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

What is a 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 :

• 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 :

• 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 :

• 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 :

• 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 :

• 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 :

• 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 .

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 :

• 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.