A healthy 2-year-old female is brought to the emergency department because she is not using her left arm. The patient was holding her father’s hand while walking when she tripped. To prevent her from falling, her father held onto the patient’s left hand and pulled her up as she tripped. The patient cried immediately and then she calmed. She did not seem to be in pain, but she would not move or use her left arm. She held her left arm close to her side with her elbow slightly bent and her palm turned toward her body (Figure 82-1). Father denies bruising, swelling, fevers, other injury, or recent illnesses. She was diagnosed with nursemaid’s elbow, which was successfully reduced in the emergency department and she regained full use of her arm immediately.
Typical posture of a child with nursemaid’s elbow. Note how the affected left arm is held next to the body with the elbow slightly bent and the forearm pronated. (Used with permission from Paula Sabella, MD.)
Nursemaid’s elbow is a very common injury in preschool aged children. It usually results from a pull to the arm or wrist of a child causing displacement of the annular ligament of the elbow and subluxation of the radial head. This results in pain and refusal to use the arm. The child classically holds the affected elbow close to the body and mildly flexed with pronation of the forearm. The diagnosis is made clinically. The radial head subluxation is usually able to be quickly and easily reduced in the office or emergency department.
Radial head subluxation; temper tantrum elbow; annular ligament displacement; pulled elbow.
Occurs in children aged 6 months to 5 years, with the peak incidence between 2 and 3 years of age.1–4
Left elbow is most commonly affected.2,4
Affects girls more than boys.1,2,4
Etiology and Pathophysiology
The classic mechanism of injury in nursemaid’s elbow involves axial traction to a child’s pronated forearm or upper extremity.2 This usually involves a pulling or tugging motion to the upper extremity.
When the radius is pulled distally, part of the annular ligament shifts proximally over the radial head and becomes caught in the radiohumeral joint (Figure 82-2).2,3 This causes pain and refusal to use the affected arm.
In many cases of nursemaid’s elbow, the typical history of a pulling type of injury is not reported.5
Examples of mechanisms reported in patients with nursemaid’s elbow include:1,2,5
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.