Nursemaid’s Elbow in Kids Caused by Common Activities

Nursemaid’s elbow is one of the most common injuries in small children, and it can happen during the most innocent activities, like swinging a child by the arms or playing tug-of-war.

“There is a natural looseness in the ligaments of little kids’ elbows,” according to CHOC Children’s pediatric orthopaedic surgeon Dr. Jessica McMichael. “Nursemaid’s elbow happens when the arm gets tugged or pulled, which can partially dislocate the radial head portion of the elbow.”

The injury can happen when a baby or small child is lifted by the hands, or when a child tugs their arm while holding someone’s hand. It can also happen when an object is pulled from their hand, when a baby rolls over or because of a fall.

What are Symptoms of Nursemaid’s Elbow?

Parents can look for these characteristic signs of nursemaid’s elbow in their child:

  • The child stops using their arm normally or treats their arm gingerly
  • The elbow appears straight and the child doesn’t want to bend it
  • The child holds their arm limply and away from the body, “like a paralyzed arm”
  • The palm is rotated inward, rather than facing out toward the front of the body
  • The child complains of pain in the elbow, forearm or wrist
  • Someone holding the child’s hand may feel a pop in the child’s wrist when the injury happens

Nursemaid’s elbow is a very common orthopaedic condition treated at CHOC, according to Dr. McMichael. It is likely to happen multiple times after a child has it once.

“Nursemaid’s elbow is not threatening to the limb, but it does need to be treated,” Dr. McMichael says. “It’s okay to wait until the next morning if your child is acting okay. If your child is not acting like themselves, get it checked out.”

How to Fix Nursemaid’s Elbow

To fix nursemaid’s elbow, a medical professional will gently and quickly pop the elbow back in place. A child might feel pain for a brief moment during the procedure but should start using their arm normally within a few minutes.

If a child’s elbow pops out of place three or more times in a month, a cast may be put on to immobilize the arm and promote stiffness.

Nursemaid’s elbow can be treated by a pediatrician, a pediatric orthopaedic specialist or at a pediatric emergency department. Parents should not correct the elbow themselves unless instructed by a doctor.

Dr. McMichael encourages parents to educate people who are around their child, like grandparents, daycare staff and preschool teachers, about the safest ways to lift a child, hold their hands and play with them.

Nursemaid’s elbow is less likely to occur after age four, when the elbow ligament starts to tighten up and improves with age and growth.

To make an appointment with a CHOC orthopaedic specialist, call 888-770-2462.

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New Orthopaedic Surgeon Places Patient- and Family-Centered Care First

A new orthopaedic surgeon with special training in orthopaedic trauma has joined the CHOC Children’s Orthopaedic Institute team. Dr. Jessica McMichael specializes in the care and treatment of fractures and a variety of pediatric musculoskeletal disorders, including limb and foot deformities, and cerebral palsy.

orthopaedic surgeon

A fierce advocate for families, Dr. McMichael strongly believes in treating patients and parents how she would want her own family to be treated.

“I like to take the time to listen to my patients and their families’ questions,” she explains. “I also know that if they’re at the clinic or hospital, they have probably taken time from work, school or other duties, and I want to show them that their time is valuable to me.”

Dr. McMichael approaches every parent interaction with her “mom hat” on.

“Being a mother changed me 100 percent. I always reinforce to parents that they know their child better than I do. I encourage them to listen to their intuition,” says Dr. McMichael, a mom to a toddler. “It’s about building a relationship with them.”

Dr. McMichael’s interest in orthopaedics started as a young girl. She remembers the exact moment. She idolized a friend’s older cooler sister, who shared that she was studying to be an orthopaedic surgeon. When Dr. McMichael learned what an orthopaedic surgeon did, she knew that’s what she wanted to do, especially if it meant being just like her idol.

Dr. McMichael earned her medical degree from Saint Louis University School of Medicine where she also completed her residency. She then served as an orthopaedic surgeon in the U.S. Air Force in Korea. Later, she provided trauma care training to military personnel as an adjunct faculty at the Center for Sustainment of Trauma and Readiness Skills in St. Louis, Missouri. Dr. McMichael completed her pediatric orthopaedic surgery fellowship at Shriners Hospitals for Children Northern California/UC Davis Medical Center.

It was during her fellowship at Shriners when Dr. McMichael became captivated by her young patients’ resilience.

“It was so invigorating to take care of someone who just wanted to play and get better,” she says. “It’s like kids are programmed to do well. That helps in their care and recovery.”

Dr. McMichael is working with the CHOC team to develop a multidisciplinary comprehensive bone health program, which would include conditions like osteogenesis imperfecta, a disorder characterized by brittle bones.

Dr. McMichael is a board-certified orthopaedic surgeon with the American Board of Orthopaedic Surgeons. She is a member of the Pediatric Orthopaedic Society of North America, the Orthopaedic Trauma Association, and the American Academy of Orthopaedic Surgeons.

In her spare time, Dr. McMichael enjoys spending time with her husband and daughter, reading, camping, and participating in any Disney-related activities.

Learn more about the CHOC Children’s Orthopaedic Institute.  

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