Nursemaid’s Elbow: When Child’s Play Ends in Pain

Maybe it happened during a game of “airplane” with Grandpa or when you caught them from a stumble at the park. A child’s developing joint takes very little force to dislocate. If your favorite little one suddenly starts holding a limp arm or flinches at your touch, they might have nursemaid’s elbow.

This type of pediatric elbow injury is common, affecting around 3 to 6% of kids annually. It happens when the annular ligament, which works like a rubber band around the top of the forearm bone (called the radius), slips out of its normal position and gets stuck. The condition is most prevalent in children under five because their developing joints aren’t fully stable. 

While it might sound scary and hard to treat, the good news is that nursemaid’s elbow typically isn’t serious. A pediatric elbow specialist knows how to realign the ligament and fix this injury fast—without too many tears. 

Read on to discover the warning signs of nursemaid’s elbow, learn about effective treatment options, and understand how to protect young kids from this common injury.

Elbow Injuries in Children

What would childhood be without turning cartwheels and playing ninja? Unfortunately, parents can’t prevent every accident. The boniest parts of a child’s body, like an elbow, are the most likely to be injured when kids are being kids.

Though elbow injuries are common in young children, they are often invisible. It might be hard for a child to communicate the problem to a parent because they don’t understand what hurts.

Similarly, elbow injuries can be tough to diagnose correctly in children. They look different than adult elbow injuries. A child’s elbow still has growth plates, and it has a higher proportion of cartilage than a full-grown one. The appearance of the joint changes at different stages of child development, too. These factors complicate detecting an injury on an X-ray.

Naturally, the radial head—the top of the forearm bone that connects to the elbow socket—is smaller than an adult’s, and the ligament holding the bones together is thinner. The delicate structure is easy to knock loose.

What Is Nursemaid’s Elbow?

Milder than a fracture, a nursemaid’s elbow is a type of dislocation caused by a partial tear in the ligament. The damaged ligament allows the radius bone to slip fully out of place. With nursemaid’s elbow, the radius is still connected to the elbow, but it’s not where it should be. 

Nursemaid’s elbow also goes by these names:

• Radial head subluxation
• Elbow subluxation
• Dislocated elbow
• Pulled elbow
• Slipped elbow
• Toddler’s elbow

Causes

Nursemaid’s elbow is caused by a forceful impact on the child’s arm. The force could come from another person or the child’s body weight. The movements most likely to cause a pulled elbow dislocation are: 

• Pulling
• Yanking
• Lifting
• Falling
• Rolling over
• Twisting

Often, the injury occurs innocently and by accident. Children may experience nursemaid’s elbow from one of these activities:

• A stronger child pulling on the arm while playing
• Picking up the child by the arms or hands
• Lifting the child by one arm, as when helping the child over a curb
• Swinging the child by the arms, wrists, or hands
• Breaking a fall with an extended arm
• Rolling over in an unusual way
• Twisting the arm while playing

Learn how you can protect your kids from wrist buckle fractures

Prevention

You can protect your child from a pulled dislocated elbow without outlawing fun—and when you aren’t together. There are actions you and older siblings should avoid, and you can show your child how to play safely, too.

Prevention tips for adults:

• When walking together, communicate with words instead of tugging on their arm to get their attention or make them walk faster
• Be patient when helping a child get dressed
• Carefully guide an arm through a sleeve
• Lift or swing a child with both hands under the arms or around the torso
• Be mindful of curbs and other places that can be tripping hazards because it’s reflexive to break a fall by pulling the arm
• Support them with both hands on their torso on the monkey bars (don’t let their arms bear weight)
• Stay close to a child on the playground to help them break a fall

Prevention tips for children:

• Teach kids not to twist or yank on anyone’s arm
• Encourage older siblings how and why they should be patient with younger children
• Tell kids to use both arms on the monkey bars

Signs & Symptoms of Nursemaid’s Elbow

The first sign of nursemaid’s elbow is usually a child protecting it from movement or contact. There isn’t a visual deformity or accompanying signs of an injury, like bruising or swelling.

