Radial Head Subluxation

Q1. What is radial head subluxation?

Radial head subluxation, often called \"nursemaid's elbow\" or \"pulled elbow,\" is a common condition where the radius bone in the forearm slips slightly out of its normal position at the elbow joint. The elbow joint is held together by a band of tissue called a ligament. In young children, this ligament is still developing, making it easier for the bone to slide under the ligament and become temporarily trapped.

Q2. Who is most likely to experience a radial head subluxation?

This injury is most common in infants and young children, typically between the ages of 1 and 4 years. It is rare in children older than 5 or 6 because their ligaments become stronger, thicker, and tighter, holding the bones more securely in place. Although very rare, adults can occasionally experience a similar injury from severe trauma or underlying ligament issues.

Q3. What causes a radial head subluxation?

A radial head subluxation is usually caused by a sudden pull on a child's lower arm or wrist. Common situations that lead to this injury include:

• Lifting a child up by their hands or wrists rather than from under their arms.
• Pulling a child quickly by the hand, such as trying to stop them from falling or stepping into the street.
• Swinging a child by their hands or forearms during play.
• A minor fall where the child lands on their arm or twists it awkwardly.

Q4. What are the common symptoms of a radial head subluxation?

If your child has a radial head subluxation, they will likely show immediate signs of discomfort. Key symptoms include:

• An immediate cry of pain, although the pain may subside to a dull ache when the arm is kept still.
• Refusal to use the affected arm, letting it hang limply by their side or holding it bent against their stomach.
• Pain when attempting to bend the elbow, turn the palm upward, or move the arm.
• An absence of obvious swelling, bruising, or deformity at the elbow joint.

Q5. How is a radial head subluxation diagnosed?

A doctor can typically diagnose a radial head subluxation by listening to how the injury happened and performing a physical examination of the arm. The doctor will check for tenderness around the elbow and look at how the child holds their arm. In most cases, the description of the injury and the characteristic way the child holds their arm are enough to confirm the diagnosis.

Q6. Can radial head subluxation be diagnosed with an X-ray?

X-rays are usually not needed to diagnose a radial head subluxation because the slight slippage of the bone does not show up on standard X-ray images. However, a doctor may order an X-ray if they suspect a different type of injury, such as a fracture or a complete dislocation, especially if the injury resulted from a fall from a height or direct impact.

Q7. What is the treatment for a radial head subluxation?

The standard treatment is a simple medical procedure called a \"reduction.\" During a reduction, a doctor gently moves the child's forearm in a specific way to pop the radial head back under the ligament. This procedure is very quick, usually taking only a few seconds, and is performed in the doctor's office or emergency room without the need for anesthesia or sedation.

Q8. Does a doctor need to put the elbow back in place?

Yes. You should never attempt to put the elbow back in place yourself. Although the reduction procedure is quick, it requires specific training to ensure the bone is reset correctly and to avoid causing further damage to the ligaments, nerves, or blood vessels in the arm.

Q9. How quickly does the elbow heal after being put back in place?

Many children experience immediate relief once the elbow is reset. They may cry for a few minutes due to the brief discomfort of the procedure, but most children are back to using their arm normally within 15 to 30 minutes. If the elbow was out of place for several hours or days before being reset, it may take a bit longer (sometimes a day or two) for the child to use it comfortably.

Q10. Is a cast, splint, or sling needed after the elbow is reset?

In the vast majority of cases, no cast, splint, or sling is necessary. Once the bone is back in its correct position, the joint is stable. The child can return to their normal activities right away. A splint or sling might only be recommended if the elbow was out of place for a long time and the surrounding tissues are sore and inflamed.

Q11. What are the risks if a radial head subluxation is left untreated?

If left untreated, a subluxation will cause ongoing pain and limit the child's ability to use their arm. Over time, the joint can become physically stiff, and the muscles around the elbow can weaken. It is important to have the elbow reset as soon as possible to prevent discomfort and ensure normal joint function and development.

Q12. Can a radial head subluxation happen again?

Yes. Once a child has had a radial head subluxation, they are more likely to experience it again. The ligament holding the radial head in place remains stretched and loose for a period of time, making it easier for the bone to slip out again. Fortunately, children completely outgrow this tendency by age 5 or 6 as their elbow structures mature.

Q13. How can parents or caregivers prevent radial head subluxation?

You can help prevent this injury by avoiding any actions that pull directly on your child's hands or wrists. Keep these tips in mind:

• Always lift your child from under their armpits rather than pulling them up by their hands or wrists.
• Do not swing your child by their hands, wrists, or forearms.
• Encourage family members, babysitters, and teachers to handle the child gently, avoiding sudden pulls on the arm.

Q14. When should we seek emergency medical care for an elbow injury?

You should seek immediate medical attention if your child injures their elbow and you notice any of the following:

• Severe pain, swelling, or bruising around the elbow joint.
• The arm appears deformed or is resting at an abnormal angle.
• The child's hand or fingers are cold, pale, or bluish.
• The child complains of numbness or tingling in their arm, hand, or fingers.
• The injury was caused by a high-impact fall or accident.

Q15. Does radial head subluxation cause long-term damage or arthritis?

No. Radial head subluxation does not cause long-term damage, joint deformity, or arthritis. Once the elbow is reset and the ligament heals, the joint functions perfectly normally. The condition is entirely temporary, and children outgrow the risk as their bones and ligaments grow stronger.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.