Nursemaids elbow (subluxation of radial head)

Shoulder | Orthopaedics | Nursemaids elbow (subluxation of radial head) (Disease)


Nursemaid elbow is a common injury among preschool-aged children. Nursemaid elbow refers to a condition (medically called radial head subluxation) in which the normal anatomical alignment of two of the three bones which form the elbow joint is disrupted. Girls are more commonly affected than boys; the left arm is more often injured than the right. This is thought to be secondary to the likelihood of the parent being right-handed (and thus most frequently pulling their childs left hand). The injury can occur innocently from swinging a young child by the arms or pulling a childs arm while in a hurry.

While nursemaid elbow is usually a temporary condition without permanent consequences, it can be quite frightening to parents who find their child suddenly lacking the ability to use his or her arm.

Causes and Risk factors

Nursemaid elbow results from a sudden pulling force applied to the extended arm of the child. Due to the relative strength of the adult in comparison to the weakness of the childs supportive annular ligament, the applied force may not seem strong to the parents and they may not realize an injury has occurred.

Typically, this type of injury occurs in children 1-4 years of age but has occurred in infants 6-12 months of age as well. The peak incidence is 27 months of age. As children grow, their bones become larger and more defined. In addition, ligaments become stronger and thus provide a better support system. Nursemaid elbow is rarely seen in children older than 6 years of age unless the child is involved in prolonged hanging by the hands or prolonged lifting of heavy objects.

Diagnosis and Treatment

The radius is easily relocated without anesthesia or X-rays. Recurrence is common and care must be taken to prevent pulling on the arm that could reproduce the injury. ...