What it is
Radial head subluxation or a “pulled elbow”, known as nursemaid’s elbow, occurs when the annular ligament slips between the radial head and the capitellum at the elbow joint. The radius bone slips partly out of its normal position within the elbow joint. A sudden pull on the forearm is the usual cause of this common type of injury in toddlers. As a result, the child holds the arm slightly flexed and refuses to use it.
Prompt reduction restores comfort quickly. Education focuses on preventing traction events.
What happens when it occurs
Axial traction places the radial head under the ligament. A brief reduction manoeuvre frees the ligament. Recurrence can happen, especially if traction events repeat.
Common causes and risk factors
- Pulling a child up by the hand or wrist
- Swinging games, pulling the child by the hands
- Sudden yanks when a child stumbles
Who is most affected
Toddlers and preschool children.
Typical symptoms
- Immediate pain and refusal to use the arm
- Arm held by the side with elbow slightly bent and forearm pronated
- Pain with attempts to move
When to seek care
Immediately, if this presentation occurs, reduction by a trained clinician is required. Seek urgent care if swelling, deformity, or severe pain are present.
How we diagnose
History and examination. Imaging is rarely needed unless a fracture is suspected.
Management
- Closed reduction in the clinic or emergency department
- A brief period of comfort care after reduction
- Education to avoid traction on the arm
- Review only if symptoms persist
Rehabilitation milestones
Most children resume everyday use within minutes to hours after reduction. No formal rehabilitation is required.
Readiness to progress
- Comfortable use of the arm during play
Prevention
- Lift under the arms rather than by the hands
- Avoid swinging games with the hands
- Guide rather than pull during walking
Australia snapshot
- A common reason for emergency presentations in toddlers
- Rapid recovery after reduction is the norm
- Recurrence can occur; prevention advice reduces risk
Latest insights
Education prevents repeat events. After a successful reduction, the priority is to return to regular play without pulling on the arm.
Imaging is seldom required unless the story or examination suggests a fracture.
