Nursemaid's Elbow: Understanding, Professional Reduction, and Prevention

How do you replace nursemaid's elbow?

Replacing a nursemaid's elbow, clinically known as radial head subluxation, is a straightforward and rapid procedure that must be performed by a trained healthcare professional to safely and effectively restore the joint's proper alignment.

What is Nursemaid's Elbow?

Nursemaid's elbow is a common musculoskeletal injury in young children, typically between 1 and 4 years of age, though it can occur up to age 6 or 7. It results from a sudden pull or tug on an extended arm, causing the radial head (the top of the radius bone in the forearm) to partially slip out from under the annular ligament that holds it in place around the humerus bone at the elbow joint. This subluxation causes immediate pain and an inability or refusal to use the affected arm.

Key characteristics include:

• Mechanism: Often occurs when an adult pulls a child up by the hand or wrist, swings them by the arms, or when a child falls awkwardly on an outstretched arm.
• Symptoms: The child will typically hold the arm still, often slightly bent at the elbow and pronated (palm facing down), refusing to use it due to pain. There is usually no visible swelling or deformity.

Why Professional Intervention is Crucial

While the reduction procedure itself is quick, it is absolutely vital that it be performed by a qualified healthcare professional (such as a doctor, physician assistant, or nurse practitioner). Attempting to "pop" the elbow back into place without proper medical training can lead to several risks:

• Misdiagnosis: The symptoms of nursemaid's elbow can mimic other, more serious injuries, such as a fracture, dislocation, or sprain. A healthcare professional can accurately diagnose the condition, often without X-rays, but may order them if there's any doubt or suspicion of another injury.
• Further Injury: Incorrect manipulation can cause additional damage to the joint, ligaments, or surrounding tissues, potentially leading to more pain, prolonged recovery, or even permanent damage.
• Incomplete Reduction: If the radial head is not fully seated, the child will continue to experience pain and dysfunction.

The Reduction Procedure: How Healthcare Professionals Restore the Joint

The goal of reduction is to gently maneuver the radial head back into its proper position under the annular ligament. Healthcare professionals typically employ one of two primary techniques, both of which are highly effective and cause minimal discomfort when performed correctly. The child may experience a brief moment of pain or a "click" as the joint reduces, followed by almost immediate relief.

1. Supination and Flexion Method:

   • The healthcare provider holds the child's arm at the wrist and elbow.
   • The forearm is first supinated (rotated so the palm faces up).
   • While maintaining supination, the elbow is then flexed (bent) fully towards the shoulder.
   • A subtle "click" or "pop" may be felt as the radial head slips back into place.

2. Hyperpronation Method:

   • The healthcare provider supports the child's elbow with one hand.
   • The other hand grasps the child's wrist.
   • The forearm is then hyperpronated (rotated forcefully so the palm faces down, beyond its normal range of motion).
   • This maneuver often causes the radial head to reduce more quickly than the supination-flexion method and is often preferred by many practitioners due to its high success rate and potentially less discomfort.

Following either procedure, the child typically begins to use their arm normally within minutes, indicating successful reduction.

What Happens After Reduction?

Once the elbow is reduced, the child usually experiences immediate relief and quickly regains full use of the arm.

• Immediate Recovery: Most children will start moving their arm and playing as if nothing happened.
• No Immobilization: Unlike a fracture, nursemaid's elbow does not typically require casting or splinting after successful reduction.
• Recurrence: While not common, nursemaid's elbow can recur, especially if the child is prone to it or if similar pulling forces are applied to the arm. Parents will be advised on preventive measures.

When to Seek Medical Attention

If your child suddenly refuses to use an arm, especially after a pulling injury or fall, it's crucial to seek prompt medical attention. Do not attempt to diagnose or treat the condition yourself. Early intervention by a professional ensures a quick and safe resolution.

Important Considerations for Parents and Caregivers

• Prevention is Key: To prevent recurrence or initial injury, avoid lifting or swinging young children by their hands or wrists. Always lift them by the armpits or under their arms.
• Gentle Handling: Be mindful of sudden tugs on a child's arm, especially when they are walking or playing.
• Reassurance: If your child experiences nursemaid's elbow, it can be distressing for both the child and parents. Reassure your child that the doctor will help them feel better quickly. The procedure is brief, and the relief is usually immediate.