Key points to remember

• A pulled elbow is caused by a sudden yank or pull on a child’s lower arm or wrist; or from a fall.
• It is unusual for children over five to have a pulled elbow.
• Don’t pick your child up by the lower arms or wrists and educate others to do the same. Prevention is the key.

Causes:

A pulled or nursemaid’s elbow (Radial head subluxation) usually occurs in young children. It happens when a young child is pulled or lifted by the hand or wrist while his or her arm is held straight. For example, the bone can pull out of position, or sublux, when you try to lift a child up  by the hand, pull a resistant child’s hand to get him or her to move faster, or hold onto a child’s hands and swing him or her around while playing.

It is often referred to as the most common orthopaedic injury in those under age 2 years

Radial head subluxation most often occurs in young children because the socket of the elbow joint and the supporting ligaments are not fully developed.The head of the radius slips out of the annular ligament,holding it in place. The distal attachment of the annular ligament covering the radial head is weaker in children than in adults, allowing it to be more easily torn.

After age 3, children’s joints and ligaments gradually grow stronger, making radial head subluxation less likely to occur.

It usually occurs between the age when children start walking (around age 1 year) and age 4 years (when they fall more often). The peak age of incidence is around 2 years.

Symptoms:

• Refusal to move the arm. Your child may keep the arm dangling down the side of his or her body. Sometimes the dangling arm turns slightly inward (pronates).
• Crying. Your child may cry from the pain and because he or she feels scared.
• Pain anywhere between the hand and shoulder.

 Although your child heals quickly, he or she has a greater chance of having another radial head subluxation, especially in the first few weeks after being injured.

Prevention:

• Be careful in how you hold or lift your child. When you lift or swing your child, hold him or her under the arms. This includes when you lift your child up onto a higher surface (such as a sidewalk or equipment at a playground).

Use care when walking with your child as you hold his or her hand or lower arm (forearm). If a child pulls back or resists, stop. Don’t pull your child. Wait until he or she is ready to go with you.

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