Pediatrics, Nursemaid Elbow Clinical Presentation

  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Dec 7, 2010
 

History

Patient history usually leads to a presumptive diagnosis.

Parents often give a history of a young child with no history of trauma who suddenly refuses to use an arm.

A history of axial traction by a pull on the hand or wrist may be elicited but often is not volunteered.

Common scenarios include the following:

  • A toddler held by his or her hand who has the hand pulled as the child and adult lurch in opposite directions.
  • A toddler is pulled by the wrist up and over an obstacle.
  • An arm is pulled through the sleeve of a sweater or coat.

The condition is usually unilateral. However, bilateral cases have been reported.

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Physical

Physical examination commonly reveals an anxious child who is protective of the affected arm.

In most children, anxiety is greater than pain.

The forearm is usually flexed 15-20 degrees at the elbow, and the forearm is partially pronated.

Often, the weight of the affected arm is supported with the other hand.

Erythema, warmth, edema, or signs of trauma are absent.

Distal circulation, sensation, and motor activity are normal. A reluctance to move digits or the wrist is common, probably from fear of eliciting pain in the elbow.

Tenderness at the head of the radius may be present.

The patient resists supination/pronation as well as flexion/extension of the forearm.

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Causes

Axial traction is the most common cause of nursemaid elbow.

A fall is the second most common mechanism of injury.

Infants have been reported with nursemaid elbow after rolling over or being assisted to roll over.

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Contributor Information and Disclosures
Author

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Devin N Boss, DO  Attending Physician, Department of Emergency Medicine, St John's Clinic

Devin N Boss, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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  14. Ring D, Hannouche D, Jupiter JB. Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow. J Hand Surg [Am]. May 2004;29(3):470-80. [Medline].

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  17. Toupin P, Osmond MH, Correll R, Plint A. Radial head subluxation: how long do children wait in the emergency department before reduction?. CJEM. Sep 2007;9(5):333-7. [Medline].

  18. Van Arsdale WH. On subluxation of the head of the radius in children with a resume of one hundred consecutive cases. Ann Surg. 1889;9:401-23.

 
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