Toddler TEOTWAWKI--Ye Olde Nursemaid's Elbow

One of my children’s favorite memories is something we called “One, Two, Wheeee.”  When they were in the range of 2-3 years old and we were walking for a distance, and they got tired, this practice would perk them up.  As we were walking with our child between us, my husband and I each took the child’s outstretched hand, and we’d slowly repeat, “One, two, (and then more excitedly), Wheeeee,” and lift and swing our child a few feet.  Lather, rinse, repeat. 

Apparently, it’s a practice we should have avoided due to the risk for developing nursemaid’s elbow.  This condition is not mentioned in any off-grid medicine books or websites (not any that I’ve been able to find, at any rate).  And yet, it is the most common elbow injury in young children.[1] 

So what exactly is nursemaid’s elbow, how does it happen, and how is it managed when there is no doctor?

Technically referred to as radial head subluxation, nursemaid’s elbow occurs when a portion of a ligament slips over one of the elbow bones and gets trapped in that position.  It can be self-inflicted (like when a child rolls over in bed), it can happen during play (like I described above), or it can happen when a parent grabs a child’s hand to prevent him from falling or running away.  It may also occur as a result of a fall or other minor injury or twisting motion.[2]

Nursemaid’s elbow most commonly affects the left elbow.  It generally occurs between the ages of 1 and 4 years.  By five years of age, the ligament is usually sufficiently thickened such that it can’t slip over the bone get trapped in the wrong position.  It also occurs more often in boys than in girls.[3]

Signs of nursemaid’s elbow include the following:

• Sudden pain around the elbow
• Inability to straighten the elbow (the child holds the bent elbow against his body)

Before initiating treatment for nursemaid’s elbow, to be sure the pain is only from a ligament out of place, and not from any broken bones (in case the injury occurred due to a fall), the doctor will apply gentle pressure to bones of the hand and fingers as well as the arms, watching the face carefully for any signs of pain. 

The condition is quite painful and the child won’t move the arm at all.  The treatment a doctor performs takes only a few seconds.  While the treatment is also painful, it is very brief, and even with all the advantages of modern medicine, rarely is anesthesia or sedation used. 

There are a few different variations of the technique used to reduce the injury (put the ligament back into place).  In general, the doctor will gently but firmly stabilize the elbow with one hand while using the other hand to bend the child’s arm upward from a straight position, turning the palm toward the child’s body as he bends the arm at the elbow.  You may hear a faint pop or click. Here are two graphics that show how this is done.   

 

 

 

There are also several Youtubes demonstrating the technique.  I prefer the one from Dr. Paul because it involves an actual patient.  Unfortunately, Dr. Paul has had his license suspended due to his recommendations to space out vaccines and Youtube has removed almost all his videos.  I was actually really surprised to see this one and highly recommend that you watch it immediately before it is also removed.  But because it may be yanked, I also have another Youtube from a different doctor. Following are the steps she outlines in her video.

• Take the patient’s hand of the affected arm as if you’re going to shake hands.
• With the other hand, stabilize the patient’s arm just above the afflicted elbow.
• With the handshake hand, turn the patient’s palm to the ceiling, straighten (actually hyperextend the elbow—make it as straight as possible—bending the elbow back as far as possible without causing injury) the patient’s elbow (the doctor and patient are facing one another and the doctor straightens the patient’s arm straight from the patient towards the doctor)
• Very quickly, the doctor raises the patient’s hand over the patient’s shoulder, keeping the elbow bent.
• If all goes well, the hand stabilizing the elbow should feel a pop.

Usually one maneuver is all it takes, but occasionally it needs to be repeated.  And the general recommendation is to observe the child for up to an hour to make sure he starts using the arm.  However, children remember pain quite well and can be very fearful of resuming activities.  To speed up their return to normal, one must be prepared to take drastic measures.  This is where having a generous supply of lollipops comes in.  Offer the child a lollipop.  However, hold it at a short distance from him and insist that he take it with the afflicted arm.  If it causes pain, then the maneuver must be repeated.  If not, the child will realize that the pain is gone and he can move freely. 

If the injury is treated quickly, and this is the first occurrence, immobilization is usually not necessary and the child will quickly return to normal behavior. If, however, this is a repeat injury or some time has passed before treatment, using a sling for a week or more may be advised.  

[Update:  A couple of years ago, Sweet Pea developed Nursemaid's Elbow.  Her mom, Buttercup, called in a panic.  I told her everything she mentioned pointed to this particular condition and we could DIY treatment, even though I suspected that she would be uncomfortable with that.  I told her what the treatment would look like and what a doctor would do.  Because they had great insurance at the time and because she is rather cautious about such matters, she took Sweet Pea into the urgent care.  The doctor didn't think it was nursemaid's elbow, but eventually gave the treatment a try, and lo and behold, it worked.]

References:

Dr. Paul's demonstration--highly recommended viewing, less than 5 minutes.  https://www.youtube.com/watch?v=7-4Aee7Mtfs

Dr. Allison Beitel's demonstration  https://www.youtube.com/watch?v=GVc0nZHmJ9E

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[1] Scott Rennie, “My Young Child Won’t Move His Arm—Is It Nursemaid’s Elbow?” Doctor Rennie’s Blog, 19 May 2012, https://doctorrennie.wordpress.com/tag/nursemaids-elbow/ (accessed 9 March 2021).

[2] Scott Rennie, “My Young Child Won’t Move His Arm—Is It Nursemaid’s Elbow?” Doctor Rennie’s Blog, 19 May 2012, https://doctorrennie.wordpress.com/tag/nursemaids-elbow/ (accessed 9 March 2021).

[3] Scott Rennie, “My Young Child Won’t Move His Arm—Is It Nursemaid’s Elbow?” Doctor Rennie’s Blog, 19 May 2012, https://doctorrennie.wordpress.com/tag/nursemaids-elbow/ (accessed 9 March 2021).