Emergency and Urgent Care - Pulled Elbow Advice

What is a pulled elbow? 

• A pulled elbow is a common injury amongst children under the age of five to six. It is a result of the lower arm (radius bone) slipping out of its normal position at the elbow joint
• A ligament normally holds the bone in place, but in some children the ligament is stretched (such as with a sudden pull) and the bone (radial head) partially slips out from underneath the ligament
• It is caused by a sudden yank or pull on a child's lower arm or wrist, such as when a child is lifted up by one arm. It can also happen when a child falls onto an outstretched arm, or when turning over in bed
• It is unusual for children over five to get a pulled elbow, as their joints are a lot stronger. In most cases, children with a pulled elbow will cry straightaway and not use the injured arm at all, or simply have it hanging by their side
• This is not the same as a dislocation, but can be painful and needs to be manipulated back into place

Treatment

• The partial dislocation will be reduced or manipulated (put back into place) by a nurse or doctor
• This procedure is painful and distressing but only lasts a short moment (until the radial bone 'pops' back into place)
• An X-ray is not necessary to diagnose a pulled elbow
• Your child will be observed for a short while to check that they are using their arm without any problems or pain. Using the arm normally may be possible almost immediately after the elbow is 'reduced', or it might take a bit longer
• The longer the elbow has been out of place, the longer it takes to fully recover
• Your child may be given medication for pain, and can continue on this at home for 24 hours post manipulation
• If a pulled elbow is not able to be put back into place or your child is still not using the injured arm, an X-ray may be ordered to check for other possible injuries such as a fracture (break)

If manipulation is unsuccessful; we often send you home as your child will usually relocate the bone whilst they are wriggling around in their sleep.

What to expect

• A pulled elbow will not cause any permanent or long term damage to your child
• Some children are more likely than others to sustain this type of injury. It can happen more than once and in some children it occurs several times. This will not cause your child any long term or permanent damage if treated promptly and appropriately
• The longer the elbow has been dislocated the more painful and difficult it is to relocate, so prevention is the key

Prevention

• Make sure you don't pick your child up by the lower arms or wrists and teach others (such as grandparents and child care workers) to do the same. This is very important to save your child from having the same injury happen again

Things to look out for:

• If your child’s arm remains painful
• Your child is still not using their arm
• You think they have another pulled elbow

Then return to the Urgent Care Centre or go to an Emergency Department.