Leaflet number: 398
Review due date: January 2018
What is a pulled elbow?
A pulled elbow is a common minor injury affecting children under the age of 5 years. It occurs when one of the forearm bones called the radius partially or completely slips out of the ligament which secures it in place at the elbow. Medically this is known as a ‘radial head subluxation’.
What causes a pulled elbow?
Pulled elbows happen because young children’s joints are not completely developed and the ring shaped ligament is looser at this age. Any sudden pulling, lifting, jerking or swinging of the child’s hand or forearm may cause it to slip.
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.
What are the symptoms?
If your child has had a sudden pull or jerk to its arm, your child may be in sudden pain, may cry and appear anxious, and be unable to fully bend their elbow. Your child will be reluctant to use its arm, which may hang loosely at their side or across their tummy.
How is it diagnosed?
Telling the healthcare professional the story of how it occurred and an examination of your child’s arm will help us diagnose a pulled elbow. An x-ray is not normally necessary because the ligament will not show up, and there is no suspicion of a break or dislocation of the joint.
How is it treated?
Initially your child will be given simple pain killers such as paracetamol or ibuprofen. Your child’s forearm will then need to be moved in a particular way to manipulate the head of the radius bone back into the ligament. This is a quick and simple manoeuvre, but 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 start to use their arm normally, especially if distracted by playing with a toy.
Possible effects of treatment
Occasionally this manipulation may not successful in getting your child to move its arm immediately. If this is the case it is possible that an x-ray will be performed to rule out any other possible diagnoses. The treatment will then be to rest your child’s arm in a sling as spontaneous correction will normally occur within 2-3 days.
Sometimes your child’s elbow may be slightly swollen and painful after the injury. If this is the case, you should give some regular simple pain killers such as paracetamol or ibuprofen for a few days.
What is the prognosis or expected outcome of treatment?
Your child is expected to make a full recovery within a few days.
Are there any possible complications?
It is extremely rare for a pulled elbow to result in any long term damage.
If you have any concerns that your child’s arm has not recovered within 2-3 days, you should either return to the Emergency Department for a further examination or make an appointment to see your GP.
If the manipulation is immediately successful we will not arrange to see your child again.
If there are any concerns that it has not worked straight away we will make an appointment to see your child again in the Emergency Department clinic 2-3 days later.