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What’s nursemaid’s elbow?
Q: My brother was swinging my 2-year-old daughter by her hands, and they were having a great time until she started screaming. Her arm looked like it was hanging funny, she couldn’t move it, and she wouldn’t let me touch it. The emergency room doctor who fixed it called it “nursemaid’s elbow.” What is this and how can we prevent it?
A: Gail, “nursemaid’s elbow” is technically known as a subluxation of the head of the radius bone in the elbow, or a minor dislocation of the elbow. This means that the bones in the elbow joint are pulled apart so they’re not meeting properly. As a result, the child has pain at her elbow, the arm appears to hang abnormally and she can’t move her arm and hand properly. Once the doctor has made the diagnosis of nursemaid’s elbow, it is fairly simple to realign the elbow joint bones, what’s known as “reducing” the elbow joint.

This is a common injury in young children. It can happen when a child’s arm is suddenly pulled upward or outward, by swinging her around by the arms or by lifting her up by one hand. Nursemaid’s elbow is more common in children who naturally have looser ligaments in their joints and tend to me more flexible. Sometimes a young child has only one episode of nursemaid’s elbow. However, if your child has had one episode, it is more likely to happen again. Try to prevent it from happening again by being careful not to swing or lift your daughter by her hands. Instead, lift her by grabbing her by the chest and underarms.

Talk with your daughter’s doctor about what you should do if the nursemaid’s elbow happens again. Some doctors will demonstrate how to check the arm and how to do the maneuver to reduce the elbow. Before doing the maneuver, you need to make sure that it is a simple nursemaid’s elbow, not a broken bone. There should be no swelling, redness or deformity of the arm bones.

If it does appear to be nursemaid’s elbow, the basic steps to reduce the elbow are as follows:

1. Support the elbow with one hand. With the other hand, rotate the wrist slowly until the child’s thumb is facing away from the body.

2. Bend the arm at the elbow and move the palm of the child’s hand toward her shoulder. The hand supporting the elbow will feel a click as the bones realign. If the reduction is successful, the child’s elbow will feel better and she will be able to fully move her elbow and hand again, usually within 15 to 30 minutes.

It may take two or three tries to get the elbow back in. If you’re unable to reduce the elbow yourself, have the doctor do it as soon as possible. With repeated nursemaid’s elbow injuries, a sling or cast is sometimes needed to help stabilize the elbow joint.