Nursemaid's Elbow
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Nursemaid’s Elbow : Cause, Symptoms, Treatment, Exercise

What is a nursemaid’s elbow ?

Nursemaid's Elbow
Nursemaid’s Elbow
  • Nursemaid’s Elbow is a common injury of the early childhood.
  • This injury means the elbow is slipped out of form to normal place at the joint.
  • It is also called = pulled elbow
  • Because in this condition child’s elbow is pulled & also partially dislocates.
  • In The medical term this injury is called = radial head sub luxation.
  • Young child’s bones & muscles are developing this time , so that very little force is pull the bones at the side of the elbow & partially out of the place, this condition make the injury very common.
  • It is happens due to when the ligament slips out of the place & gets to caught between to two bones of the elbow joint.
  • In this injury fell initial pain but it is not to long-term damage
  • Sometimes it is unstuck by to itself.
  • Doctor is easily reset the elbow .
  • So that quickly relieving of discomfort & restoring of the movement of arm
  • Many children are squeal with delight when the swing around or back & forth with the use of arms. But some fun activity is lead to most common injuries .

Who Gets Nursemaid’s Elbow?

  • It is a common injury for the toddlers & preschoolers.
  • It is occurs most often in the children ages of 1 to 4, but it is also happen any time from the birth to age 6 or 7 years.
  • This injury is not common seen in the kids older than 5 or 6 year .
  • Because of that the children is grow , their bones is harden & the ligaments is become tighter and thicker.
  • This is help to keep the elbow firmly in the place.

Anatomy of elbow joint :

Anatomy of elbow joint
Anatomy of elbow joint
  • Elbow joint is joint of three bones:
  • Upper arm bone = humerus
  • Two bones = in forearm = radius& ulna .
  • Radius is in the lateral side [ outside] of the elbow when the ulna is in the medial side [ inside ] of the elbow & also include to olecranon ,which is on the tip of the elbow .
  • The elbow joint is hold together with the help of Muscles, ligaments, and tendons
  • Elbow joint is two type of the joint [ hinge & a pivot ] .
  • Hinge part of the joint is lets to arm bend like as the hinge of the door;
  • Pivot part is allows to the lower arm for twist & rotate.
  • Many muscles, nerves, tendons & connective tissues between muscles and bones are cross to the elbow.
  • This all structure are contribute in stability & function of the elbow .
  • In nursemaid’s elbow involve is radiocapitellar joint

Cause of the Nursemaid’s Elbow :

Cause of the Nursemaid's Elbow
Cause of the Nursemaid’s Elbow
  • It is happen with the just small amount of force .
  • It is occurs when the caregiver hold the child’s by hand or wrist & pull the suddenly on the arm .
  • Jerking of the arm when pulling the child .
  • Most common cause is = pulling-type injury.
  • Catch the child with the help of the hand for stop to fall .
  • Child lifting by the hands or wrists .
  • Pull the child’s arm form to jacket sleeve .
  • Swing the child .
  • Infant is roll over to on the arm

Symptoms of the Nursemaid’s Elbow :

Symptoms of the Nursemaid's Elbow
Symptoms of the Nursemaid’s Elbow
  • Patient feel the pain when moving the injured arm so that the child hold the elbow in affected side & not to try the move the arm.
  • Children is keep the arm in slight bend of elbow or in straight position .
  • This injury did not be seen because this condition does not cause is deformity or swelling.
  • Patient feel severe pain at the side of elbow but no swelling occurs .
  • Child is complain of the elbow hurts
  • Child is cry when the try to touched or moved the arm .
  • Child is hold the affected arm close to affected side and support the elbow with the other arm .
  • Child is start to not use the affected arm and not to move the elbow .

Doctor Examination :

Doctor Examination
Doctor Examination
  • Family physician, pediatrician , or orthopedic surgeon is typically diagnosis of this situation based on the how to injury is occurred & how to manner in which the child holds the arm.
  • In this situation x-ray is not required because in this situation no broken bones.
  • Diagonals is getting form child’s history & do the physiotherapy assignment .
  • Special tests are not needed for diagonals of this condition .
  • X-rays is taken when the child is not move the arm after to reduction.

Medical treatment of the Nursemaid’s Elbow :

  • Doctor is give mostly pain relieving medicine eg. acetaminophen or ibuprofen.
  • Tylenol & Advil, Motrin is also give for pain relief .
  • Never give the aspirin for child under age 12.

