Pediatric Survival Medicine | Nursemaid’s Elbow

Nursemaid’s elbow is a common pediatric occurrence.  Put simply, it is a dislocation of the radius (the bone that line’s up with the thumb).

nursemaids elbow

Nursemaid’s elbow is very common in children under the age of 4, and most common in boys.  This dislocation occurs when a parent or guardian suddenly grabs the child’s extended arm and pulls them, usually away from danger.  Again, this is a very common injury and not a sign of child abuse.  A common presentation of children with this type of dislocation is that they sit or walk with their affected arm held nearly 90-degrees at the elbow and supported by their unaffected arm.

As in all dislocations, prompt reduction (undoing the dislocation) is the first step for management.  In the case of the nursemaid’s elbow, unless there has been significant trauma and the radial head is also fractured, reduction is the only step.  To reduce a nursemaid’s elbow:

  • First, place your hand over the affected elbow applying firm pressure over the outer upper part of the bend of the arm (the spot over the radial head).
  • Second, fully extend the patient’s arm with their palm down.
  • Third, turn their palm up and (this is important), keeping pressure with your thumb over the radial head, and bend their arm upward toward their shoulder at the elbow.
  • There should be a pop or click that you feel as the radius re-seats itself in the correct position.

This will normally reduce a nursemaid’s elbow on the first attempt.  Second and third attempts should be made if at first unsuccessful.  You will know that the reduction has worked if the patient reports reduced or absent pain and begins to use their arm normally again, usually within minutes.