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Nursemaid Elbow (cont.)

Nursemaid Elbow Treatment

Patient Comments

The doctor will move the bones back into place (the subluxation will be reduced) in this manner:

  • The child will sit on the parent or guardian's lap facing the doctor. While gently feeling the radial head with one hand, the doctor will hold the affected hand and turn it palm upward (causing supination) while fully bending (flexing) at the elbow. Alternatively, the forearm may be fully straightened with the palm inward (pronation). Often a click will be felt by the doctor and rarely may be heard.
  • Your child will probably cry briefly during the procedure. After the reduction, movement will generally be pain free, and the child will quickly revert to using his or her arm as if nothing were ever wrong.
  • If this procedure does not produce the expected results, it may be repeated using the same technique. After several attempts, if the child has not improved, X-rays may be ordered to check for bone fractures. There are many reports of relocating the radial head during the X-ray process due to positioning the elbow by the technologist.
  • If the reduction is not possible in the emergency department, the child may have a temporary splint placed on the arm with close follow-up arranged. This situation may occur more often if the parent has delayed medical attention for the condition and the annular ligament is thus overly stretched. On follow-up examination, the elbow has often reduced itself spontaneously or will be more likely to succeed on reattempt. It is very rare to need an operation to restore the proper elbow anatomy.

Nursemaid Elbow Follow-up

Should initial reduction attempts be unsuccessful and a splint is required, follow-up should be done in 24-48 hours.

  • If the child continues to have any loss of function of the affected arm, bruising, deformities, or other unexpected or unusual findings, a reevaluation is in order.
  • Should your child be experiencing this condition time after time, the doctor may put the arm in a cast to keep it immobile and discuss surgery to "tighten" the annular ligament.

Nursemaid Elbow Prevention

Avoid any sudden jerking to the hand, wrist, or forearm of any small child to prevent this injury. This is even more important in the child who has already experienced a nursemaid elbow. Pick up the child by placing your hands on his or her chest and under the axillae.

Nursemaid Elbow Outlook

The condition poses no long-term problems, but it can happen again easily.

Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery

REFERENCE:

"Radial head subluxation (nursemaid's elbow)"

UpToDate.com


Medically Reviewed by a Doctor on 1/7/2016

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