Pulled Elbow

What is a pulled elbow?

A pulled elbow — also called nursemaid's elbow — happens when a ligament around the elbow slips out of its normal position. It's a typical injury of young children, usually between 1 and 4 years old, and almost always follows a sudden pull on the arm.

Common scenarios include lifting a child by the wrist, swinging them by the arms, or a child suddenly pulling away while their hand is held. The ligaments at this age are still developing and more prone to this kind of slip.

It's a benign and entirely reversible condition. Once the ligament is back in place, normal arm use returns within minutes to hours.

What does it feel like?

The story is usually clear:

• Sudden onset after a pull on the arm

• The child won't use the arm

• The arm is typically held slightly bent and turned inwards

• Refusal to bend the elbow or lift the arm

• Often, no swelling or obvious deformity

Children with a pulled elbow are usually distressed at the moment of injury but settle quickly. The hallmark is the unwillingness to use the arm rather than dramatic ongoing pain.

How is it diagnosed?

Diagnosis is typically clinical — the history and presentation are very characteristic. X-rays aren't usually needed when the picture is clear, particularly given that pulled elbow doesn't show on X-ray anyway.

Imaging is sometimes arranged when there's uncertainty about whether a fracture might also be present, particularly if the mechanism is unclear or there's swelling or significant pain.

Assessment also confirms there's nothing more serious going on — though pulled elbow is by far the most common cause of this presentation in young children.

What are the treatment options?

The treatment is a quick manipulation that returns the ligament to its proper position. The clinician performs a specific movement, often hearing or feeling a small click, after which the child usually starts using the arm again within minutes.

Once reduced, no further treatment is typically needed. Some children are prone to recurrence — if it happens once, parents are taught to recognise the picture and seek prompt assessment if it happens again. Nev will go through this with you at your consultation if relevant.

When should you get it checked?

Seek prompt assessment if:

• Your young child has stopped using their arm after a pull

• There's no swelling but they won't lift or bend the arm

• You suspect a pulled elbow but want it confirmed and treated

• There's also significant swelling, bruising or pain — to exclude a fracture

• You're not sure whether to be worried

Pulled elbow is reassuringly straightforward to diagnose and treat. The relief once the manipulation is done is usually immediate.