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By Paul M. Marz, M.D.
The snow is flying and you are in line with your little one somewhere, waiting for your turn. The line moves up and your child is off in the ozone looking at something. So, as every good parent will do, you just pull the child along by the hand. You have done this uncountable times in the past, but this time, the air is filled with cries of pain and fear.
You look down and the child is acting like you broke their arm!! They are clutching the elbow and whimpering in pain. This passes eventually, but now the child will not—absolutely will not—use that arm.
Congratulations! You have joined the rich and varied historical crowd of families with the mysterious “Nursemaid Elbow”.
This problem started years and years ago when families had the luxury to afford to hire a nursemaid to watch the children. It has lots of other names, too: babysitter elbow, pulled elbow, dislocated proximal radial head, to name a few.
But, to understand exactly what happened, let’s take a minute and look at a growing child’s bones.
Children grow, thank goodness. As time goes by they reach adulthood. During this growing process the child has sections of the growing bone that have not yet hardened into the stuff we all think of when we talk bones. It is more like a plastic, rubbery material in the shape of the bone to be, but able to grow as the child grows.
The designers who make the elbow did a good job, no question, but the design requires that the child knows the tug or pull on the arm is coming. So, now we jump back to our little story. With the child’s attention focused elsewhere, they do not notice that the line has moved and hence the tug comes unexpectedly from the child’s point of view. This sudden tug on an unprotected elbow will sometimes cause the end of the bone to “fold up” and slip out of the joint. It is a true dislocation–just ask the kids with the pain-but it does not take much force to do the deed.
Because of all the reasons this may occur, the repair is equally simple. As the rubbery bone is pulled into an unnatural shape, it would like to be popped back into place. A gentle pull/twist/shove on the arm and with a pop and a yell, the whole elbow is good as new with relief of all the painful complaints–and the child will be using that arm again trouble-free.
If you think your toddler has suffered this historical occurrence, just call your handy local pediatrician who will happily pop it back in place. For us old people (over 6 years), the story is not so simple…but that is another story.
(Dr. Marz, a board-certified pediatrician, is supervising physician for the Town of Barnstable school system. He practices with Bass River Pediatrics in South Yarmouth.)