Causes and risk factors
The ligaments that are present in and around the elbow are loose in children. This makes it easy for the elbow to slip out of place. The most common cause of nursemaid’s elbow is a pulling-type of injury. This may happen in the following scenarios: Lifting a child up by the hands or wrists, pulling a child’s arm through a jacket sleeve, catching a child by the hand to stop a fall, swinging a child by the arms or hands, pulling a child’s arm to make him or her walk faster, a child braces himself by his hand during a fall, rolling over of an infant onto his arm.
Clinical presentation
When the injury occurs, the child usually begins crying right away and refuses to use the arm because of elbow pain. The child is anxious. Arm hangs straight down on the side of the body, the forearm is usually flexed 15-20 degrees at the elbow, and the forearm is partially pronated. The child may hold the arm slightly bent [flexed] at the elbow and pressed up against the belly [abdominal] area. The child will not use the affected arm. Tenderness may be present at the head of the radius.
Investigations
Medical history by the patient and clinical examination by the doctor helps in diagnosis. X-ray of affected arm is required.
Treatment
Nursemaid’s elbow is treated by carrying out a closed reduction, i.e., a maneuver is made which allows the bone to go back into its normal place. This is done by supination of forearm with flexion at elbow joint. Occasionally, pain relieving drugs such as ibuprofen will be prescribed along with a sling for the affected arm. In severe cases, open reduction, i.e., surgery is required.
Complications
Complications such as malunion, permanent dislocation can occur. A nerve or artery can become trapped between the dislocated bones and produce symptoms. Avulsion fracture can occur. There is a higher risk of osteoarthritis in the affected joint in future.
When to Contact a Doctor
One must consult a doctor if the child is crying due to pain and/or refuses to move an arm.
Prevention
Avoiding tugging, pulling, or swinging the child’s arm can prevent the disease.
Systems involved
Musculoskeletal system
Organs involved
Elbow, arms
