Nursemaid’s Elbow
Okay, I am not gonna lie. Nursemaid’s elbow is hands down my favorite thing to treat in clinic. A nursemaid’s elbow, also known as a radial head subluxation, is a very common minor traumatic injury that we see in young kids. What happens is that the top part of the radius (one of the bones in the forearm) can slip out of place within the elbow. The typical situation/story is that a kiddo is being swung around by their arms or playing 1,2,3 swing or jump with their parents while holding their hands, and then they feel a pop and start crying and saying their arm hurts. Or a parent was holding their kiddo’s hand, and the kiddo was about to fall when the parent quickly pulled on their hand/arm in an upward motion and felt/heard a pop, and then their kiddo was crying and not wanting to move their arm.
By the time the kiddo is in my clinic, they usually have the same positioning: the affected arm is kept down and close to their side. As long as I don’t make any sudden movements towards their arm, they will just sit there, worried that I will touch that arm.
I will explain to their parents that with the story of the injury and what the kiddo is looking like on physical exam, they probably have a nursemaid’s elbow. Then I explain how the treatment works: I will take the kiddo’s hand and arm and quickly move it up in a hyperflexion movement while rotating their hand towards their body and then, if needed, quickly down in a hyperextension movement while rotating their hand away from the body. Or sometimes vice versa. I will do this while holding at the kiddo’s elbow so I can feel the radial head (top part of the bone) click back into place. I will then let the family know that this doesn’t feel great when it is happening, so the kiddo will cry. Once I feel it pop into place, I will leave the room for 2 minutes, and when I come back, the kiddo will look as if nothing has happened and ready to reach for the sticker/toy/lollipop with their previously affected arm. It is like magic. And it makes me look like a rock star. I would run a whole clinic every day doing this if I could.
Once treated and popped into place, those kiddos are more likely to have it pop out again in a similar fashion as the tendon there is now a little more stretched than it was before. So I will often show families how to do this at home if the kiddo presents the same way after having their arm pulled up quickly.