What is a pulled elbow?

A ‘pulled elbow’ is a common injury amongst young children under the age of five years. It is not a dislocation. It is the result of a ligament that has slightly slipped over the head of one of the arm bones (radius) making it difficult and painful for a child to move their arm.

Why does it happen?

A pulled elbow happens because young children’s joints are not completely developed and the ring-shaped ligament is looser at this age.

How does it happen?

It happens as a result of a sudden pulling, stretching, jerking or swinging of the child’s hand or forearm. This is commonly done by either: 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 and it may occasionally even occur after a fall or, in a smaller child, simply rolling over on the arm.

Does it need an X-ray?

If it is clear from the story and signs that the child has a pulled elbow, an X-ray is not needed as there is no injury to the bones. An X-ray may be needed if the method of injury is unclear.

How is it treated?

Normally, a quick and simple manoeuvre will re-position the ligament back into the correct place by a nurse or a doctor. This 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. Your child will be checked before leaving the department.

Will it happen again?

There might be a tendency, if the child’s arm is tugged hard again for a ‘pulled elbow’ to reoccur. After the age of 5, it is unlikely as the bones get bigger and have matured.

Are there any long-term problems?

No. There are not thought to be any long-term problems to the elbow joint because of a ‘pulled elbow’.

What to do when discharged?

Your child should be comfortable and using their arm normally. If the manipulation is immediately successful we will not arrange to see them 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 for 2–3 days. The elbow will usually get 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 return to the Emergency Department for a further examination.
At home, your child may need some painkillers as necessary.

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.

If you have any further questions or concerns, please contact:
Paediatric Assessment Unit Emergency Department
Telephone: 01935 384788

If you need this information in another format, please telephone: 01935 384256

Ref: 10-17-117
Review: 03/19