Pulled elbow

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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W8MD medical weight loss NYC and sleep center NYC

Pulled elbow
Illustration of the elbow joint
Synonyms	Nursemaid's elbow, radial head subluxation
Pronounce	N/A
Specialty	N/A
Symptoms	Pain in the elbow, refusal to use the arm
Complications	None
Onset	Sudden
Duration	Usually resolves with treatment
Types	N/A
Causes	Sudden pull on the extended arm
Risks	Young children, especially under 5 years old
Diagnosis	Clinical examination
Differential diagnosis	Elbow fracture, Elbow dislocation
Prevention	N/A
Treatment	Reduction maneuver
Medication	Analgesics for pain
Prognosis	Excellent with treatment
Frequency	Common in young children
Deaths	N/A

A pulled elbow, also known as nursemaid's elbow, is a common injury among young children, typically under the age of five. It occurs when the radius slips out of its normal position at the elbow joint, specifically at the radiocapitellar joint. This injury is often caused by a sudden pull on the extended arm, such as when a child is lifted or swung by the hands.

Anatomy

The elbow joint is a complex hinge joint formed by the articulation of three bones: the humerus, the ulna, and the radius. The head of the radius is held in place by the annular ligament, which encircles the radial head and attaches to the ulna. In young children, the annular ligament is relatively loose and elastic, making it easier for the radial head to slip out of place.

Causes

Pulled elbow typically occurs when there is a sudden traction force applied to the arm. Common scenarios include:

• Lifting a child by the hands or wrists.
• Swinging a child by the arms.
• A sudden pull on the arm, such as when a child is pulled away from danger.

Symptoms

The primary symptom of a pulled elbow is pain in the affected arm, particularly around the elbow. The child may refuse to use the arm and hold it slightly bent at the elbow, with the forearm pronated (palm facing down). There may be no visible swelling or deformity.

Diagnosis

Diagnosis of a pulled elbow is typically made based on the clinical history and physical examination. The characteristic presentation and mechanism of injury are usually sufficient for diagnosis. X-rays are not typically required unless there is suspicion of a fracture or other injury.

Treatment

The treatment for a pulled elbow involves a simple manual reduction technique to relocate the radial head. This can be performed by a trained healthcare professional and involves: 1. Supination of the forearm (turning the palm up). 2. Flexion of the elbow (bending the elbow). This maneuver is often successful in relieving the pain and restoring normal function almost immediately. After reduction, the child should be able to use the arm normally without pain.

Prevention

To prevent pulled elbow, caregivers should avoid lifting or swinging children by the arms or hands. Instead, they should lift children by holding them under the arms or around the torso.

See also

• Elbow joint
• Radius (bone)
• Annular ligament