Pulled Elbow In Children

What is a pulled elbow?

A pulled elbow is an injury when one of the elbow bones slips out of its normal place. It is also called a nursemaid's elbow. The elbow is the joint where the humerus (upper arm bone) meets the radius and ulna (two forearm bones). Normally, the bones are held together and supported by ligaments. In children, these ligaments may still be weak. A forceful stretching of the elbow causes the radius to slip out of the ligament that supports it. This causes the ligament to slide over the tip of the bone and become trapped inside the joint. A pulled elbow is the most common injury of the upper limb in children under six years old.

What causes a pulled elbow?

A sudden pull, yank, or jerk of your child's arm may lead to a pulled elbow. This commonly occurs when your child's arm is outstretched and turned in an inward direction. A pulled elbow may be caused by any of the following:

  • Child abuse.

  • Dragging your child by the hand.

  • Grabbing your child's arm to keep him from falling.

  • Lifting your child up by the hand, wrist, or forearm.

  • Swinging your child by the hands or forearms.

What are the signs and symptoms of a pulled elbow?

Your child will have pain in the injured elbow and may cry right after his arm was pulled. The arm is usually kept slightly bent with the forearm facing down. Your child may have a hard time moving his elbow or arm, or may refuse to use it. The elbow may look normal, without swelling or deformity.

How is a pulled elbow diagnosed?

Your child's caregiver will take a detailed history. It is important that he knows how the elbow got injured and how long the injury has been present. It is also important to inform your child's caregiver if other procedures have been tried to treat your child's elbow problem. Your child may also have the following:

  • Physical exam: Your child's caregiver will carefully check your child's arm, from the wrist up to the shoulder. He will check for signs of broken bones, open wound, or other problems. How well your child moves and feels things on his shoulder, arm, and hand may be tested. This may be done on both the injured and normal elbow.

  • X-ray: This is a picture of the bones and tissues in your child's elbow. X-rays of the elbow and arm may be done to check for broken bones or other problems. Several pictures of your child's bones may be taken. X-rays of both your child's injured and uninjured elbows may be needed.

How is a pulled elbow treated?

Treatment of pulled elbow is to release the trapped ligament and return the bone to its normal position. Your child's caregiver will move your child's arm in different directions. A click may be heard or felt once the bone returns to its place. If treatment fails or was delayed for more than 12 hours, your child may need to wear a splint. A sling may be needed if your child's pulled elbow happens again. Treatment outcome may be affected by the time that passed since your child's elbow was injured. Recovery of normal range of motion may take longer if the injury has been present for a long time.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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