Dr. Carlos Rebollón
Babysitter's elbow or
Elbow pronation
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Nursemaid's elbow or Pronation of the elbow
Elbow pronation
Painful pronation is one of the most common traumatic injuries in preschool-aged children (2-6 years old). It is usually caused by an improper pull on the arm, which results in displacement of the radial head, leaving the child’s limb sore and partially immobile.
In these cases, it is common for the child’s arm to be locked in an extended position or, alternatively, bent with a 90° flexion.
Most partial dislocations of the elbow occur involuntarily when an adult (father, mother, uncle, grandparent, babysitter, etc.) pulls on the child’s arm to help them walk, lift, jump, or play.
This instantly causes pain and impairs arm function. There are few cases in which nursemaid’s elbow or elbow pronation occurs as a result of a fall or the child’s own incorrect movements.
WHAT IS NURSEMAID'S ELBOW?
Nursemaid’s elbow is simply a subluxation of the radial head. Remember that the elbow consists of three bones: the humerus, ulna, and radius, so any sudden pulling motion can cause the bones to slide out of place.
Elbow pronation is more prevalent in children than adults because the anatomy of young children has much looser ligaments, making them susceptible to this type of dislocation.
Diagnosing painful pronation is relatively simple. The specialist only needs to perform a careful physical examination of the upper limb and a complete medical history to gather information about what happened.
WHAT IS ELBOW PRONATION AND SUPINATION?
Pronation and supination are terms used to describe rotational movements of the elbows, hands, feet, wrists, among others. In elbow pronation, the pronator teres and pronator quadratus muscles are involved to allow the forearm to rotate and make the palm of the hand face downward. Supination has the opposite effect, allowing the palm to rotate upward.
Symptoms of Nursemaid's Elbow
The most evident symptom when a pronation of the elbow occurs is the onset of intense pain. Additionally, there may be a noticeable limitation in the child’s arm movements, as if it were locked. Generally, the forearm is positioned with the palm facing inward, in pronation.
Nursemaid’s elbow is a readily solvable injury; however, the pain, crying, and distress of the moment can create a state of panic in both the child and the adult.
It is worth noting that elbow pronation does not usually show visible marks, swelling, or deformities. Therefore, it is recommended to seek medical attention to assess the situation and perform the appropriate reduction maneuvers.
Treatments for Nursemaid's Elbow or Elbow Pronation
The primary treatment method for nursemaid’s elbow is reduction. These special maneuvers involving supination, flexion, or forced pronation allow the physician to relocate the radius back into place. It is advisable for the reduction maneuvers to be performed shortly after the injury to ensure immediate recovery without sequelae.
As a general note, there is no specific physiotherapeutic treatment for nursemaid’s elbow.
Maneuver to Correct Nursemaid's Elbow or Elbow Pronation
As mentioned in the previous point, there are two types of maneuvers:
Supination and flexion: The physician stands in front of the child, holding the elbow with one hand and the wrist with the other, and gently rotates the forearm upward while flexing the elbow to relocate the radius.
Forced pronation (hyperpronation): In this option, the forearm is rotated in the opposite direction, forced downward to achieve pronation.
At the end of both maneuvers, a clicking or snapping sound may be heard, indicating that the bone has properly returned to its place.
FAQs about Elbow Pronation
We provide answers to the most common questions regarding this topic…
At the moment the subluxation of the radial head occurs, the child may experience intense pain that gradually diminishes over time. However, the pain will reoccur whenever the child attempts to move the arm.
Clinical treatment for elbow pronation is practically mandatory, as it is a problem that does not resolve on its own.
Nursemaid’s elbow is primarily treated by pediatricians and orthopedists, as these specialists are capable of evaluating and diagnosing the condition without subjecting the child to unnecessary X-rays at a young age.
This injury typically occurs until the age of 5 or 6 when the bone, ligament, and joint structures become stronger. At this stage, the chances of encountering a situation that causes elbow pronation also decrease.
There are two very simple actions that can help prevent nursemaid’s elbow. Firstly, lift the child carefully by their armpits rather than their wrists. Secondly, avoid any sudden or forceful pulling when the child is holding an adult’s hand.
