injuries and poisoning
Elbow Dislocations
Radial Head Subluxation (Nursemaid's Elbow)
Radial head subluxation is partial separation of the bones in the elbow. The end of one forearm bone (radius) slips out of place at the elbow. Radial head subluxation, which is common among toddlers, can occur when a caregiver pulls a toddler forward or catches a toddler by the wrist. The only sign may be a toddler's refusal to move the injured arm. Doctors suspect radial head subluxation based on the description of how the injury happened, symptoms, and results of a physical examination. Doctors can usually manipulate the bones back in place without making an incision and without needing to use sedatives or pain relievers. This injury typically occurs in toddlers (who are about 2 to 3 years old). In toddlers, the head of the radius (one of the forearm bones) is small enough to slip through the ligaments that hold the elbow in place. The head of the radius can slip through the ligaments when a parent or other caregiver pulls a reluctant toddler forward or catches the toddler by the wrist during a fall—actions many caregivers do not remember. As children grow, the head of the radius enlarges, so that eventually, the head of the radius is too big to easily slip out of place. The elbow may be only mildly tender. Because toddlers usually cannot describe their symptoms, the only sign of this injury may be unwillingness to move the arm. The arm may dangle down by the side of the body, sometimes turning slightly inward. Or toddlers may hold the arm in a bent position against their body. Parents or other caregivers should not try to move the arm. Toddlers may cry when the injury happens but then calm down and continue to act normally except that they do not use the injured arm. A doctor's evaluation If toddlers have symptoms that suggest elbow subluxation, parents or other caregivers should take them to a doctor. If they think the elbow has slipped back into place, the toddler will have full ability to move the elbow normally. If the toddler cannot move the elbow fully, they need to be seen by a doctor. Doctors suspect this injury based on the description of how it happened, symptoms, and results of a physical examination. X-rays do not show the injury and so may not be taken. To prevent elbow subluxation in toddlers, parents and other caregivers should Not suddenly jerk the hand, wrist, or forearm of toddlers Not lift toddlers by one arm, wrist, or hand only Not swing children by their hand or forearm Lift toddlers from under their arms or from both arms Usually maneuvers to put the joint back in place Doctors usually attempt to put the joint back in place (called reduction). Usually, no sedatives or pain relievers are needed. When the bone is slipped back in place, a soft pop or click may be heard. Toddlers may start to move their elbow after about 10 to 20 minutes. If they do not move it, doctors may take x-rays of the elbow. If toddlers move the joint, the joint does not need to be x-rayed or immobilized. If after 24 hours toddlers continue to have pain or if they still cannot use their arm, the joint may not be completely in place or a bone may be fractured. In such cases, toddlers should be seen by a doctor again. With treatment, most toddlers recover completely. However, 20 to 40% of them dislocate their elbow again. 