Subluxation of the Radial Head (Pulled Elbow)

Children’s Emergency Department

Colchester Hospital

Tel: 01206 742847

What is a pulled elbow?

A pulled elbow is a common minor injury which usually affects children under the age of five years.

It occurs when one of the forearm bones (the radius) partially slips out of the ring-shaped ligament which secures the neighbouring bone (the ulna) at the elbow, thus causing pain and reduced movement.

More Information

A pulled elbow happens because young children’s joints are not completely developed and the ligament is looser at this age.

Usually the arm has been stretched or pulled forcefully from the wrist.

Any sudden pulling, jerking or over-extension of the limb can cause this to occur, however. A child may also cause this injury by simply rolling over on the arm.

Your child may initially cry and then refrain from using the limb fully. To prevent use they may hang it by the side of their body and will usually become distressed once moved or touched.

Taking the history of the event is crucial in diagnosing this injury.
An X-ray is not usually required to diagnose this injury because ligaments will not show on X-rays.

If your child seems in pain, simple pain relief is advised. Once the diagnosis has been made, the nurse or doctor will need to undertake a procedure to manipulate it back to the correct position. This is a quick and simple procedure but will cause brief discomfort.

Following the procedure your child may be observed (usually in the waiting room, where they are distracted by toys) to ensure they are using it fully with no pain or tenderness.

In some children this may take a little longer than others. If the practitioner is satisfied the procedure was successful, you will be discharged home where your child can begin to use the arm in the comfort of his or her own home.

Your child is expected to make a full recovery within a few hours. If the manipulation is successful, we will not need to see you again. Occasionally the procedure may need to be repeated or you may be asked to return for a review.

In some children this can reoccur fairly easily. You can avoid reoccurrence by not playing games that involve swinging or pulling on that arm.

It is extremely rare for this injury to result in any long-term complication and usually pulled elbow stops occurring as the child develops.

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