Pulled elbow - First hospital visit! Florence and I were spending the morning at The Crabtree, pottering around doing the flowers and making the place look pretty. She is quite clingy at the moment... this could be typical attachment disorder in toddlers OR her new favourite programme 'Parent trap'! Every 5 minutes she is running up to me saying 'Mummy, love you so much". Anyway... holding my hand, EVERYWHERE we went, she suddenly thought it would be funny, to turn herself to jelly. As she did so, I pulled up to stop her falling over and I heard an awkward click/crunch. Florence burst into tears and I immediately ran her over to my Dad and Uncle (who were trying to get the accounts done in the office) and asked them what I should do?? I had no idea. They both discreetly checked to see if she was moving her hand, which she was, so we knew nothing was out of its socket. Dad suggested I put her in the car and let her have a sleep whilst heading back to Brighton where the hospital was if I needed it. She fell asleep and I was too scared to go home so went to Mum's. When she woke up she immediately held her arm again and started crying. Mum said we should go to hospital just in case. So with Mum driving and a very tearful Florence, we head to the hospital. Luckily for us there was no one else in the waiting room and we got shown straight in. The lovely nurses put the 3D... YES 3D TV on for Florence, gave her a little pair of 3D glasses which she promptly put on - she never does this at home! Whilst distracted I give them the lo down. One of the nurses said she knew exactly what it was and explained that it was PULLED ELBOW. I have never heard of this and thought it would be a good referral for all the mummies and daddies out there. With one swift manoeuvre it was all sorted. Florence was fit as a fiddle afterwards as if nothing had ever happened. What is a pulled elbow? A pulled elbow is a common minor injury which usually 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 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 or forearm may cause it to slip, and 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 the arm, but occasionally may seem to be surprisingly upset by what seems to be a very minor event. 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, and 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? If your child seems to be in pain they should be given simple painkillers such as paracetamol or ibuprofen. Once the examination has shown no other injury your child’s arm will need to be moved in a particular way to manipulate the head of the radius bone back into the correct position. 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, but 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 your child again. If we think it is likely there might be another injury, or the treatment is not successful it is possible that 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 it’s 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 possible 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 up 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.
It was incredibly scary and I really wish I had known what I was dealling with straight away. Florence is very proud of herself and actually has asked if she can go back to the hospital!! The nurses did mention that they cringe every time they see people swinging little children because this is one of the most common causes... we used to do it all the time with Florence so if I do it now I will hold onto her under arm instead!