Alternative Names radial head dislocation , radial head subluxation, nursemaid's elbow, pulled elbow.
Definition A dislocated elbow occurs when the head of the radial bone, one of the two bones of the lower arm, is moved out of place at the elbow. The dislocation results in pain and decreased movement of the elbow joint. It occurs most often in children younger than 5 years old.
What are the signs and symptoms of the injury? A child usually will begin to cry right after the injury. He or she will refuse to use the affected arm. The arm may be held up against the belly, with the elbow slightly bent. The child will move the shoulder, but not the elbow. Any movement of the elbow will cause pain.
What are the causes and risks of the injury? Dislocation of the elbow generally occurs in young children when an adult jerks the child's arm by pulling the hand or the wrist. It is often seen after someone lifts a child by one arm up a stair or a curb.
What can be done to prevent the injury? A dislocated elbow can be prevented by educating parents and caregivers. They need to know what causes this injury so it doesn't happen again.
How is the injury recognised? A dislocated elbow is diagnosed by the history of injury and symptoms. A joint x-ray is usually not needed, unless the way the injury occurred is unusual. If there is doubt about the cause of the injury, the doctor may ask questions to see if there is any child abuse.
What are the treatments for the injury? The treatment for a dislocated elbow is to snap it back into place. A doctor can do this by having the child sit in the caregiver's lap. The child should be warned that there may be some discomfort. The child's arm is extended while the palm of the hand is faces up. The arm is then flexed while the doctor is holding the elbow. The doctor can generally feel a click over the radial head.
What are the side effects of the treatments? Sometimes there is slight discomfort after the elbow is snapped back in place. If a dislocated elbow is not treated, it may result in the inability to extend the elbow completely.
What happens after treatment for the injury? The child is usually comfortable after treatment, and has full use of the arm. If there is any discomfort, a sling may be used. If the child is still not using the arm normally, a joint x-ray should be taken to be sure there is not a fracture.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 27/02/2005 Contributors Potential conflict of interest information for reviewers available on request
