Tag: nursemaid’s elbow

Mother comforting a crying child while embracing her on a sofa

Child Won’t Move Their Arm? It Could Be Nursemaid’s Elbow

On By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment
Photo credit:  http://www.tamilbrahmins.com/share-your-knowledge/14868-nursemaid-s-elbow.html   A parent brought her young child in to see me today and told me that she was holding hands with her and then the child suddenly jerked her hand away and attempted to twirl around in a dance move.  After the little girl yanked her arm away, she cried and didn’t want to move her left arm at all.  This is a common scenario and classic story for what we call nursemaid’s elbow or radial head subluxation (RHS). Nursemaid’s elbow is the most common elbow injury in young children.  It usually affects kids between one and four years of age.  The left arm is more commonly affected than the right. Mechanism:  With sudden traction of the child’s arm with the elbow extended, a portion of a ligament in the elbow slips over one of the elbow bones and gets trapped in this position.  By 5 years old, this ligament becomes thicker and more resistant to being displaced. The typical story is that the wrist was pulled while the child’s palm was pointed down towards the ground.  This is common when the parent or caregiver grabs the child’s arm to prevent them from falling or pulling away.  It can also occur when the child is swung by the forearms during play. Falling onto the elbow, minor trauma, or twisting motion of the arm can also cause radial head subluxation.  Younger children sometimes roll over in bed and this can somehow trap the forearm under the body and result in longitudinal traction. Symptoms:  When the child comes in, I usually hear the story that she’s not using the affected arm. Treatment:  Most of the time after explaining the procedure to the parents, we can treat the displaced ligament by relocating it by putting the child’s arm/elbow through a range of motion technique.  No anesthesia or sedation is required, although the procedure is painful briefly. Complications/Recurrence:  Nursemaid’s elbow can sometimes occur again if the child sustains another injury with the typical mechanism.  There are no long term complications associated with nursemaid’s elbow.  As previously mentioned, the annular ligament strengthens with age and therefore radial head subluxation rarely occurs after age five. The little girl who came into the clinic today is doing great.  The procedure to fix her elbow took a few seconds and after a few minutes she was using her arm again and practicing her dance moves.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Woman cradling her elbow and forearm with her opposite hand at a table

Elbow Pain: Several Common Causes and Treatment Options

On By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment
shutterstock_56557723Pain in the elbow is a common musculoskeletal complaint seen in the urgent care.  It can happen as a result of sports injury or trauma or can be symptoms of underlying infection, gout or bursitis.  Several causes are listed below: Elbow tendinopathy:  This is usually called golf or tennis elbow and is caused when then tendon, or strong band of tissue that connects muscles to bones is injured or inflamed.  The symptoms are pain, swelling and even weakness in the elbow. Olecranon bursitis:  A “bursa” is a small fluid-filled sac that sits near a bone.  Bursitis happens when the bursa gets irritated and swollen and can happen when a joint is moved over and over again in the same way over a short period of time.  It may also happen if the elbow sits on a hard surface or stays in a position that presses on the bursa for a long time. Nerve entrapment: The ulnar, median and radial nerves course in close proximity to the elbow.  Ulnar neuropathy is the most common compression neuropathy and it can cause sensory loss, pain and paresthesias over the ring and small fingers. Osteoarthritis:  Degenerative processes of the elbow are rare because it is non-weight bearing.  When present however osteoarthritis is usually related to prior fractures that involve the joint.  If there is an elbow deformity, we often think about underlying inflammatory arthritis. Radial head fracture:  Fracture of the radial head of the elbow most often occurs when the patient falls on an outstretched hand.  The radial head and neck make up the proximal portion of the radius.  Pain and swelling over the lateral elbow can be a sign of this type of fracture. Elbow dislocation:  Posterior elbow dislocation is the most common dislocation in children younger than 10 years of age and the second most common in adults, after shoulder dislocation.  Posterior elbow dislocations usually occur after a fall or a twisting injury to the elbow. Radial head subluxation (nursemaid’s elbow):  This is a common elbow injury in young children typically between 1-4 years old.  The mechanism of injury is sudden traction on the distal arm with the forearm pronated and the elbow extended.  A portion of the annular ligament of the patient’s elbow slips over the head of the radius and slides into the radiohumeral joint where it becomes trapped and causes pain.   The treatment is generally fairly easy by an experienced healthcare provider and the patient has immediate relief of pain when it is done properly. Gout:  Usually characterized by the sudden onset of severe elbow pain often with redness, swelling and tenderness.  There is no history of trauma.  It is caused from the uric acid crystals that develop in the joint (usually a single joint) and is less common in the elbow than the big toe. Treatment of elbow pain:  Identifying the cause of the patients elbow pain and treating that is the most efficient way to treat the patient’s pain.  Treatment may involve manipulation of the joint, using a shoulder sling and ice, or medication such as anti-inflammatories, and pain relievers, and possibly antibiotics.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.