Nursemaid’s Elbow in Children: Causes, Symptoms & Treatment Guide
What is Nursemaid’s Elbow?
Nursemaid’s elbow is a common childhood injury that occurs as a result of a forceful tug on a child’s hand, causing a subluxation of one of the bones that makes up the elbow joint.
There are two bones in the forearm: the radius and the ulna. The Head/top of the radius bone sits within part of the ulna and is then held in place by a ligament. Unfortunately, it is NOT that stable of a joint, especially in young children. That is where Nursemaid’s elbow comes in!
Facts & Common Causes of Nursemaid’s Elbow
Nursemaid’s elbow most commonly occurs in children between the ages of 0-4 years old (though it can happen beyond that), and most often when they are NOT actively using their muscles - more on that in just a moment.
Due to the natural instability of the elbow joint in children as their bones, muscles & other supporting structures that act to provide added stability to the joint develop, it unfortunately doesn’t take much force to cause a nursemaid’s elbow injury. *Side note- this is where weight bearing through hands and really working those arm muscles during tummy time and crawling is SO important!
When a child is tugged or pulled by their hand, especially when they are not activating muscles in preparation for that force, that pull can result in the radial head subluxing outside of it’s groove within the ulna. Many years ago, this injury often occurred under the care of ‘nursemaid’s’ caring for a child, which is where the name ‘Nursemaid’s Elbow’ originated.
Unfortunately, once this injury happens, re-injury rates are often very high AND often require much less force to occur.
For more information on common questions about nursemaid’s elbow.
Signs & Symptoms of Nursemaid’s Elbow to Watch For:
(*this is not an all inclusive list- if you have concerns a nursemaid’s elbow has occurred for your child, medical care should be sought!)
**Complaints of wrist pain are very common & can be confusing for parents, as the injury actually occurred at the elbow.
Sudden decrease in use of the injured arm
Crying, signs of pain & discomfort
An audible noise or pop when someone tugs on a child’s hand or arm
There is NOT usually obvious swelling or deformity
Treatment Options & When To Seek Medical Care:
If you suspect nursemaid’s elbow has happened to your child, seeking immediate medical care is required to relocate the radial head. Thankfully, it is a fairly quick & easy procedure with almost instant pain resolution for the child, which is huge!
Though the bone can occasionally relocate on its own, it’s always best to have them thoroughly assessed after the injury occurs to ensure no soft tissue or bony damage has occurred.
For children with repeat occurrences of Nursemaid’s elbow injury, medical providers occasionally teach parents how to relocate the bone on their own, however thorough instruction & demonstration should be provided first.
Preventative Tips To Decrease Risk
One of the best things about Nursemaid’s elbow is that despite how common it can be, it is ALSO often very preventable! A round up & visuals of many of the preventative tips below can be found HERE (link to Tips to reduce nursemaid’s elbow), but let’s talk about it!
Avoid swinging your children by their hands - more on this, including a visual demonstration of passive versus active can be found HERE.
Avoid pulling your child into sitting by their hands - visual demonstration of this can be found HERE.
Use caution when dressing – avoid pulling hands through long sleeves or jacket)
Avoid picking children up by their hands (support under their armpits around their trunk)
Use care when siblings are playing
Use caution when holding onto your children's hands (crossing the street)
Avoid holding hands when learning to walk (if you are holding on to their hands and they fall, the force can cause it to occur)
As an aside, please do not worry about holding your child! There is an immense difference between holding their hand and they are ACTIVELY holding back, versus holding their hand while they are resisting and/or trying to pull their hand away. That is what may contribute to a potential injury, HOWEVER please know, safety is always the top priority and you know your child best! Nursemaid’s elbow is just something to be mindful of, and simple tips to modify everyday activities can make a big difference in avoiding the injury!
Quick Tip! Avoid pulling on hands during dressing- Instead pull/push the CLOTHING, rather than their hand or arm. Added bonus - this encourages them to help push their arm through, which encourages independence in dressing! Same when removing, aim to grab only the clothing when possible. For a visual of this practice, watch my instagram reel here.
What about pulling to sit/chin tuck practice?
Commonly tested at well visits with your pediatrician, this is such a common question in regards to Nursemaid’s elbow risk, so let’s talk about it!
The reality is, I know many amazing clinicians who test for head control & chin tuck by pulling gently from the arms, and I respect them! For me personally, I feel comfortable in assessing the same skill (chin tuck & head control) in a way that does NOT involve using their hands, so that is what I do!
Regardless, the key to safety is that the child has to be actively contracting their muscles. If they are passive and we are pulling on their hands, there is a risk that this injury could occur. As with everything when it comes to your little one, the choice is yours, but hopefully this information helps you make a decision that feels best!
For a full visual on how a child’s muscles are activated during the pull to sit test, how I modify it to avoid hands, and isolates neck muscles more in my opinion - check out this Instagram Reel.
Lastly- let’s address the elephant in the room!
One of the most common questions I get in regards to nursemaid's elbow is- what about swinging by the hands between two adults?! (as shown in this Instagram video)
To avoid being labeled a “fun sucker”, hah!, let me share how I prefer to do a similar activity with my little one, and why!
The crucial part is breaking down PASSIVE versus ACTIVE muscles again.
If you watch the first clip below, the child is PASSIVE. His muscles are not actively contracting to stabilize that joint, and he is essentially hanging by his hands with a relatively strong force used to lift him. This becomes problematic because as mentioned above, the joint involved in nursemaid's elbow is relatively unstable, and even more so when under 4 years of age. Essentially, there isn’t much providing stability to the joint OUTSIDE of muscles being active, so setting up situations where that is able to occur are key! Muscles ACTIVE = MORE stability to the joint and REDUCED risk of a nursemaid’s elbow occurring.
Example of a child being passive.
Now, compare that to the next clip below. See how she is much more ACTIVE? SHE is holding onto OUR hands, rather than us gripping hers, and then SHE is lifting her feet off the ground using her muscles. If she can no longer sustain the position, her feet drop down. It’s a similar idea to a child on monkey bars- if they can’t hold themselves, they drop down!
Example of active involvement from the child.
This idea is similar to a child using monkey bars. While there CAN be a small risk of nursemaid’s elbow occurring during use (especially for children with a history or the injury), because they are ACTIVE while navigating monkey bars, there is much less of a risk of initial injury. For more on common childhood playground injuries & preventative tips, check THIS out!
In general, a child’s muscles being ACTIVE versus PASSIVE greatly reduces the risk of nursemaid's elbow, and is one of the biggest tips I have for you and your little ones!
As a parent myself, I know any injury is scary when it comes to our little ones, and nursemaid’s elbow is no different. BUT - there ARE so many ways to reduce risk of occurrence, which is huge for prevention & keeping our kiddo’s injury free!
Knowledge is power, and I hope this blog helped you feel just that!
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