Subluxation of the radial head, commonly referred to as nursemaid’s elbow, is a frequent injury in young children that occurs when the radial head partially dislocates from its normal position at the elbow joint. This condition usually results from a sudden pull on the extended arm, such as when a child is lifted or swung by the hand. Although it can cause immediate pain and limited mobility, subluxation of the radial head is typically treatable and does not usually result in long-term complications when addressed promptly. Understanding the causes, signs, treatment options, and preventive strategies is essential for parents, caregivers, and healthcare professionals.
Anatomy of the Radial Head
The radial head is the top part of the radius, one of the two bones in the forearm. It forms a joint with the humerus and the ulna at the elbow, allowing for rotation of the forearm and bending of the elbow. The radial head is stabilized by a ligament called the annular ligament, which encircles the bone and keeps it aligned with the elbow joint. In children, this ligament is more flexible and weaker than in adults, which makes the radial head more susceptible to subluxation.
Causes of Radial Head Subluxation
Subluxation of the radial head occurs when a sudden force pulls the forearm while the elbow is extended, causing the radial head to slip partially out of the annular ligament. Common causes include
- Pulling a child’s arm abruptly during lifting or swinging
- Accidental tugging while holding hands
- Falls that involve extending the arm to break the impact
- Sports-related injuries in older children
Because the annular ligament in children is more elastic and not fully developed, even a minor pull can cause subluxation. This condition is most common in children between one and four years of age and is rarely seen in adults due to stronger ligamentous support.
Signs and Symptoms
Recognizing the symptoms of radial head subluxation is crucial for prompt treatment. Key signs include
- Sudden onset of pain in the elbow or forearm
- Child refuses to move the affected arm
- Elbow may appear normal with no visible swelling or bruising
- Forearm held slightly bent and close to the body
- Mild tenderness over the radial head on palpation
Children may cry or show distress immediately after the incident and may avoid using the affected arm until the subluxation is reduced. In many cases, there is no visible deformity, making careful clinical assessment essential.
Diagnosis
Diagnosis of radial head subluxation is primarily clinical and based on the history of a sudden pull and the physical examination findings. In most cases, imaging such as X-rays is not required unless there is suspicion of a fracture or if the diagnosis is uncertain. The following diagnostic steps are often used
Clinical Examination
The healthcare provider evaluates the child’s arm, checking for pain, range of motion, and tenderness. The classic presentation of a child holding the arm close to the body with limited movement strongly suggests radial head subluxation.
Imaging
X-rays or other imaging modalities may be used in atypical cases, recurrent subluxations, or when trauma may have caused a fracture. However, most cases of nursemaid’s elbow are diagnosed without the need for imaging.
Treatment of Radial Head Subluxation
Effective treatment of subluxation of the radial head involves reduction, which is a simple procedure to reposition the radial head back into its normal alignment. The two common techniques include
- Supination-Flexion TechniqueThe forearm is gently supinated (rotated palm-up) while the elbow is flexed. A click or pop may be felt as the radial head slides back into place.
- Hyperpronation TechniqueThe forearm is gently pronated (rotated palm-down) with steady pressure applied to the radial head. This method is sometimes preferred for children who do not respond to supination-flexion.
Reduction usually provides immediate relief, and the child typically begins using the arm normally shortly after the procedure. Pain and tenderness subside rapidly, and no further immobilization is usually required.
Aftercare and Recovery
After successful reduction, parents should monitor the child for any signs of persistent pain, swelling, or inability to use the arm. Most children recover fully within a few hours to a day. Pain management is generally not necessary, but mild analgesics may be given if needed. It is important to follow up with the healthcare provider if symptoms persist, as rare complications or misdiagnoses may require further evaluation.
Prevention
Preventing subluxation of the radial head involves minimizing the risk of sudden pulling forces on a child’s arms. Recommended strategies include
- Avoid lifting or swinging a child by the arms or hands
- Use alternative lifting methods, such as holding the child under the arms or supporting the torso
- Educate caregivers about safe handling techniques
- Encourage children to use playground equipment safely to avoid falls or awkward pulls
By implementing these preventive measures, parents and caregivers can significantly reduce the likelihood of nursemaid’s elbow in young children.
Complications
Complications from radial head subluxation are rare when treated promptly. However, repeated subluxations can occur in some children, especially those with ligamentous laxity. Infrequently, untreated subluxation or misdiagnosis can lead to persistent pain, limited range of motion, or chronic instability of the elbow. Early recognition and proper reduction are essential to prevent these outcomes.
When to Seek Medical Attention
Parents should seek immediate medical care if a child experiences
- Persistent pain or inability to move the arm after attempted reduction
- Swelling, bruising, or visible deformity of the elbow
- Recurrent subluxations without clear cause
- Signs of fracture, such as severe pain or abnormal positioning
Prompt evaluation ensures proper management and reduces the risk of complications.
Subluxation of the radial head is a common pediatric injury that results from a sudden pull on the arm. Recognizing the signs and symptoms, understanding the anatomy of the elbow, and applying appropriate reduction techniques can lead to rapid recovery and minimal complications. Education on safe handling and preventive strategies is key to reducing the incidence of this condition. With proper treatment, children typically regain full function of the affected arm quickly, making awareness and timely intervention critical for caregivers and healthcare providers.