Radial Head Subluxation

Topic Overview

What is radial head subluxation?

Radial head 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 normal place.

The radius connects to the elbow joint at one end; the other end connects into the wrist joint.

What causes a radial head subluxation?

Radial head 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 subluxation include:

  • 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 inward (pronates).
  • Crying. Your child may cry from the pain and because he or she feels scared.
  • Pain anywhere between the hand and shoulder.

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. Usually 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 normally.

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 child.

Be sure to follow your doctor's directions on how to care for your child after a radial head subluxation.

Related Information

References

Other Works Consulted

  • 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 York: McGraw-Hill.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Revised February 16, 2011

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