Nursemaid Elbow Overview
Nursemaid elbow is a common injury
among preschool-aged children. In fact, review articles cite it as the
most
common orthopedic injury in children under 2 years of age. Nursemaid
elbow refers to a condition (medically called radial head subluxation)
in which the normal anatomical alignment of two of the three bones which
form the elbow joint is disrupted. Girls are more commonly affected
than boys; the left arm is more often injured than the right. This is
thought to be secondary to the likelihood of the parent
being right-handed (and thus most frequently pulling their child's left
hand). The injury can occur innocently from swinging a young child by
the arms or pulling a child's arm while in a hurry.
- While nursemaid elbow is usually a temporary condition without
permanent consequences, it can be quite frightening to parents who find
their child suddenly lacking the ability to use his or her arm.
- The elbow joint involves the two bones of the forearm (radius and
ulna) and the bone of the upper arm (humerus, hence the name "funny
bone"). The ulna is the bone that is on the side of the forearm that has
the baby finger. The radius runs the length of the forearm on the thumb
side. The radius forms an individual connection with the capitellum,
the far end of the humerus. The relationship between the ulna and the
humerus is sturdy. However, the head of the radius requires a tight
ligament (the annular ligament) to anchor the radial head into the
proper region of the capitellum. If the radial head receives a sudden
pull or is subjected to chronic traction, this ligament may partially
tear and slip out of position, allowing the radius to lose its proper
fitting in the "socket" at the end of the humerus.
- Typically, this type of injury occurs in children 1-4 years of age
but has occurred in infants 6-12 months
of age as well. The peak incidence is 27 months of age. As children
grow, their bones become larger and more defined. In addition, ligaments
become stronger and thus provide a better support system. Nursemaid
elbow is rarely seen in children older than 6 years
of age unless the child is involved in prolonged hanging by the hands or
prolonged lifting of heavy objects. (The appellation "nursemaid elbow"
stems from this injury occurring when women were forced to carry heavily
filled milk buckets for long distances. Currently, airport baggage
handlers are those most likely to sustain such an injury.)
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