A pulled elbow is a common elbow injury seen in childhood, more so in children less than 5 years of age. The elbow joint is a hinge joint made up at the meeting of the ends of 3 bones – the upper end of the radius and the ulna (both of which are the bones of the forearm) and the lower end of the humerus, which is the bone of the upper arm. A strong ligament loop around these bones, helping to hold them in a place during movements. The ligament holding the bones of the elbow joint may not be fully developed and tough in children, particularly the ligament which loops around the neck of the radius bone. Any movement causing a sudden tugging or stretching of this ligament can allow the head of the radius to slip out of this loop and trap a part of a ligament under the bone. This is what we call as a pulled elbow. In medical terms refer to as subluxation of the radial head.
Usually the child present with the typical history where the elbow joint was pulled in an act such as holding on to the child’s arm to prevent a fall, the child pulling away forcefully from parents in a temper tantrum, the child is being swung around by the arm, lifting a child up by the arm, a fall on an outstretched arm or a forceful push against an outstretched hand such as a motorcycle accident. Soon after any such incident the child might cry in pain for a while after which he/she may calm down, but will refuse to move the affected arm at the elbow.
Any child refusing to move their arm needs prompt medical attention. Upon obtaining a typical medical history and performing a physical exam, which may reveal no pain on pressing but, the child has a limitation of movements and has pain upon trying rotational movement at the elbow joint, your doctor can arrive at the diagnosis. Usually, no x-rays are needed unless there is a suspicion of any broken bones.
In terms of management, the child will be given some painkillers and sometimes sedation might be required before your doctor performs a non-surgical reduction maneuver to reset the elbow in position. Now, the procedure is quick and can produce pain but once successfully done the child gets immediate relief and return of normal functioning in about 10-15 minutes. The child is sent home on a sling for 10 days to allow rest and healing of the ligament. Avoid pulling or lifting the child by the arm as any such action may prompt recurrence of a pulled elbow.