Pulled Elbow vs. Dislocated Elbow: Understanding the Differences, Symptoms, and Treatment

What is the difference between a pulled elbow and a dislocated elbow?

While both a "pulled elbow" and a "dislocated elbow" involve displacement at the elbow joint, they differ significantly in their mechanism, severity, the specific structures involved, and the age groups they typically affect, with a pulled elbow being a minor subluxation common in young children and a dislocated elbow a major traumatic injury affecting any age.

Understanding the Elbow Joint

To appreciate the distinction between these two conditions, it's crucial to understand the basic anatomy of the elbow. The elbow is a hinge joint formed by three bones: the humerus (upper arm bone), and the radius and ulna (forearm bones). These bones are held together by a complex network of ligaments, which provide stability and guide movement. Key ligaments include the medial (ulnar) collateral ligament, lateral (radial) collateral ligament, and the annular ligament, which encircles the head of the radius, holding it against the ulna.

What is a Pulled Elbow (Nursemaid's Elbow)?

A pulled elbow, medically known as Nursemaid's Elbow or radial head subluxation, is a common injury primarily seen in young children.

• Definition: It occurs when the radial head (the top part of the radius bone, near the elbow) partially slips out from under the annular ligament. It is a subluxation, meaning a partial dislocation, rather than a complete separation of the joint.
• Mechanism of Injury: This injury is almost always caused by a sudden pulling force on an outstretched arm. Common scenarios include:
  • Pulling a child up by one hand.
  • Swinging a child by their arms.
  • Catching a child by the hand to prevent a fall.
  • Rolling over awkwardly in bed (less common, but possible in infants).
• Common Demographic: Children typically under the age of 5 or 6 are most susceptible. Their bones and ligaments are still developing and are more pliable, making the annular ligament more easily displaced. It is rare in older children and adults.
• Symptoms:
  • Sudden onset of pain in the elbow or arm.
  • Refusal to use the affected arm.
  • The child often holds the arm slightly bent (flexed) at the elbow and turned inward (pronated), close to their body.
  • Minimal or no visible swelling or deformity.
  • No significant bruising.
  • The child may cry initially but often settles down, though they will continue to avoid using the arm.
• Diagnosis: Diagnosis is typically made clinically based on the history of the injury and the characteristic presentation. X-rays are often not necessary unless there's a concern for a fracture or another injury.
• Treatment: Treatment involves a simple, quick reduction maneuver performed by a healthcare professional. This involves specific movements of the forearm and wrist that guide the radial head back into place. There are two primary techniques:
  • Supination-flexion: Turning the forearm palm up (supination) while flexing the elbow.
  • Hyperpronation: Turning the forearm palm down (hyperpronation).
  • A distinct "click" may be felt or heard as the radial head relocates.
• Prognosis: The prognosis is excellent. Once reduced, the child usually experiences immediate relief and begins using the arm again within minutes to hours. Recurrence is possible, so parents are often advised on prevention strategies.

What is an Elbow Dislocation?

An elbow dislocation is a much more severe injury involving the complete separation of the joint surfaces of the humerus from the radius and ulna.

• Definition: This occurs when the bones of the forearm (radius and ulna) are forcibly displaced from their normal alignment with the humerus. The most common type is a posterior dislocation, where the forearm bones move backward relative to the humerus.
• Mechanism of Injury: Elbow dislocations are typically caused by high-energy trauma. Common mechanisms include:
  • Fall on an outstretched hand (FOOSH): This is the most frequent cause, often with a twisting component.
  • Direct blow to the elbow.
  • Sports injuries: Especially contact sports or activities involving falls (e.g., gymnastics, wrestling, cycling).
• Common Demographic: While possible at any age, elbow dislocations are more common in young adults and athletes due to their active lifestyles and exposure to high-impact activities.
• Symptoms:
  • Severe, immediate pain.
  • Obvious deformity of the elbow joint, often appearing misshapen or "out of place."
  • Significant swelling and bruising rapidly develop.
  • Inability to move the arm at the elbow.
  • Possible numbness or tingling in the hand or forearm if nerves are compressed or stretched.
  • Possible coldness or pallor in the hand if blood vessels are compromised (a medical emergency).
• Diagnosis: Diagnosis is made clinically due to the obvious deformity and confirmed with X-rays. X-rays are crucial to rule out associated fractures (which are common with dislocations) and to assess the extent of the displacement.
• Treatment: An elbow dislocation is a medical emergency requiring prompt attention.
  • Immediate reduction: A healthcare professional (often a physician or orthopedic surgeon) will manually manipulate the bones back into their correct alignment. This is usually done under sedation or anesthesia due to the pain.
  • Immobilization: After reduction, the elbow is typically immobilized in a splint or sling for a period (usually 1-3 weeks) to allow soft tissues to heal.
  • Rehabilitation: Physical therapy is essential to restore range of motion, strength, and stability once the initial healing phase is complete.
  • Surgery: Surgery may be required if there are associated fractures, severe ligamentous damage, or if the dislocation is unstable and cannot be reduced or maintained non-surgically.
• Prognosis: The prognosis varies depending on the severity of the dislocation, the presence of associated injuries (fractures, nerve/vessel damage), and adherence to rehabilitation. Potential complications include long-term stiffness, recurrent instability, or chronic pain.

Key Differences Summarized

When to Seek Medical Attention

Anytime you suspect an elbow injury, especially if there is:

• Obvious deformity
• Severe pain
• Inability to move the joint
• Numbness, tingling, or coldness in the hand or fingers
• Rapid or significant swelling

It is crucial to seek immediate medical evaluation. While a pulled elbow is less severe, it still requires a specific maneuver for reduction. An undiagnosed or improperly treated elbow dislocation can lead to significant long-term complications.

Conclusion

While both "pulled elbow" and "dislocated elbow" refer to a displacement at the elbow joint, they represent vastly different clinical entities. A pulled elbow is a minor, easily treatable subluxation of the radial head common in toddlers, caused by a pulling force. In contrast, an elbow dislocation is a major traumatic injury involving complete joint separation, typically caused by high-energy impact, affecting any age, and requiring urgent medical intervention and extensive rehabilitation. Understanding these distinctions is vital for appropriate diagnosis and management.