treatment
Following the successful reduction of the dislocated bone, additional measures may be recommended to aid recovery and prevent recurrence.
Immobilization:
If the injury is treated promptly during the first episode, immobilization of the joint is usually unnecessary. However, subsequent occurrences or persistent discomfort may require more proactive measures.
In such cases, a physician might recommend a cast on the arm for a period of time to allow ligaments to heal fully. This helps stabilize the joint and allows the ligaments around the elbow to heal properly.
Physical Therapy:
After the cast is removed, gentle exercises under the guidance of a physical therapist can help strengthen the muscles and ligaments around the joint, improve flexibility, and prevent further slippage.
Exercises may include:
- Squeezing a tennis ball
- Bending and straightening the elbow
- Wrist curls
- Gentle range-of-motion exercises
However, after the first episode, a child is more vulnerable to recurrences. In these cases, our physical therapists can help by designing—with your child’s physician—a therapy program to enhance recovery and help prevent subsequent dislocations.
Long-Term Outlook, Management, & Recovery
Nursemaids Elbow Recovery Time
Recovery time for nursemaid’s elbow varies depending on several factors, including the severity of the initial injury and the effectiveness of treatment.
- In general, children typically experience rapid improvement following nurse elbow reduction, with many gaining full use of their arm within minutes to hours after the procedure.
- For those requiring additional measures such as immobilization with a splint or sling, recovery may extend over several days to weeks to allow the ligaments around the elbow joint to heal fully.
- Physical therapy exercises prescribed by healthcare providers can further expedite recovery by enhancing muscle strength and joint flexibility.
Regular follow-up appointments with a healthcare provider are recommended to monitor progress and address any concerns during the recovery phase.
Long-Term Outlook
With proper treatment and preventive measures, children with nursemaid’s elbow can regain full range of motion and return to their normal activities without pain or stiffness.
It’s important to remember that nursemaid elbow recurrence is possible, especially if preventive measures are not followed.
By understanding the comprehensive treatment options available and implementing preventive measures, caregivers can effectively manage nursemaid’s elbow and promote a smooth return to normal activities for their child.
Final Thoughts
If you suspect your child has nursemaid’s elbow or have concerns about their elbow health, it’s crucial to seek medical attention.
In conjunction with your child’s pediatrician, we can work with your child’s natural growth patterns to ensure healthy development and strengthen surrounding ligaments, thus forestalling a recurrence of nursemaid’s elbow.
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The Jackson Clinics is dedicated to empowering your child to regain full range of motion and return to normal activities with comfort and confidence. Take a look at our 18 locations and get started with us today!