April 10, 1995 in Features

Take It Easy On Children’s Elbows

Ann Doss Helms Charlotte Observer
 

A 2-year-old walking hand in hand with his mother stumbles, and she yanks the child’s arm to break the fall.

A sitter lifts a soggy toddler out of the bathtub by the arms.

A father grabs his preschooler’s hands and swings her into the air.

All these situations can end with the child shrieking in pain and the adult overwhelmed with guilt.

“Nursemaid’s elbow” - a partial dislocation of the elbow in young children - is so common that some medical experts say it accounts for 25 percent of all elbow injuries in children. Doctors know it usually doesn’t signal abuse.

But parents rarely have a clue as to what’s going on until it strikes their child.

“I feel like everybody should know about this, and nobody does,” said Bob Wodke of Charlotte, N.C., whose daughter, Brittany, now 4, suffered from nursemaid’s elbow when she was younger. Before the doctor explained it, he wasn’t sure whether to believe the sitter, who said it had happened when she helped Brittany out of the tub.

The good news is nursemaid’s elbow is easy to treat. A doctor gently rotates the elbow back into place. The pain vanishes and there’s rarely any lasting damage.

The injury happens when a child’s extended arm is pulled sharply. Doctors say they’ve seen it happen with something as simple as pulling a child’s arm through a sleeve.

“Parents always have a guilt feeling, but it’s really not anything bad they do,” said Dr. Leon Dickerson of Charlotte Orthopedic Specialists.

The injury usually happens before age 5; after that, a child’s ligaments mature and tighten. Two- and 3-year-olds, who are likely to dart, stumble or dash while reaching up to hold an adult’s hand, are most at risk (another common name is “temper-tantrum elbow,” named for kids who drop to the ground in a fit).

Because the injury doesn’t show up on X-rays and rarely requires surgery, doctors aren’t sure exactly what happens. Some believe there is a small tear in the ligament that holds the two bones of the forearm together; others say the ligament is not damaged but gets pinched between the forearm and upper arm bones.

What they’re sure of is that the child shows up in intense pain, refusing to use the arm.

The treatment is so simple that Dr. Andrew Asimos, an emergency medical physician at Carolinas Medical Center, doesn’t even do an X-ray anymore. With one of his hands on the child’s elbow and the other on the child’s hand, he gently rotates the arm until the bones and ligament return to their proper place. Technicians often accomplished the same thing just positioning the child’s arm for the X-ray, he said.

By the time the child stops crying in fear, the pain is gone, Asimos said.

“It’s enormously satisfying to treat,” he said. “The parents think you’re God.”


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