You may have been swinging your daughter by her wrists, or yanking your son out of oncoming traffic when, with a sudden jerk, his or her arm goes limp. It’s “Nursemaid’s Elbow” or radial head subluxation, and the fact that it’s an incredibly common childhood injury with no known long-term consequences doesn’t make it any less terrifying when it happens to your kid (or, hell, your kid’s buddy). There’s seldom any obvious sign of injury, or even much pain. But a child will resist using that arm until someone pops that troublesome radial head back into place.
Fatherly spoke with pediatric surgeon Dr. Jennifer Weiss of the American Academy of Orthopedic Surgeons, about the predictable injury—how to fix it, how to avoid it, and what the heck “subluxation” is.
It’s all about the subluxation
Nursemaid’s elbow, contrary to popular belief, is not the same thing as dislocating an elbow. But it’s close. Instead it’s a subluxation, which means that the bone called the radius begins to dislocate from the elbow joint, but doesn’t lose surface contact entirely. “There’s a joint in the elbow, made up of three little bones, and one of the bones called the radius,” Weiss says. “The radius subluxes, or moves around the joint, but it doesn’t dislocate or come out.”
And it’s usually an adult’s fault. Parents swinging or yanking their kids by the wrist seldom realize that the relatively benign, parental gesture can sublux a radius like nothing else. “A kid gets pulled, most commonly because a parent is trying to have fun,” Weiss says. “A parent pulls the child by the wrist or picks them up and throws them around, and then the radius can sublux in the joint.”
Don’t feel bad—it happens a lot
You’d think parents yanking their kids’ radiuses out of line would be a relatively rare phenomenon, but it’ (probably) not. “We don’t have a good sense in a scientific, epidemiological way—we don’t have a study that says it happens to X percent of kids,” Weiss says. “But it’s common. Most people have heard of it, and almost every parent has seen somebody with it.”
And (if you have a strong stomach) you can fix it at home
Fixing nursemaid’s elbow is pretty simple, and safe to do at home as long as you’re certain that there’s no fracture (if there is a fracture, this procedure can make things worse). “There’s a maneuver, where the elbow is bent with the wrist pulling toward the shoulder,” Weiss says. “When you do that, sometimes you’ll hear a pop or a click.” Although it won’t always result in pain relief immediately, that’s usually all it takes. “I will have the child wait in the waiting room after the maneuver,” Weiss says. “Almost always, about 45 minutes later, the child is happy.”
But it takes a doctor’s intuition to diagnose
One of the odd quirks of nursemaid’s elbow is that it is almost never detectable by x-ray or MRI, which means diagnosing the condition has a lot to do with a physician’s intuition and experience. “It’s really a clinical diagnosis,” Weiss says. “In my mind, I want to be sure I’m not missing a break or an infection. So if I know the child has been pulled by his or her wrist, I do the maneuver and give it some time. If it truly doesn’t help, then I move onto x-rays. An infection is far less likely than a break, and that’s something we’d then diagnose by taking labs.”
It’s not the worst injury in the world, but you can prevent it
Despite rumors to the contrary, there’s no evidence that nursemaid’s elbow leads to arthritis or elbow instability, according to Weiss. But just because there’s no long-term damage doesn’t mean a painful injury isn’t worth learning how to avoid. “Do not lift your children by their wrists, and don’t twirl them by the wrist,” Weiss says. As for you and your partner holding your child’s hands and swinging him in the air, Weiss has similarly sober advice: “Don’t do that,” she says.
But Weiss also stresses that, given all of the terrifying parts of parenthood, nursemaid’s elbow is probably not the sort of thing that should keep you up at night.
“I’m always worried if a child is in pain, but we have to choose what we’re going to be anxious about, as parents,” Weiss says. “This is not the one I’d be nervous about.”