Nursemaid’s Elbow

How does a subluxed elbow occur?

It can happen in several different ways:

• when a child’s straightened arm is pulled suddenly— for example, if an adult yanks a child by the arm to make him or her behave
• when a child is lifted, even playfully, by the arms
• when a child holding hands with her parents suddenly lifts her feet to swing and drops all her weight onto her outstretched arms
• when a child hangs from a climber on a playground

What are the symptoms of a subluxed elbow?

The child will hold the arm close to his or her body, slightly bent at the elbow with the palm of the hand facing down, with the thumb closest to the body. He or she will refuse to use the hand or arm and complain loudly if you try to move it. There is no swelling or redness at this point.

Fixing the subluxed elbow

It is fairly easy to fix a subluxed elbow, and the procedure is called “reduction.” The bones need to be realigned so the ligament will move itself to the proper position. Physicians often teach parents how to do it after it has happened once, because it will probably happen again.

As long as there is no swelling, redness, pain or disfigurement of the forearm, you can perform these steps to fix the elbow:

1. Support the elbow with one hand; with the other hand, rotate the wrist slowly until the child’s thumb is facing away from the body.
2. Bend the arm at the elbow and move the palm of the child’s hand toward his/her shoulder. The hand supporting the elbow will feel a distinct “click.” After this, the joint will feel to the child as if nothing had happened and he or she will have full range of motion in the elbow again.

Slings or splints are not usually required

After fixing the elbow, there is no need for a sling or splint unless reduction has been delayed for more than 12 hours after the injury (in that case, use a sling to immobilize the upper arm while keeping the lower arm horizontal to the floor). Talk to your health care provider if the elbow has had three or more episodes of subluxation, because it may need a cast.