3 years old Diya was brought to our hospital in tears. Her father had been swinging her playfully when she suddenly began crying. Initially they thought she was just cranky from hunger or lack of sleep. But when Diya refused to use her arm, they anxiously rushed her to our hospital. Diya’s orthopedic doctor diagnosed her with a nursemaid’s elbow, also called a pulled elbow. Here’s all about nursemaid’s elbow and why you should never swing your child in the air by the arm:

What happens in a Nursemaid’s Elbow?

A bone from the upper arm (called the humerus) joins with two bones from the forearm (called radius and ulna) to form our elbow joint. Elastic bands called ligaments hold the radius bone of the forearm in place. In kids younger than 5 or 6 years, these bands are still weak and lax. This causes the radius bone to easily slip out of place when tugged at. Unlike a complete dislocation, the radius doesn’t entirely lose surface contact with the joint, but it begins to dislocate (medically called subluxation).

How is a Nursemaid’s Elbow caused?

A pulled elbow can occur when you pull on your kid’s hand or lower arm. There are even more chances of the elbow getting pulled if the arm is twisted. The force need not be too severe. It is commonly seen when:

• You lift up your child by the wrist or hand especially when helping him/her up a big step or up the slide.
• You swing your child by the hands.
• Your kid tries to break a fall by reaching out his/her arm and ends up over-extending it in the process.
• You catch/ jerk your kid by the hand to stop a fall or to prevent him from stepping onto something.
• Your infant rolls over onto his / her arm.

Who gets Nursemaid’s Elbow?

Nursemaid’s elbow or pulled elbow is common in ages below 5 or 6 years. Girls are slightly more prone to it than boys. After kids grow, their bones become stronger and so do the tissues that hold these bones in place.

How do you know your child has a pulled elbow?

The most common symptom of a pulled elbow is pain while using the arm. Your child will begin to cry immediately. S/he may refuse to use the arm or prefer the other arm. Kids typically hold their arm by their side in a way that it is bent at the elbow with the palm pressed towards their tummy. One does not typically find swelling or deformity or bruising.

How is a Pulled Elbow treated?

Your doctor will examine your child’s elbow to determine if there is a fracture. An X-Ray may not be required as it is mostly normal. Your doctor will then hold the wrist and elbow and move the arm in a specific way till the elbow pops back in place. This hardly takes a few seconds.

This procedure may be painful for the few seconds that it takes. Most of the times, your child may begin to move his / her arm within ten minutes. Some kids may remember how painful their arm was earlier, and may refuse to use their arm. If this happens, your doctor may advise some medications for the pain. He may ask you to observe the child for the next hour if your kid still refuses to use the arm. Two or three attempts are usually all that is needed. This does not leave any permanent damage. If the pain continues even later, then it may be more than a pulled elbow and your doctor may advise further testing (X Ray or MRI).

Do not attempt to set the pulled elbow yourself. (Even though that YouTube video you saw, said it was an easy procedure!) It can be difficult for a parent to identify if it’s a pulled elbow or a fracture. You may cause further damage if you attempt any of these manoeuvres on a fractured arm.

How can you prevent Nursemaid’s Elbow?

After the age of 5 or 6 years, your child’s bones and ligaments will become strong enough to bear a slight pull. Also, if your kid has had a pulled elbow earlier, he is more likely to have it again. Hence do remember these tips:

• Do not lift your child by his/her hands. Lift your child by placing your hands under both his/her armpits instead.
• Do not hold your kid’s hands to swing them in the air. You can swing your child by holding their upper body close to yours and holding them under their arms.
• Do no jerk your child’s hand. Lift him/her by the waist instead.

Diya’s elbow was reset in the first attempt. Her parents were surprised at how she left the hospital giggling after spending the entire morning howling in pain.

Have you ever had an experience of pulled elbow with your kid? Do let us know in the comments below!

Dr. Mandar Agashe is a Pediatric Orthopedic Surgeon with years of experience with treating pulled elbows, elbow pain and fractures in kids. If you have any queries related to your child’s elbow pain, do get in touch with Dr. Mandar Agashe. Dr. Agashe can be reached via email at contactus@agashehospital.com or via call at 022 42 43 5000 or via facebook at www.facebook.com/agashehospital/