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JAMA Patient Page
February 6, 2018

Nursemaid’s Elbow (Elbow Subluxation)

JAMA. 2018;319(5):515. doi:10.1001/jama.2017.22031

Elbow subluxation is one of the most common pediatric joint injuries in children aged 6 months to 5 years.

Pulling the arm of a child too strongly can make the ligament in the elbow slip. Ligaments are like elastic bands that hold the bones together. In children, these bands are fairly loose and can easily glide off the bone. With age, the ligaments strengthen and children are no longer at risk of this particular injury.

The medical term for this is annular ligament displacement, referring to the elastic band that holds the 2 forearm bones (the radius and the ulna) together at the elbow. When a child’s arm is pulled suddenly, the annular ligament slips over the radius and gets trapped between the bone and the joint. It is important to understand that neither the ligament nor the bone are actually broken; they simply have slipped out of their proper joint position. Elbow subluxation is also called pulled or slipped elbow and was called “nursemaid’s elbow” when a child’s nanny was inadvertently blamed for causing the injury.

Symptoms

The injury occurs when a child’s outstretched arm is pulled suddenly. You may hear or feel a “pop” from the joint. The child may briefly cry or report pain, but the discomfort usually passes fairly quickly. The main ongoing symptom is inability to move the elbow. Children with this injury will typically hold their arm on their lap or close to the body and refuse to use it.

Treatment

A doctor may be able to pull the ligament out of the joint and back over the bone. This maneuver is called reducing the joint and should take only a few seconds. There are several techniques for repositioning the ligament and the bones, so it may take a few tries before the child can use the arm again. Usually, acetaminophen can be used for discomfort. Because there are no broken bones, an x-ray is usually not necessary. Within minutes of the joint being reduced, the child will start using the arm again.

Prevention

  • Avoid pulling a child’s wrists or hands abruptly.

  • Avoid swinging a child by their hands or wrists.

  • If a child pulls you in one direction, do not pull them back toward you.

  • Always lift children up by their armpits and not by their hands or wrists.

Some children’s joints are very loose, and this injury may occur even with gentle traction of the forearm. If the same injury occurs multiple times, a doctor may teach you how to reduce the joint yourself until the child is able to outgrow the condition.

Warning Signs

Elbow subluxation does not typically present with a significant amount of pain. Although children may briefly feel sharp pain at the moment of injury, many do not continue to have clear discomfort by the time they get to the doctor’s office. A great deal of pain, swelling, deformity in the bone, or any cut in the skin could be a sign of a fracture (a broken bone) and should be evaluated with an x-ray. If the doctor is not able to reduce the joint and the x-ray finding is normal, then an elbow splint and an evaluation by an orthopedic specialist might be needed.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Browner EA. Nursemaid’s elbow (annular ligament displacement). Pediatr Rev. 2013;34(8):366-367.

Topic: Childhood Injuries

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