Dislocation of the elbow, also known as nursemaid’s elbow or radial head subluxation, is a common injury among toddlers and preschoolers. The injury occurs when the elbow has slipped out of its normal place at the joint.
A child's elbow may be dislocated when their arm is pulled or held in tension. In some cases, it happens with very little force. The bones in a child’s limbs are not fully developed and the ligaments, which hold the bones together, are loose. This makes it easier for some bones to slip in and out of place. The risk decreases after the preschool years because children's bones enlarge and harden, and the ligaments tighten.
This type of injury can be confusing because the cause of the child’s distress may or may not be obvious, and it tends to happen at an age when many children are not able to communicate well. While it can occur if the child is lifted by the hands or wrists or when he is swung around, it can also happen when you try to catch the child by the hand to stop a fall, when the child’s arm is pulled through a jacket sleeve, or when he rolls over onto his own arm. In addition, unlike a sprained or broken arm, there is no obvious swelling or bruising.
Symptoms to watch for include:
- He cries out when the arm is moved.
- Your child uses only one arm. The affected arm hangs alongside his body.
- He complains of pain in the elbow, wrist, or shoulder.
Generally, your child’s health care provider can diagnose nursemaid's elbow without x-rays, and she will be able to manipulate the elbow back into place using what’s called a reduction maneuver. It only takes a matter of minutes and in most cases, your child should feel no residual pain, and have full range of motion in the arm. However, because it has been the source of recent pain, your child may be unwilling to use the affected arm right away. And occasionally, a reduction has to be repeated.
Children who have had a dislocated elbow are more likely to have it again.
To avoid this injury:
- Always lift infants and toddlers under the armpits. Pulling a child up by their hands or wrists can put stress on the elbows.
- Avoid swinging a toddler by the hands or wrists. This common action may seem playful but can also put stress on the elbow joint.
- Always be gentle when taking a child by the hand. Jerking an arm when pulling a toddler along or quickly grabbing his or her hand can make the ligament slip.