SpinalColumnBlog

[originally published in KCN, November 2009]

Imagine, if you will, a Hollywoodesque, classic scene of a bygone era when a tantruming, unruly, obstinate toddler is grabbed by the wrist from his stern, fast-walking, nursemaid — who exemplifies the antithesis of Mary Poppins — and is briskly pulled along across the courtyard and up the steps of the manor.  What you probably wouldn’t imagine though is what might happen next:  the child shrieks out in pain and the arm that had been pulled by the nursemaid now hangs motionless.  Too hard to imagine?  Well, it must have happened often enough, because doctors ended up giving it a name: “nursemaid’s elbow.”

Though fun, because of the delicate nature of younger elbows, swinging your child by the arms should be avoided

And while the position of “nursemaid” is largely antiquated nowadays — unless your household also happens to employ a butler, a cook, and a housekeeper — the elbow diagnosis continues to use the “nursemaid” reference.  Seeing as how, even today, this condition has been deemed the most common upper extremity injury in children younger than age 6 seeking help at neighborhood emergency rooms — and is one of the “more common” pediatric pain syndromes presenting in chiropractic offices —  I think it’s clear that yesteryear’s nursemaid has been given a bum rap.

Today, other names, though not as popular as the “nursemaid” moniker, have also been applied to this diagnosis —  from the more modern “babysitter’s elbow” to the blame-shifting “toddler’s elbow.”  You might also see it referred to as “pulled elbow,” “slipped elbow,” or “radial head subluxation.”
The condition is a common mishap that typically affects young children between the ages of 1 to 3.  However, younger and older kids can get it too.  It rarely is seen in children above the age of 6.   Mostly the injury occurs innocently from swinging a young child by the arms or pulling a child’s arm while in a hurry.

Specifically, the ligaments that hold the two bones of the forearm (the radius and ulna) together at the elbow become stretched or torn when the child’s arm is forcibly pulled.  These elastic-like bands are developmentally “looser” in children of this age, and the bones involved are not yet fully formed — making it easier for the bones to slip in and out of place.

In a nursemaid's elbow situation, the annular ligament around the raidal head (left) is torn or stretched when the arm is pulled (middle), causing it to "ride" up into the radiocapitellar joint when the arm is released (right), causing exquisite pain and robbing elbow motion.

When the child’s arm is tugged upon, and the ligaments stretch or tear, a widening of the elbow’s joint space is created causing part of the damaged ligament to slip in.  The result is entrapment of some of the ligamentous fibers between the head of the radius and the adjacent bone.  This “pinching” of the annular ligament can be very painful for some — but the hallmark sign to look for is the child’s inability, or refusal, to use his arm.  Doctors call this “pseudoparalysis.”

Fortunately the injury does not cause long term damage, but can certainly give the parents and child a scare.

It’s important to seek care as soon as possible.  Chiropractors and many medical professionals are trained to maneuver the elbow in such a way that the elbow bones are able to realign, allowing the ligament to return to its normal position.  Most times X-rays are not needed unless the doctor has reason to believe that a fracture might be present as well.

Oftentimes, especially if treatment is initiated soon after the “nursemaid episode,” the elbow will regain full function and relief of pain almost instantaneously.  Depending on the mechanism of injury, chiropractors will also make sure that the neighboring joints of the shoulder, wrist, neck and upper back are also not part of the problem.

It is important to note that children that have had nursemaid’s elbow are at higher risk for it happening again.  But also know that some kids are just more prone to it than others, making it unavoidable.  Fortunately, as kids get older and their elbows grow, the ligaments tighten and the bones harden, and the risk of nursemaid’s elbow diminishes.

Even playful "arm tugging" can bring about a nursemaid's elbow.

Parents, and the caregivers they employ, need to be mindful of the delicate nature of young elbows and avoid jerking, tugging, and pulling children by the arm.  Also, remember — as fun as it is — that swinging a toddler by his arms is something that should be avoided.

If this does happen to your child, stay calm and seek care with your local chiropractor or medical professional as soon as possible.  For they most certainly have the “fix” that will soon have you humming “A Spoonful of Sugar Helps the Elbow Back In” — allowing you, your child, and Mary Poppins to breathe a sigh of relief.

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Here’s a helpful computer animated video from wrongdiagnosis.com that show’s exactly what is happening to the child’s elbow during a “nursemaid’s” situation.

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Source used for this article:

Anrig and Plaugher.  Pediatric Chiropractic. Williams & Wilkins.  1998. pgs. 626-7.

Davies.  Chiropractic pediatrics:  a clinical handbook. Harcourt Publishers Limited.  2000. pg. 207-8.

Fysch.  Nursemaid’s elbow.  Dynamic Chiropractic. 13(16).  1995.  <http://www.chiroweb.com/mpacms/dc/article.php?id=40399>  as seen on 09/15/09.

Macias, et. al.  A Comparison of Supination/Flexion to Hyperpronation in the Reduction of Radial Head Subluxations.  Pediatrics.  102(1) e10.  1998. <http://pediatrics.aappublications.org/cgi/content/full/102/1/e10>  as seen on 09/15/09.

Nursemaid.  Wikipedia.com  <http://en.wikipedia.org/wiki/Nursemaid> as seen on 09/15/09.

Nursemaid’s elbow.  Encyclopedia of Children’s Health.  <http://www.healthofchildren.com/N-O/Nursemaid-s-Elbow.html>  as seen on 09/15/09.

Nursemaid’s elbow.  KidsHealth.org. <http://kidshealth.org/parent/medical/bones/nursemaid.html#> as seen on 09/15/09.

Nursemaid elbow.  WebMD.com.  Children’s Health.  <http://children.webmd.com/nursemaid-elbow>  as seen on 09/15/09.

Nursemaid’s elbow.  Wikipedia.com.  <http://en.wikipedia.org/wiki/Nursemaid’s_elbow> as seen on 09/15/09.

This entry was posted on September 25, 2009 at 6:00 am and is filed under adjustment, children, extremities, subluxation. You can subscribe via RSS 2.0 feed to this post's comments.

Tags: adjustment, Anchor Chiropractic, children, chiropractic, chiropractic adjustment, chiropractor, Dr. Thomas Lamar, elbow, elbow pain, extremity pain, health, kids, Kingston, Kitsap, nurse maid elbow, nursemaid elbow, nursemaid's elbow, pain, pulled elbow, radial head subluxation, slipped elbow, subluxation, toddler, toddler's elbow