A pulled elbow is a common minor injury which affects children under the age of five years. It occurs when one of the forearm bones, called the radius, partially slips out of a ring shaped ligament at the elbow, which secures the radius to the bone next to it called the ulna. Medically this is known as a ‘radial head subluxation’.

What causes a pulled elbow?

A pulled elbow happens because young children’s joints are not completely developed and the ring shaped ligament is looser at this age. Usually the arm has been stretched or pulled forcefully along the direction of the length of the arm. This is commonly done by

  • You and your child moving in opposite directions, quickly whilst holding hands

  • Lifting your child by one hand

  • Pulling an arm through a sleeve whilst dressing

Any sudden pulling, stretching, jerking or swinging of the child’s hand forearm may cause it to slip. It may occasionally even occur after a fall or in a smaller child, simply rolling over on the arm.

What are the symptoms?

Your child may initially cry, appear to be in pain and be unable to fully bend their elbow. There is sometimes a ‘crack’ or ‘popping’ sound heard. They will be reluctant to use their arm, which may hang loosely at their side. Often they are then not distressed unless you try to move them.

How is it diagnosed?

The story of how it occurred and an examination of your child’s arm will help us diagnose a pulled elbow. An x-ray is not normally necessary because the ligament will not show up. When we examine your child we will be able to tell if there is a more serious injury or break to the arm

How is it treated?

This is a quick and simple manoeuvre, but may cause a brief moment of discomfort. Often a click is felt as the bone slips back into position. Shortly after this your child should be able to start using their arm, especially if distracted by playing with a toy but sometimes, this can take a few hours or more. The longer the arm has been ‘subluxed’ the longer this is likely to take, but every child is different.

We usually advise observation in Children’s A&E until your child has started to use their arm. This decision will be discussed with you at the time, as some children are more likely to relax and start to use it once they have gone home. If the arm seems a little sore or swollen after it has been treated you should give regular simple painkillers such as Paracetamol or Ibuprofen until they are using it normally.

What is the prognosis or expected outcome of treatment?

Your child is expected to make a full recovery within a few days. If the manipulation is immediately successful we will not arrange to see them again. If we think it is likely there may be another injury, or the treatment is not successful it is possible than an x-ray will be performed.

If the x-ray is also normal the treatment will then be to rest your child’s arm in a sling for 2-3 days. The elbow usually gets better on its own with this treatment.

If you have any concerns that your child’s arm has not recovered within 2-3 days you should either return to the A&E Department for a further examination or make an appointment to see your GP.

Are there any complications?

It is extremely rare for a pulled elbow to result in any long-term damage.

Prevention

To prevent this happening it is best to avoid swinging games and pulling or lifting your child by the hand. Use the child’s upper arms or armpits to lift them. Remember to teach others (like grandparents and childcare workers) to do the same.

Should you have any worries or concerns please contact:

Your ……………………………team is based at…………………………………………….

Telephone: ………………………………………………………………………………………

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302