Nurse Maid Elbow
Nursemaids elbow is common injury of early childhood which results in subluxation of the annular ligament due to sudden longitudinal traction applied to the hand. It is also known as pulled elbow and children between the age 1-4 years are affected.
The annular ligament encircles the radial head and holds it against the ulna. Axial traction on a pronated forearm and extended elbow causes the annular ligament to slip over the head of the radius and become trapped in the radio humeral joint between the radial head and capitellum.
Condition occurs commonly in children under 5 years of age, due to shallow, concave radial head, relative plasticity of the cartilage and immaturity of annular ligament. In rare cases, subluxation may lead to osteochondritis dissecans of the radial head.
PATHOPHYSIOLOGY:
- Injury usually occurs when a child is lifted & swung around by one of his arms thus pulling the radial head out of the annular ligament.
- Pulling a child’s arm to prevent them from falling can lead to radial head subluxation.
- Fall on the elbow or twisting of forearm
- Longitudinal traction when a child less than 6 months rolls in bed onto their arms.
SYMPTOMS:
- Sudden acute pain
- Loss of function in affected arm
- Swelling
- Reduced range of movement of elbow & wrist
INVESTIGATIONS:
Your doctor may perform XRAY of the elbow joint if there is suspicion of elbow fracture, dislocation, or if oedema or deformity is seen on physical examination.
TREATMENT:
- Arm back slab with supinated forearm.
- Closed reduction of subluxation- Hyper pronation, Flexion supination manoeuvre to reduce the pulled elbow. Immobilize for 2 weeks after reduction. If left neglected, this may cause permanent functional disability of the elbow.
- Ice packs - 3-4 times / day to reduce pain & swelling
