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”, a dislocation of the joint commonly seen in children (more often girls) younger than six years old. A sudden pull on a child’s hand while her arm is in a certain position can cause one of the bones near the elbow to slide out of place. The name nursemaid’s elbow reflects the fact that caretakers may cause the injury while playing with the child or trying to pull the child to safety.
Symptoms of nursemaid’s elbow include swelling, discoloration and tenderness around the elbow. Generally, an immediately conducted physician’s examination usually confirms the diagnosis, but x-rays are sometimes ordered to rule out a fracture. Treatment is simple and effective. The physician gently manipulates the arm to “pop” the bone back in place. 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. If the first episode of this injury is treated immediately, it is probably not necessary to immobilize the joint. However, after the first episode, a child is more vulnerable to recurrences. In these cases, we can help by designing—with your child’s physician—a therapy program to enhance recovery and help prevent subsequent dislocations. A cast on the arm for a period of time allows ligaments to heal fully. To relieve pain and swelling, anti-inflammatory medication may be prescribed. After the cast is removed, gentle exercises, such as squeezing a tennis ball or bending and straightening the elbow, can help strengthen the ligaments around the joint and prevent further slippage. Parents, babysitters and child care providers must be instructed not to pull forcefully on the child’s hand or lift the child by the arms. Children at risk should avoid activities, such as swinging on monkey bars, that stress the joint. In conjunction with your child’s pediatrician, we can work with your child’s natural growth patterns and ensure healthy development and strengthen surrounding ligaments, thus forestalling a recurrence of nursemaid’s elbow. Regaining full range of motion will ensure your child’s return to normal activities without pain and stiffness.