subluxation means that the radius, one of two long
bones in the lower arm (forearm), has pulled away from its normal position. The
ligament that supports the radial bone then slips into
the elbow joint. When this happens, the radial bone can't move back into its
The radius connects to the elbow joint at one end;
the other end connects into the wrist joint.
What causes a radial head subluxation?
subluxation usually occurs in young children. It happens when a young child is
pulled or lifted by the hand or wrist while his or her arm is held straight.
For example, the bone can pull out of position, or sublux, when you try to lift
a child up onto a sidewalk by the hand, pull a resistant child's hand to get
him or her to move faster, or hold onto a child's hands and swing him or her
around while playing.
Radial head subluxation most often occurs
in young children because the socket of the elbow joint and the supporting
ligaments are not fully developed. This injury is especially common in children
between ages 2 and 3 years, although it can happen anytime between 6 months of
age and 7 years. After age 3, children's joints and ligaments gradually grow
stronger, making radial head subluxation less likely to occur.
This injury is sometimes called "nursemaid's elbow." Although physical
abuse is sometimes the cause of this injury, most often a parent, caregiver, or
sibling is simply playing or is trying to help or hurry a child along. But if
the injury recurs often, abuse may be suspected.
What are the symptoms?
Symptoms of radial head
Refusal to move the arm. Your child may keep the arm dangling
down the side of his or her body. Sometimes the dangling arm turns slightly
Crying. Your child may cry from the pain and
because he or she feels scared.
Pain anywhere between the hand and
Medical attention is needed if your child has symptoms of
radial head subluxation.
How is a radial head subluxation usually diagnosed?
Your doctor usually suspects the injury from your report of how it
happened, your child's symptoms, and results of the physical exam. The doctor
will feel different areas of the arm and try to move it into certain positions.
X-rays of the elbow are not needed. But your doctor
may order one to find out if your child has a more serious injury.
How is it treated?
Radial head subluxation should
be treated by a doctor.
Allow your child to keep the
arm in the most comfortable position until you get medical help.
You can also put an ice pack on your child's elbow. But if your child
resists, don't insist. Be careful not to move your child's arm from his or her
most comfortable position.
A doctor will move your child's arm to
free the trapped ligament and put the end of the radius back into its normal
position. The doctor rotates your child's forearm. At the same time, he or she
gently bends your child's arm at the elbow up toward the shoulder. Usually,
your child starts feeling better right away, although sometimes the pain
lingers for a bit. It may take from 30 minutes to a few hours for him or her to move the arm
The doctor may place a sling or splint on your child's
arm to wear until all pain is gone. If your child can move the arm normally
without pain soon after treatment, a sling or a splint is not needed.
What should I do after my child is treated for radial head subluxation?
Although your child heals quickly, he or she has a
greater chance of having another radial head subluxation, especially in the
first few weeks after being injured.
Be careful in how you hold or lift your
child. When you lift or swing your child, hold him or her under the arms. This
includes when you lift your child up onto a higher surface (such as a sidewalk
or equipment at a playground).
Use care when walking with your
child as you hold his or her hand or lower arm (forearm). If a child pulls back
or resists, stop. Don't pull your child. Wait until he or she is ready to go
with you without resistance. If this is not possible, pick up your
Be sure to follow your doctor's directions on how to care
for your child after a radial head subluxation.
Eilert RE (2005). Trauma section of Orthopedics. In WW
Hay Jr et al., Current Pediatric Diagnosis and Treatment, 17th ed., pp. 818–820. New York: McGraw-Hill.
Hopkins-Mann C, et al. (2004). Upper extremity
injuries section of Musculoskeletal disorders in children. In JE Tintinalli et
al., eds., Emergency Medicine, 6th ed., pp. 878–882. New
Primary Medical Reviewer
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
How this information was developed to help you make better health decisions.