Pulled Elbow: Symptoms, Diagnosis, Treatment, and Prevention

How do you fix a pulled elbow?

A pulled elbow, clinically known as a radial head subluxation or Nursemaid's elbow, is an injury where the radius bone slips partially out of its normal alignment at the elbow joint. Fixing it requires a specific, gentle manipulation performed by a trained healthcare professional to correctly reposition the bone.

What is a "Pulled Elbow"?

A pulled elbow occurs when the radius, one of the two forearm bones, partially slips out of the annular ligament that holds it in place at the elbow joint. This ligament normally encircles the head of the radius, allowing it to rotate smoothly. When a sudden pulling force is applied to the arm, especially when the elbow is extended and the forearm pronated (palm down), the radial head can slip through the ligament, causing a temporary entrapment. It is one of the most common orthopedic injuries in young children.

Who is Susceptible?

While possible at any age, a pulled elbow is overwhelmingly common in children between the ages of 1 and 4 years. Their bones and ligaments are still developing, making them more pliable and susceptible to such injuries. Common scenarios leading to a pulled elbow include:

• Pulling a child by the hand or wrist: Often occurs when lifting a child over a curb, swinging them, or pulling them along.
• Catching a falling child by the arm.
• Sudden jerking of the arm during play.
• Rolling over in bed in very young children.

Symptoms of a Pulled Elbow

The onset of symptoms is typically sudden and dramatic. A child with a pulled elbow will usually:

• Refuse to use the affected arm: They may hold it still, often with the elbow slightly bent and the forearm pronated (palm facing down or towards the body), close to the body.
• Experience immediate pain: Though the pain subsides once the arm is still, any attempt to move it will elicit discomfort.
• Show no visible swelling, bruising, or deformity: This is a key characteristic distinguishing it from fractures or other more severe injuries.
• Cry or appear distressed immediately after the injury.

Immediate First Aid and Professional Consultation

If you suspect a pulled elbow, the most important immediate steps are:

• Keep the child calm: Agitation can lead to attempts to move the arm, increasing discomfort.
• Avoid manipulating the arm: Do not try to straighten, bend, or pull on the arm yourself, as this can worsen the injury or cause unnecessary pain.
• Seek professional medical attention promptly: A pulled elbow requires diagnosis and reduction by a physician or other trained healthcare provider.

Medical Diagnosis

Diagnosis of a pulled elbow is primarily clinical, based on the history of the injury (e.g., a pulling mechanism) and the characteristic symptoms.

• Physical Examination: A healthcare provider will observe the child's posture and reluctance to use the arm. They will gently palpate the elbow area.
• X-rays: While a pulled elbow itself does not show on an X-ray (as it's a ligamentous issue), X-rays may be taken to rule out a fracture or other bone injury, especially if the mechanism of injury was severe or atypical, or if there's swelling or deformity.

Treatment Strategies for a Pulled Elbow

The "fix" for a pulled elbow is a simple, quick, and generally effective procedure known as a reduction maneuver. This should only be performed by a trained medical professional.

Reduction Maneuvers

There are two primary techniques used for reduction, both designed to gently guide the radial head back into its proper position within the annular ligament:

1. Supination-Flexion Method:

   • The healthcare provider holds the child's wrist with one hand and places the thumb of the other hand over the radial head at the elbow.
   • The forearm is then slowly and firmly supinated (rotated so the palm faces up).
   • While maintaining supination, the elbow is fully flexed (bent) towards the shoulder.
   • A subtle "click" or "pop" may be felt or heard as the radial head slips back into place.

2. Hyperpronation Method:

   • The healthcare provider holds the child's arm with the elbow flexed to about 90 degrees.
   • The forearm is then hyperpronated (rotated further inward, palm facing down) in one smooth, quick motion.
   • This method is often preferred for its slightly higher success rate on the first attempt and potentially less discomfort.
   • Again, a "click" may indicate successful reduction.

Post-Reduction Care

• Observation: After a successful reduction, the child will typically start using the arm within minutes to 15-30 minutes, often spontaneously reaching for toys or objects. This return to normal function confirms the successful reduction.
• Pain Management: Pain relief is usually not required after reduction, as the pain resolves almost immediately once the bone is back in place.
• Activity Restrictions: No specific activity restrictions are usually needed beyond avoiding re-injury. The child can typically resume normal play once comfortable.

Rehabilitation and Prevention

• No Formal Rehabilitation: Unlike fractures, a pulled elbow generally does not require formal physical therapy or rehabilitation. The joint's stability is immediately restored upon reduction.
• Prevention of Recurrence: Education is key for parents and caregivers. Since children who have had one pulled elbow are at a slightly higher risk of recurrence, it's crucial to:
  • Avoid pulling or yanking a child by their hands or wrists.
  • Lift children by their armpits or around their torso, rather than their arms.
  • Be mindful of sudden jerking movements during play.
  • Educate other caregivers (grandparents, babysitters) about the risk and proper handling techniques.

When to Seek Emergency Care

While a pulled elbow is generally not an emergency, seek immediate medical attention if:

• The child continues to experience severe pain or refuses to use the arm after a reduction attempt.
• There is obvious deformity, swelling, or bruising around the elbow or arm.
• The injury resulted from a significant trauma (e.g., a fall from a height, direct impact).
• There is an open wound near the elbow.

Important Considerations

As an expert in exercise science and kinesiology, it's vital to emphasize that while the mechanism of a pulled elbow is biomechanical, its treatment is purely medical. Self-diagnosis and self-treatment of a pulled elbow are strongly discouraged. Always consult a qualified healthcare professional for proper diagnosis and reduction to ensure the child's safety and optimal recovery. Understanding the anatomy and mechanism helps in prevention, but the "fixing" must be left to medical experts.