CHILDREN’S HEALTH: DISLOCATED ELBOW
A dislocated elbow (Malgaigne’s subluxation) is a condition in which the bones are out of their proper place in the joint. Actually, a dislocated elbow is not completely out of place. Therefore, it is more properly called a “subluxation” (partial dislocation). It is also known as “nursemaid’s elbow.” It is the only common dislocation in young children. It frequently occurs between one and three years of age; it is rare beyond age four.
The elbow contains two separate joints. The larger is a hinge joint that allows the forearm to bend and to straighten in relation to the upper arm. The smaller, less obvious joint of the elbow is between the upper ends of the two bones of the forearm (radius and ulna). This smaller joint allows the forearm to rotate, to turn the palm up and down. It is this smaller joint (radioulnar joint) that is partially dislocated when there is a sudden yank on the child’s hand or wrist. It may occur when a parent tries to save the child from a stumble or fall. It may also occur when a child is swung around by the wrists in a game or when the child tries to grab a handhold to prevent falling.
Signs and symptoms
When an accident causes a dislocated elbow, there is immediate pain. The pain may be felt anywhere from the elbow to the wrist. The child refuses to use the affected arm, clutching it against the side with the good arm. The child holds the affected arm with the palm of the hand facing back. Attempts to turn the palm forward cause pain. Swelling of the wrist and hand develops several hours later. If you know that the arm has been yanked and the child holds the arm with palm facing back, a dislocated elbow is a likely cause. However, if you do not know that the arm has been pulled, you may not realize the cause of the problem. A dislocated elbow is commonly mistaken to be an injured wrist.
Home care
The first time you suspect your child has a dislocated elbow, have a doctor treat it.
A dislocated elbow tends to occur again, however. There is a simple procedure for correcting a dislocated elbow, which parents can frequently do themselves. Your doctor may teach you the procedure if the elbow becomes dislocated often. If this manoeuvre is done within a few hours of the accident, a sharp snap or click is heard and actually felt near the elbow. The child is immediately relieved of pain and can use the arm freely.
Caution: Do not attempt to correct a dislocated elbow unless you have been taught the correct procedure by a doctor.
Precautions
• Do not use the procedure for correcting a dislocated elbow unless the symptoms exactly fit the description and you are sure the arm has been yanked. A fracture (break) of a forearm bone can produce similar symptoms. • A dislocated elbow should be treated as soon as possible. If the elbow is dislocated for more than a few hours, correcting it may be more difficult because of the swelling; then for one to two days after correction, the arm may still be sore and not fully usable. • After an elbow is dislocated, the joint remains susceptible to another dislocation for three to four weeks. Be careful.
• Make a habit of lifting your child by the upper arms or under the armpits. Do not lift a child by pulling on hands, wrists, or forearms.
Medical treatment
Your doctor will determine if the elbow is dislocated and may request an X ray to be sure there are no broken bones. (Sometimes, positioning the arm for the X ray returns the dislocated bone to its proper place.) After the diagnosis is certain, your doctor will correct the dislocation using the standard procedure mentioned.
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