Pulled elbows: How it affects your toddler

Carly Cragg, a mother of five in Orillia, Ont., will never forget the day she thought she’d accidentally broken her two-year-old son’s arm. They had just returned home from a walk. When she tried to take off little Harry’s sweater, he protested and pitched himself onto the floor in a tantrum. Once he had calmed down, she noticed his right arm was hanging limp at his side. “He wouldn’t move it or bend his elbow. I tried to bend his arm a little and he started screaming.” Cragg was horrified. She wondered if she’d somehow caused the injury, and how she could have missed it. “I had been holding onto his arm when he fell to the floor. I thought: What have I done?”

They rushed to their family doctor for an emergency visit. Within minutes, the doctor diagnosed Harry with a pulled elbow, one of the most common injuries in toddlers and young children.

Sometimes referred to as “nursemaid’s elbow,” a pulled elbow is usually the result of the child’s arm being jerked or yanked. Toddler ligaments are naturally loose and stretchy, and sometimes a fairly normal tug on the arm can cause one of the bones in the elbow joint to slip beneath the surrounding ligaments and become trapped. (As children get older, their ligaments become more rigid and the bones are less likely to get caught out of place.)

Unlike a broken bone, a nursemaid’s elbow won’t be accompanied by swelling or bruising. Most children experience pain only if they try to bend or rotate the affected arm from the elbow. The doctor will do an examination and ask some questions about how the injury occurred (if you know) before making a diagnosis — an X-ray is not usually required.

Martin Osmond, a paediatric emergency physician in Ottawa, says that his ER sees at least one case of pulled elbow a day; it’s as common as the flu. Osmond is also a professor of paediatrics at the University of Ottawa and has done research into the diagnosis and treatment of pulled elbow (the medical term for it is “radial head subluxation”) in children. He says that while broken bones can require a cast and weeks of healing, the treatment for pulled elbows takes only a few seconds and usually results in an immediate and complete recovery.

“Staff have been known to fight over these cases when they come in because pulled elbow is one of the most rewarding conditions for a physician to treat,” says Osmond.

A doctor or nurse will extend the child’s arm, turn the palm of the hand either fully up or fully down, and then firmly bend the arm to click the ligaments of the elbow back into place. This action is momentarily painful, but in the vast majority of cases, says Osmond, your toddler will be back to normal within minutes.

Cragg was shocked when she saw how quickly the doctor was able to fix Harry’s arm. “She did it so fast — I barely had time to react. Harry was fine and stopped crying instantly.”

A child who has pulled an elbow once is more prone to a repeat injury. Some doctors will show parents how to fix a pulled elbow by themselves, in case it happens again. But Osmond recommends parents still see a doctor as soon as possible to rule out other problems.

The best way to prevent this kind of injury is to avoid yanking or swinging your child by one arm. But some kids are simply more susceptible, says Osmond. “They just have stretchier ligaments.”

Brett Chamandy, a dad in Ajax, Ont., says his four-year-old daughter, Grace, has pulled her elbow three times — the first time when she was two and tripped while holding her father’s hand. “Now if she trips on the sidewalk, I don’t yank her up,” says Chamandy. “I feel a bit bad letting her go, but a bumped knee is better than another pulled elbow.”

A version of this article appeared in our December 2013 issue with the headline "Out of joint," p. 84.

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