Nursemaid Elbow Clinical Presentation

Updated: Dec 18, 2018
  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Kirsten A Bechtel, MD  more...
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Presentation

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. [9]

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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 held in incomplete extension, and the forearm is partially pronated.

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

Notably, 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, perhaps 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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