Symptoms and Signs of Nursemaid's Elbow in Children

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 8/6/2021

Doctor's Notes on Nursemaid's Elbow in Children

Nursemaid elbow (radial head subluxation) is a common injury among preschool-aged children in which the normal anatomical alignment of two of the three bones that form the elbow joint is disrupted. It takes very little force to pull the bones of a young child's elbow out of place and nursemaid elbow may occur simply by swinging a young child by the arms or pulling a child's arm while in a hurry. 

Symptoms of nursemaid elbow include

  • crying from pain immediately after the injury,
  • refusal to use the involved arm,
  • holding the arm protected against the body slightly bent with the forearm turned with the thumb toward the body, and
  • supporting the painful arm with the other hand.

Shortly after the acute injury the child will usually calm down and may return to activities but will refuse to use the affected arm. Children old enough to talk may describe pain in the wrist or shoulder in addition to, or in place of, pain in the elbow.

What Is the Treatment for Nursemaid Elbows?

Treatment for nursemaid elbow is done by a manipulating movement of the child’s forearm that relocates the radial head subluxation. 

  • While gently holding the child’s elbow, the forearm is rotated “outward” (called supination) and then the arm is flexed
  • This often causes a “click or pop” that can be heard or felt by the person performing the reduction maneuver
  • Alternatively, the child’s arm can be rotated “inward” (called pronation) and the elbow flexed causing the same “click or pop” sensation
  • Young children are often anxious about moving the extremity, but the reduction maneuver is quick and relatively painless
  • A few moments after the reduction, the child will begin to move the arm normally again

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.