Pulled Elbow

Pulled Elbow

(Nursemaid’s Elbow; Radial Head Subluxation; Partially Dislocated Elbow)

Definition

Three bones come together at the elbow. The upper arm has one bone and the lower arm has two bones. A pulled elbow is when one of the lower arm bones slips out of place at the elbow. This problem is common in young children.

The Elbow Joint

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Causes

Ligaments help keep bones in place. These ligaments are loose in young children. Their bones are also not fully formed yet. This makes it easier for the bones to slip out of place.

An pulled elbow is caused by a sudden jerk, tug, or blow to the elbow. It is most likely when the arm is extended and twisted. In children, even a small amount of force may cause the injury.

Risk Factors

This problem is more common in children who are 1 to 6 years of age.

Other things that may raise the risk are:

  • Pulling a child up by the hands
  • Swinging a child by their arms
  • Jerking a child’s arm
  • Falling onto an outstretched arm
  • Rolling over in an awkward way

Children that have had a pulled elbow are more likely to have it happen again.

Symptoms

The main problem is pain at the elbow that happens after pulling or trauma. The child may also refuse to use the arm or keep it close to the side of their body.

Diagnosis

The doctor will ask about your child's symptoms and health history. You will be asked how the injury happened. A physical exam will be done. It will focus on the elbow.

Images are not usually needed, but they may be done with X-rays.

Treatment

The doctor will move the bone back in place. For some children, the pain will go away when the bone is back in place. A child may also be able to easily move their arm within a few minutes.

For other children, it may take a few tries to move the bone back in place. Treatment may also be delayed in younger children with mild pain.

Choices to manage pain are:

  • A sling to keep the elbow in place while it rests
  • Cold compresses
  • Over the counter pain relievers

Prevention

Most pulled elbows are due to accidents. These are hard to prevent. The risk of other pulled elbows may be lowered by:

  • Not jerking or tugging a child’s arm
  • Not swinging a child by their arms or wrists
  • Lifting young children from under their arms

RESOURCES:

Kids Health—Nemours Foundation
http://kidshealth.org/

CANADIAN RESOURCES:

References:

Krul M, van der Wouden JC, et al. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database Syst Rev. 2012 Jan 18;1:CD007759.
Nursemaid’s elbow. Healthy Children—American Academy of Pediatrics website. Available at:
...(Click grey area to select URL)
Accessed February 2, 2021.
Nursemaid’s elbow. Kids Health—Nemours Foundation website. Available at:
...(Click grey area to select URL)
Accessed February 2, 2021.
Radial head subluxation (nursemaid elbow)—emergency management. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/radial-head-subluxation-nursemaid-elbow-emergency-management. Accessed February 2, 2021.
Last reviewed December 2020 by EBSCO Medical Review Board Teresa Briedwell, PT, DPT, OCS, CSCS
Last Updated: 2/2/2021

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