Emergency and Urgent Care - Pulled Elbow

This leaflet contains discharge advice following your attendance to the Accident & Emergency Department (A&E).

Your child has suffered a pulled elbow also known as “radial head subluxation”. There is no broken bone/fracture. The injury involves a ligament known as the annular ligament in the elbow see below:

Within the elbow joint there is a bone called the radius which sits in a ring type ligament (annular ligament). As adults our radius bone sits comfortably within this ligament. As children are still growing and the bone has not yet fully developed, the bone can sometime slip out of the ring causing a “pulled elbow”.

This happens when the lower arm is pulled suddenly, such as when someone has tried to prevent a fall by holding onto the arm or hand, or when a child is lifted or swung by their arms, it may also happen if a child twists the arm.

Your child will stop using the affected arm usually from the elbow down, they will complain of pain on any movement, assisted or not. Your child will be observed dangling or guarding his/her arm.

When the doctor or nurse assesses your child they will ask for a detailed history of what has happened and how. This will help give us the diagnosis of a pulled elbow.

How we treat a pulled elbow

The doctor or nurse who has seen your child will have to perform a manipulation procedure to put the bone back into place. This procedure is usually very successful but can cause some pain and upset to your child. Children generally recover very quickly and start to use their arm/elbow normally again.

There are no long-lasting effects of the injury but sometimes it is unavoidable and can happen again.

If the 1st manipulation procedure fails we will not try a second time, this would be too distressing to your child. We may provide a sling and bring you back to A&E consultant’s clinic for a further review in 2-3 days. An appointment will be made for you. By this time the pulled elbow may have resolved by itself, this happens a lot, if not further management will be arranged.

Give your child regular pain killers:

• Give simple pain killers such as paracetamol and/or ibuprofen which can be purchased from a chemist or shop
• Always give medication according to manufacturer’s instructions

If all was successful and your child is using their limb normally no follow up with be required.

If you have any concerns please contact your local Accident & Emergency department for further advice on:

Telephone: 0161 627 8926
The Royal Oldham Hospital, Rochdale Road, Oldham, OL1 2JH