Capsule of elbow-joint (distended). Anterior aspect. (Nursemaid's elbow involves the head of radius slipping out from the anular ligament of radius.)
Specialty
Emergency medicine
Symptoms
Unwilling to move the arm[2]
Usual onset
1 to 4 years old[2]
Causes
Sudden pull on an extended arm[2]
Diagnostic method
Based on symptoms, Xrays[2]
Differential diagnosis
Elbow fracture[3]
Treatment
Reduction (forearm into a palms down position with straightening at the elbow)[1][2]
Prognosis
Recovery within minutes of reduction[1]
Frequency
Common[2]
A pulled elbow, also known as nursemaid's elbow or a radial head subluxation,[4] is when the ligament that wraps around the radial head slips off.[1] Often a child will hold their arm against their body with the elbow slightly bent.[1] They will not move the arm as this results in pain.[2] Touching the arm, without moving the elbow, is usually not painful.[1]
A pulled elbow typically results from a sudden pull on an extended arm.[2] This may occur when lifting or swinging a child by the arms.[2] The underlying mechanism involves slippage of the annular ligament off of the head of the radius followed by the ligament getting stuck between the radius and humerus.[1] Diagnosis is often based on symptoms.[2] X-rays may be done to rule out other problems.[2]
Prevention is by avoiding potential causes.[2] Treatment is by reduction.[2] Moving the forearm into a palms down position with straightening at the elbow appears to be more effective than moving it into a palms up position followed by bending at the elbow.[1][4][5] Following a successful reduction the child should return to normal within a few minutes.[1] A pulled elbow is common.[2] It generally occurs in children between the ages of 1 and 4 years old, though it can happen up to 7 years old.[2]
^ abcdefghijklmnop"Nursemaid's Elbow". OrthoInfo - AAOS. February 2014. Retrieved 4 December 2017.
^Cohen-Rosenblum, A; Bielski, RJ (1 June 2016). "Elbow Pain After a Fall: Nursemaid's Elbow or Fracture?". Pediatric Annals. 45 (6): e214–7. doi:10.3928/00904481-20160506-01. PMID 27294496.
^ abKrul, M; van der Wouden, JC; Kruithof, EJ; van Suijlekom-Smit, LW; Koes, BW (28 July 2017). "Manipulative interventions for reducing pulled elbow in young children". The Cochrane Database of Systematic Reviews. 2017 (7): CD007759. doi:10.1002/14651858.CD007759.pub4. PMC 6483272. PMID 28753234.
^Bexkens, R; Washburn, FJ; Eygendaal, D; van den Bekerom, MP; Oh, LS (January 2017). "Effectiveness of reduction maneuvers in the treatment of nursemaid's elbow: A systematic review and meta-analysis". The American Journal of Emergency Medicine. 35 (1): 159–163. doi:10.1016/j.ajem.2016.10.059. PMID 27836316. S2CID 2315716.
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