Nursemaid Elbow

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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• Nursemaid Elbow Overview
• Nursemaid Elbow Causes
• Nursemaid Elbow Symptoms
• When to Seek Medical Care
• Exams and Tests
• Nursemaid Elbow Treatment
• Self-Care at Home
• Medical Treatment
• Next Steps
• Follow-up
• Prevention
• Outlook
• Synonyms and Keywords
• Authors and Editors

Nursemaid Elbow Overview

Nursemaid elbow is a common injury among preschool-aged children. In fact, review articles cite it as the most common orthopedic injury in children under 2 years of age. Nursemaid elbow refers to a condition (medically called radial head subluxation) in which the normal anatomical alignment of two of the three bones which form the elbow joint is disrupted. Girls are more commonly affected than boys; the left arm is more often injured than the right. This is thought to be secondary to the likelihood of the parent being right-handed (and thus most frequently pulling their child's left hand). The injury can occur innocently from swinging a young child by the arms or pulling a child's arm while in a hurry.

• While nursemaid elbow is usually a temporary condition without permanent consequences, it can be quite frightening to parents who find their child suddenly lacking the ability to use his or her arm.



• The elbow joint involves the two bones of the forearm (radius and ulna) and the bone of the upper arm (humerus, hence the name "funny bone"). The ulna is the bone that is on the side of the forearm that has the baby finger. The radius runs the length of the forearm on the thumb side. The radius forms an individual connection with the capitellum, the far end of the humerus. The relationship between the ulna and the humerus is sturdy. However, the head of the radius requires a tight ligament (the annular ligament) to anchor the radial head into the proper region of the capitellum. If the radial head receives a sudden pull or is subjected to chronic traction, this ligament may partially tear and slip out of position, allowing the radius to lose its proper fitting in the "socket" at the end of the humerus.



• Typically, this type of injury occurs in children 1-4 years of age but has occurred in infants 6-12 months of age as well. The peak incidence is 27 months of age. As children grow, their bones become larger and more defined. In addition, ligaments become stronger and thus provide a better support system. Nursemaid elbow is rarely seen in children older than 6 years of age unless the child is involved in prolonged hanging by the hands or prolonged lifting of heavy objects. (The appellation "nursemaid elbow" stems from this injury occurring when women were forced to carry heavily filled milk buckets for long distances. Currently, airport baggage handlers are those most likely to sustain such an injury.)