What Is the Reduction of a Radial Head Subluxation (Nursemaid’s Elbow)?

A radial head subluxation (Nursemaid's Elbow) occurs when the radius bone slips partially out of the elbow joint.

The elbow is made up of the upper arm bone (humerus) and two bones in the forearm (radius and ulna). Some strong ligaments in the elbow hold these bones in the elbow joint together.

A radial head subluxation occurs when the radius bone slips partially out of the elbow joint. It is known as a nursemaid’s elbow. It occurs most commonly in children, particularly below six years of age. Two to three years is the most affected age group in children.

The two joints in the elbow are:

Humeroulnar joint: This joint is between the ulna and humerus that allows the bending of the elbow.

Radiocapitellar joint: This joint is between the radius and humerus that allows the rotation of the forearm to turn the palm up or down.

A nursemaid's elbow occurs when there is a subluxation of the radiocapitellar joint.

In children, ligaments around the elbow are not as developed as they are in adults, therefore it takes only a little force to pull the radius out of its place in the elbow. This usually happens when children are pulled from their wrist with their hands in extension or pulled suddenly from their arms. Generally, caregivers do this to avoid the child from falling from steps or stopping the child from doing something dangerous.

A radial head subluxation may also occur when a child is held by his/her wrist and swung around playfully.

Radial head subluxations rarely happen because of a fall. If the child’s elbow becomes extremely painful and he/she refuses to move his/her arm after a fall, then there may be more to a radial head subluxation - there may be a complete radial head dislocation or/and a fracture.

Patients with previous radial head fractures are more likely to get a radial head subluxation.

Using the arm with a radial head subluxation will be extremely painful for the child. Hence, the child will hold the arm close to his/her body and refuse to bend or rotate the elbow or use the arm.

A doctor can usually diagnose radial head subluxations by looking at how the child is holding his/her arm.

Although an X-ray is not required for your doctor to diagnose a radial head subluxation, he or she may order one to make sure there is no fracture.

The doctor will gently move the bones back into their normal position to fix a radial head subluxation. This procedure is known as reduction of a radial head subluxation and is done as follows:

• The doctor will hold the child’s wrist or forearm and rotate the hand outward till the palm faces up.
• While pressing near the top of the radius bone with his or her thumb, the doctor will slowly bend the elbow.
• When this happens, a small click may be heard which means reduction has been achieved.

Following the reduction, the child gets immediate relief from the elbow pain.

The doctor will leave the child and return after 10 minutes to check if the child can move his/her affected arm. Sometimes, the child may take 30 minutes to resume moving his/her hand normally.

If the child is still unable to move his/her hand normally, the doctor will repeat the reduction. If the child does not begin using the arm normally after such repeated attempts, an X-ray of the elbow will be taken to observe for broken bones.

Although a sling may be placed on the elbow for 24 hours, it is not required for most patients. Only if the symptoms last for several days, a sling may be worn for longer.

It is easy to prevent radial head subluxations in children by just taking a few precautions:

• Do not swing a child by holding his/her hands or arms.
• Do not tug or pull on a child’s hands or arms.
• Lift a child safely by grasping gently under his/her arms and not by holding his/her hands or arms.