Treatment of the Nursemaid’s Elbow :

REDUCTION
REDUCTION
  • Treatment is depends on the child’s age & health.
  • If the swelling or sign of another injury are not present so that the doctor perform the gentle maneuver.
  • In the most of the cases of this situation , the doctor is gently move the bones for back into normal position.
  • This procedure is called the reduction.
  • The child is sit in the parent’s lap .
  • In this treatment doctor is hold the child’s forearm or wrist & turn to hand so the arm faces palm up.
  • When put the pressure near to top of the radius bone with the thumb, and the doctor is slowly bend to elbow.
  • A pop or click sound is heard when the joint is goes back into the place.
  • This procedure is complete only to in few seconds .
  • Child feel the severe pain during this treatment but child quickly feel the better .
  • In some cases require more than one reduction for the successfully fix form injury .
  • After the treatment of the 5 to 10 minutes child may be used to full arm .
  • But the child is not to use the arm because of the fear of pain .
  • If the child feel the any discomfort , doctor is give to sling to the child .
  • In some causes , doctor is give to splint (a partial cast) for protect the arm .
  • After few days of rest doctor check the child .
  • Rarely Surgery is not needed .

Exercise of the Nursemaid’s Elbow :

RICE PRINCIPAL
RICE PRINCIPAL
ultrasound of child's elbow joint
Ultrasound of child’s elbow joint
  • After the reduction give the child ice for pain relief .
  • Apply to RICE principle ,
  • Use of RICE Principle = Rest , ice , compression , elevation
  • In the rest time give to the ball for squeeze to child .
  • Gently move the elbow and forearm by the parents .
  • If the give to splint to the child so give the squeeze the palm .
  • Ultra sound is also give to child for pain relief by therapist .
  • In starting phase do the active movement of the elbow or wrist & squeeze the ball .
  • In this time give to the child to wand for active assisted exercise of elbow .
  • After that start to some passive movement of the elbow movement but in pain free range of motion.
  • Do not apply stretching of elbow and pulled of the elbow.
  • Mostly the Range of motion (ROM) is normal but if the splint is given so that the ROM is may be affected .
  • Main thing is that weakness of the muscle so that the strengthening the muscle is required .
  • In strengthening first of all apply to the manual resistance in the movement of the elbow or wrist .
  • Then use the thera-band and dumbbells for the strengthening of the movement of the elbow or wrist .
  • Also do the movement supination and pro nation .
  • Use the blocks for this movement .
  • Do the some work by the child in which the elbow is bend , such as the drinking water / milk , eat the meal .
  • In the playing time of the children try to open the lock with the key for supination and pro nation .
  • Do the gripping exercise for the child .
  • Use the the ball and gripping strengthening , tip to tip , tip to pad manual griping exercise .
  • In child give to toys for exercise of finger .
  • All the exercise is perform by the therapist with the help of the parents because the child is may be cry during exercise .
  • All the exercise in 10 repetition and 3 times a day .
squeeze the ball
squeeze the ball
strengthening of elbow with theraband

Risk factors of the Nursemaid’s Elbow :

Age

  • Young children’s elbow is more flexible than to adults.
  • So that it is so easier for the dislocated to elbow for the younger children .

Heredity

  • Some people is born with the looser ligaments of the elbow than the other people.

Sports participation

  • Sports-related elbow dislocations is many time
  • Sports are require to weight bearing in the arms like as the floor exercise which is the risky for the elbow dislocations.

Complications of the Nursemaid’s Elbow :

Fracture :

  • The force which is responsible for the dislocates to elbow it is also become to cause of to fracture in the any bones of the elbow .

Pinched nerves

  • In the Rarely case nerves are pinched in this condition .
  • It is the travel to across the elbow it can become to pinched or trapped between to dislocated bones & within the joint when bone is realigned.
  • This nerves is produce numbness in the arm & hand.

Avulsion fractures :

  • In the case of the some elbow dislocation, stretch to ligament is pull off to the tiny bit of the bone from to the attachment point.
  • This type of complication is most common in the children.

Osteoarthritis of Elbow:

  • This dislocate elbow joint is higher risk of the develop to osteoarthritis in future.

Prevention of the Nursemaid’s Elbow :

prevention
prevention
  • It is important to parents to understand that, once the this condition is occurred, it is a recurrence in many time in the childhood. so that some preventive thing is most important for the parents .
  1. To lift a child safely and grasp gently under to the arms.
  2. Do not lift to the children by to the hold by the hands / arms.
  3. Do not swing to child by holding to hands /arms.
  4. to avoid the pulling or tugging in the child’s hands or arms.

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