Nursemaid’s Elbow (Pulled Elbow)
Radial head subluxation — commonly called nursemaid’s elbow or pulled elbow — is one of the most frequent musculoskeletal injuries in children between one and five years of age. It occurs when the radial head slips out from under the annular ligament, which normally holds it in place, following sudden axial traction on the extended, pronated forearm.
Typical mechanisms include swinging or lifting a toddler by the hand or wrist, catching a falling child, or pulling the arm to hurry the child along. The child typically stops using the arm immediately, holding it slightly flexed and pronated at the side, and cries with any attempt at movement. There is usually no visible swelling or deformity.
Despite its alarming presentation, nursemaid’s elbow reduces very easily with a simple clinical manoeuvre (supination-flexion or hyperpronation technique) and usually requires no imaging, no sedation, and no immobilisation. Recovery is immediate once the radial head is relocated — the child typically resumes normal use of the arm within minutes.
True Elbow Dislocation
True dislocation of the elbow — where the radial head and ulna dislocate posterolaterally from the humerus — is less common in young children and becomes more prevalent in adolescents, where the injury pattern begins to resemble that seen in adults. It typically results from a fall on an outstretched hand with the elbow partially flexed.
The presentation is dramatic: significant pain, deformity, and marked swelling of the elbow, with the child refusing any movement. Associated fractures — particularly of the medial epicondyle (in up to 50% of cases) — must be carefully sought on imaging. Neurovascular assessment is essential.
- Plain radiographs in two planes confirm the dislocation and identify associated fractures
- Closed reduction under sedation or general anaesthesia restores normal anatomy
- Post-reduction X-rays confirm joint congruence and exclude osteochondral injury
- A brief period of immobilisation (one to two weeks) is followed by early, supervised mobilisation to prevent stiffness
- Associated fractures may require separate surgical management
Recovery & Prevention of Recurrence
Nursemaid’s elbow carries an excellent prognosis. Some children experience recurrent episodes — parents can be counselled to avoid traction on the arm and, after two or three recurrences, the annular ligament typically matures sufficiently to prevent further episodes. By age five, the condition is rarely seen.
True elbow dislocation in children generally recovers well with appropriate management. Physiotherapy is commenced early to restore motion. Residual stiffness is uncommon in children but is more frequently seen in adolescents, mirroring the adult injury pattern. Long-term instability requiring ligament reconstruction is rare in the paediatric age group.
Discuss Elbow Dislocation
For a personalised assessment and treatment plan, contact Dr. Pirpiris’s rooms at Cabrini Medical Centre, Malvern.
📞 Call 03 9508 9600