Here are other indications:

• The child cannot rotate the arm at the elbow
• Cradling the arm with the elbow slightly bent and the palm facing down
• Trying to keep the limb still
• Resist letting anyone touch it
• The child may or may not complain about pain
• Crying when the arm is touched
• Tenderness at the outside point of the elbow
• Increased pain when the arm is extended and twisted from palm up to palm down
• Age (this injury is most common in younger kids, with an average age of 28.6 months)

What to Do for Nursemaid’s Elbow

You may put an ice pack on the elbow but do not try to put the elbow back in place yourself. You risk causing further damage, like a fracture, as well as worse pain for the child. Instead, see a pediatrician or orthopedic specialist if you notice any of these signs.

Although the elbow might slip back into place on its own, it’s still a good idea to seek medical attention to ensure the dislocation is fully fixed and to discuss rest time and medication. Note that a child is at an increased risk of another dislocation for the first few weeks after treatment.  

If a case of nursemaid’s elbow becomes chronic, the doctor may teach a parent how to reset it at home.

Diagnosing Nursemaid’s Elbow

Be ready to share any details of the incident that caused the pain in an exam room, if known. If the physician suspects the injury is nursemaid’s elbow, they may perform a gentle physical exam to assess the range of motion and feel for tenderness around the joint. 

However, the doctor may want an X-ray to rule out a fracture.

Learn about hand and upper extremity services for kids provided by IHTSC

How It’s Treated

Most cases of nursemaid’s elbow can be fixed on the spot in the exam room. The non-invasive treatment doesn’t require a shot to numb the area. The physician will gently maneuver the child’s elbow back into alignment without causing much if any, pain. 

The two techniques typically used to treat nursemaid’s elbow: 

• Supination technique: rotating the forearm while putting slight pressure on the radial head with a thumb until it moves back into place with a slight “click,” and
• Hyperpronation technique: firmly pronating the forearm (turning it so the palm faces down) while the elbow is bent at 90 degrees, which moves the radial head back into place

FAQs About Nursemaid’s Elbow

How Long Will My Child’s Elbow Be Sore After Treatment?

Pain medication should kick in a few hours after nursemaid’s elbow is treated at a doctor’s office. Follow the doctor’s order for the amount of rest the child needs afterward.

Can Adults Also Dislocate Their Elbows?

Yes, elbows are the second-most common large-joint dislocation in adults, behind shoulders. However, nursemaid’s elbow doesn’t affect adults because their ligaments are stronger. Adults are likelier to dislocate the entire radial head by falling on an outstretched hand or during sports. The risk decreases with age between 19 and 65. 

What Happens If Radial Head Subluxation Goes Untreated?

The longer nursemaid’s elbow goes untreated, the more likely it is to cause complications with the surrounding muscles, blood vessels, and tendons. An untreated case can lead to a permanent disability and leave the child without full use of the elbow.

Benefits of Specialized Care for Kids’ Elbow Injuries

A specialist with experience in pediatric elbow injuries can diagnose and treat a nursemaid’s elbow quickly and with minimal discomfort. Also, you should let an experienced orthopedic reset the bone for the best chance of resolving pain quickly and regaining full use of the elbow.

Trust IHTSC to Provide Expert Care for Your Whole Family 

All of the skilled specialists at Indiana Hand to Shoulder Center can see a pediatric patient with signs of nursemaid’s elbow, as well as the most complex injuries or congenital conditions in children. Many patients turn to us for treatment of rare and complex cases. Our specialists lead the field in Indiana at treating children of all ages with owwies of all shapes and sizes. Trust your little one’s long-term health with our expertise. 

Call (317) 743-3985 to schedule a consultation or request an appointment online.

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Medically reviewed by Kathryn Peck, MD