Pulled elbow (radial head subluxation)

Pulled elbow is a common injury suffered by children usually between the age of 1 and 5 years. Young children’s ligaments (the elastic-like bands that hold bones together) are slightly loose so it is easier for a ligament in the elbow to slip out of place. It is unusual for children over 5 years old to get a pulled elbow, as their ligaments are less stretchy. In most cases, children with a pulled elbow will cry straightaway and will not then use the injured arm normally.

It is normally the result of a sudden pulling or jerking action on the child’s arm or forearm, for example:

• Pulling a child up or swinging them by the hands
• Jerking an arm when holding a toddler’s hand while walking

This sudden tug on the arm pulls the radius bone through the annular ligament. The ligament may partially tear and become trapped between the radial head and the capitellum.

Following this the child will usually hold the arm in a straight position or with a slight bend in the elbow. The injury does not usually cause swelling or bruising. It is not the same as a dislocation where the bones in the joint are not lined up correctly.

The elbow should be manipulated (put back into place) by a nurse or doctor; this will only take a few seconds. The child will be able to sit on a parent or carer’s knee for the procedure. The doctor/nurse will then gently take the arm from a straight position and bend it upwards or straighten the arm while turning the palm to the floor.

The child will usually feel a brief moment of pain during the procedure, but quickly feel much better. Most have full use of the arm within 5 to 10 minutes. Some children may need this procedure to be repeated (especially if the pulled elbow happened less recently) before the ligament returns to normal. Often children may not want to use the arm after the procedure, fearing it will be painful but once they have their attention on playing they will forget the experience.

If the nurse or doctor is sure that the injury is a pulled elbow, an X-ray is not needed as there is no injury to the bones

Usually your child will not need pain relief medication but if the elbow was 'out' for a while, then your child may need some pain relief medication on the day of the treatment. If your child is not moving their arm fully by the next day, they will need to return either to a Minor Injuries Unit or Emergency Department. Children who have had a pulled elbow might get it again.

This can be prevented by being mindful of the risk and avoiding pulling, tugging, or swinging your child by the arms or hands. Please share this advice with anyone who provides care for your child. Please visit the NHS Choices website for further information.