This week’s guest columnist is Dr. Michelle Taylor, a family practice resident at University Health Center here in Lafayette.
2 year-old Lily was playing around the pool. You go to move her from the edge and grab her hand. She slips in a puddle and her arm gets tugged. She bursts into tears and now keeps her arm at her side and doesn’t move it. Now you’re crying too: “What did I do to my baby? Did I break her arm?”
Thankfully, you didn’t. Lily has what’s called a “Nursemaid’s elbow.” Nursemaid’s elbow is a common injury of early childhood, in infants, toddlers, and preschoolers.
What exactly happens? You have two bones in your forearm, the radius and the ulna. They lie side by side and their upper ends are part of your elbow joint. Those ends are bound together by a ligament, like a rubber band holding two sticks together. In some kids that ligament is weak and the radius end slips out when tugged.
Actions that cause a Nursemaid’s elbow include 1) jerking a child by the wrist. Even something as minor as pulling a child’s arm through a sleeve can cause the radial head to slip. 2) Pulling a child up by the hands. Lifting a child under the armpits is safest. 3) Swinging a child around by the arms. While lots of kids love this, save it for when they are older than 4 years. 4) Falling over. Sometimes if a baby is sitting up and flops over on her side, her arm can be pinned under her so that the radial head clicks out.
How do you know if your child has a Nursemaid’s elbow? First of course, the arm is tugged like above. When it happens, the parents usually feel a pop in the child’s arm, often in the wrist. Since they are holding the wrist, they think that’s where the injury is. However, the pop happens in the elbow and the parent feels the pop transmitted down the child’s radius to the wrist.
The child cries at the time of dislocation, but often settles down and acts fine as long as the elbow doesn’t move. He will walk around with his arm hanging by his side. Only when he forgets and tries to use that elbow will he whimper. There is no swelling.
How do you know if the elbow is broken, not just a Nursemaid’s elbow like above? Let’s change Lily’s story from above. Instead of having her arm tugged, say she was running around the pool, slipped, and fell on her elbow. She cries and cries and doesn’t settle down and the elbow swells. Then it may be cracked.
Sometimes with toddlers, we don’t know how they got hurt. Say Lily was playing in her room with 3 year-old cousin Elliot. You hear a cry and Lily comes running out holding her arm. Did Elliot pull on the arm and cause a nursemaid’s elbow, or did she fall off the bed and break it? Elliot and Lily can’t say- they don’t have the words yet .
Those cases we have to x-ray. Broken elbows are often swollen because the crack in the bone bleeds within the joint, but not always! If we don’t have a clear story that the child’s elbow was only pulled on and not fallen on, a cracked bone is possible. Broken elbows need to be casted so that they will hold still for the month or two it takes for the bone to heal.
However, if it is a nursemaid’s elbow with a clear story of the arm simply being pulled on, no casting or xrays are necessary- the doctor fixes it right away. We have the child sit on mom’s lap, perform a gentle twisting and flexing maneuver, and feel the radius pop back in place. The child cries, but usually settles down and within 5 minutes is using the arm normally.
You are not a bad parent if your child has a nursemaid’s elbow. You can’t know if your child has loose ligaments in the elbows until it happens. Kids who get it may get it again- those ligaments don’t tighten up until age 4 or 5. Remember to avoid tugging your child’s arm or swinging them around. And if that elbow pops out again, bring them in and we’ll pop it right back.