Nursemaid Elbow (Pediatric)

“I think I broke my kid’s elbow!”
On occasion I’ll meet a distraught parent who was happily swinging junior by the arms one minute, only to have junior whimpering and refusing to use an arm the next. Whether it was happy swinging or an irritated or protective yank, the guilt is immense in either case.

If they arrive in an ER, an X-ray followed by a long nervous wait may be the path. However, that wasn’t the case for a dad who called me this weekend. I was out of town when he called so was unable to come by for a visit. But it seemed like dad had read the textbook on “nursemaids elbows.” I told him as much and suggested he spend some time on Google and Youtube to see if that diagnosis seemed about right before heading to an ER. 15 minutes later I got a call back that he’d actually fixed the elbow himself and junior was back in the game. Neat, right?

Red Flags:

• Direct fall onto arm
• Obvious deformity
• Bruising, swelling around elbow
• Sense of bones crunching inside… “crepitus”
• Concurrent injuries like broken wrist or clavicle
• Can’t move hand or wrist
• Exposed bone (obviously)

Happy Words

• “Kid refuses to use the elbow ever since getting tugged.”
• Previous nursemaid’s elbows

There are a few approaches to the reduction. If the injury is to the right elbow, then I shake the kid’s right hand (gently) with mine. With my left hand I put a thumb on the radial head to feel for a click when I hyperpronate the kid’s right hand. That almost always gets the job done. But I follow with supination and elbow flexion to be sure. Some docs go straight to supination and flexion, but I have a “non-evidence-based” hunch that approach causes a bit more pain. Either work though.

Very few problems in medicine are more enjoyable to fix, because the kids go from whimpering to smiling in minutes.

I’m not sure what the California medical board thinks of me pointing a parent to Youtube. But I do know what that dad thinks! So here it is:

HELP! I Accidentally Dislocated My Daughters Elbow (Nursemaid Elbow) | Dr. Paul and What is nursemaid’s elbow?

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