Doc Mommy : How to know if your child has Pulled Elbow and how to treat it?

If one of your kids suddenly stopped using one of his arms and keeps it against his body and does not want to be touched, and he did not suffer from a fall, he might be having a PULLED ELBOW.

What exactly is it? It’s literally a pulled elbow! It is also called Nursemaid's Elbow or Radial Head Subluxation... Anyway, this happens when you pull your kids up by holding their hands or wrist, or by catching your child by the hand to stop a fall, or when you yank their arms to make them walk faster. Guilty of doing these? A lot of us are!

When a child’s arm is pulled by the wrist or hand, the ligament (Annular Ligament) that goes around one of the bones of the forearm (Radial head) slips out. The elbow won’t look distorted nor swollen but your child will refuse to move it. That is actually the most obvious sign that he has a pulled elbow.

My 3 kids experienced this especially my eldest when he was about 1 to 3 years old. He got Pulled Elbow with just a minor tug on his wrist. And it happened frequently because he is super active!

The other day, Javi was having minor tantrums and I had to hold his wrist to stop him from falling on the floor and hitting his head, then I felt it on his forearm, the feeling of something coming loose on the side of his elbow. I knew exactly what to do, from years of experience. I just twisted his wrist toward his body (pronate) while stabilizing his elbow and forearm. Then I felt his bone slip back to the ligament that holds it in place. 

Our helper’s kid in my mom’s house also had this few years back. My mom told me that he had not been moving his other arm for a few days already and I told her that he must have a Pulled Elbow. One day I visited my mom’s house and saw the kid and I was 100% sure that he had a Pulled Elbow because his arm was just tucked beside his body. I did the above procedure to him and he instantly moved his arm again as if nothing happened.

In my experience, the older the kid gets, the worse the pain is while doing the procedure. And it is more difficult to slip back. It’s like you will feel a resistance. I think it’s also because they are already aware that their arm will be touched and moved so they are more scared and hesitant and they tend to contract their muscle. They will also feel a bit surprised and a bit of pain as you do this. But once you feel the bone click or snap back, the pain will instantly disappear.

There’s no need for an X-ray to diagnose this injury. You just need to watch out for the following signs

• Your child stops using his/her arm
• Arm is held in extension and wrist is pronated (turned toward the body)

Pulled Elbow is a fairly common injury among kids below 5 years old. Beyond this age, the joints are much stronger so it is unusual for older kids.

We sometimes cannot avoid incidents that cause pulled elbow especially with super active kids. But here are the things that we should avoid and watch out for:

• Pulling your child up by the hands - Never pick up your child or baby by the hands or wrist, either from sitting down or from the lying down position. It is safer to lift them under their armpits.
• Swinging by the arm – A lot of parents and adults do this when they play with their kids. Stop!
• Yanking or jerking your child's arm - Be very gentle when holding or taking the child by the hand. 
• Pulled elbow can sometimes not be painful unless moved so if your kid is relatively active but has his arm tucked to his side and primarily uses the other arm or hand, then he might have a pulled elbow.

How to treat Pulled Elbow?

Surgery is not required for this. The easiest way to treat this is by doing the following steps:

1. Face the child. Your one hand should be on the child’s wrist, and the other hand should stabilize the child’s forearm.
2. Twist the child’s wrist toward his body (pronate). You can use your thumb to push the bone of the wrist inward.
3. You will feel a click and this should mean that the radial head already slipped back the ligament.
4. Your child should be able to move his arm fully and without pain.

In real life, the child won't be smiling while you do this.
This is just a re-enactment hehe

See where my right thumb is? That is where you push inward. I am using my left hand to stabilize the elbow.

Your child may have a Pulled Elbow more than once, but don’t worry because it won’t cause any long-term or permanent damage. But the longer it is dislocated, the harder and more painful it is to slip back. So, remember the signs so you can treat your child immediately. Educate your yayas, as well as everyone in your household so they’d know how to prevent this.

P.S. If your child fell and the arm is red and swollen and there’s extreme pain, go to the doctor  at once because there might be a fracture. Remember that with Pulled Elbow, the pain is just minimal and your kid will still be able to play.