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It looks like a dislocated elbow, but it’s not. Infants and toddlers have extremely flexible joints, as many adults have observed in envy. Since babies grow at such an extraordinary rate, their bones are softer than adult bones, and their tendons and ligaments are more flexible as well.

In nursemaid’s elbow, the ligament that stretches over the elbow joint is popped out of place, easily sliding over the smooth end of the bone. This injury is common among children up to age three, and rarely occurs after age five or six. After that age, the end of the bone is no longer completely made up of smooth cartilage, and it is harder for the ligament to slide over it.

How does this happen?

Quite simply, if the child’s arm is pulled and twisted at the wrong angle, the ligament can pop out of place. This can happen during sibling struggles, or if you are swinging a child by his arms. It can even occur if you are holding your child’s hand and she pulls and twists to get away. Typically the arm will be nearly completely straight when the injury occurs, and then the combination of being twisted and the force on the arm cause the ligament to pop.

How do I know this is the problem?

The child reacts immediately! This is a painful condition. The child will hold the arm against his body and cry if you move or touch it. Usually, the elbow is slightly flexed, and hand is turned so that the palm faces the body. The child will resist using the arm for any reason.

If your child has a special toy or comfort object, you can easily see if this is the problem by watching how the child holds it. Usually young children will hug their teddy bears with two hands, holding it close to the body. If the child won’t use the arm at all after a pulling/twisting incident, chances are very good that it’s nursemaid’s elbow.

Medical Diagnosis

Since the problem with the arm is a displaced ligament, an x-ray is useless. Diagnosis is made on the basis of how the injury occurred, and how the child is behaving.

Treatment

Some extremely flexible children can pop the ligament back into place themselves, but most cannot. Your doctor can easily move the ligament into its proper position by a simple movement involving straightening the arm, turning the hand a bit outward, and bending the elbow so that the hand comes up to the shoulder. DO NOT ATTEMPT TO DO THIS YOURSELF! This process is painful to the child, but when done correctly, it immediately resolves the problem. Often the child’s crying will stop as soon as the “pop” is heard, and within minutes (sometimes seconds), he is back to using his arm as usual.

If this is the first time this has happened, and the problem was resolved within a few hours or so, there isn’t any need for a sling or other extended treatment. If the problem occurs frequently, or was left untreated for some time, a sling or a cast may be necessary to stabilize the joint and protect it from re-injury.

Prevention

A few common sense guidelines can help avoid this injury entirely. Don’t swing children under the age of three by their outstretched arms; hold them under the arms, instead. If you’ve got a restless child by the hand and she extends her arm and begins twisting to get free, let go and take her by the upper arm or shoulder, or hold her around the waist. Remember that once past the age of three, there isn’t much danger of this injury, but it is something you should be cautious of through age six.