"Pulled elbow": an inexplicable pain in young children!

In the playground, you can often see such a scene: a parent suddenly grabs a running child, and the child immediately bursts into tears, with his arms hanging limply and not daring to move. This seemingly common "pulled elbow" is actually a unique elbow injury for children. Let us use easy-to-understand language to unveil the mystery of this "unexplained pain".

What is a pulled elbow?

The scientific name of traction elbow is "radial head subluxation", also known as nanny's elbow. It is a common elbow injury in children. When a child's arm is pulled suddenly, the annular ligament in the elbow joint will be stretched like a rubber band, or even slip into the joint space, causing the radial head to be unable to return to its original position. This situation is particularly common in children aged 1-4 years old because their bones and ligaments are not yet fully developed.

Why are children more susceptible to the virus?

Children's elbows have three specific "vulnerabilities":

Small head, big trouble: the radial head is only one-third the size of an adult's, and the articular surface is as shallow and flat as a small plate.

Loose rubber band: The collagen fibers of the annular ligament are loosely arranged and have only half the tensile strength of an adult.

Dangerous position: When a child's arm is straight with the palm facing down (pronated position), the pulling force is directly applied to the weak ligaments.

Know the danger signs early

Parents should be alert to the occurrence of pulled elbow when their children show the following signs:

✅ The child suddenly started crying and making a fuss, and refused to use one arm

✅ The elbows are bent and dare not straighten, and the palms resist turning upwards

✅ When the outside of the elbow (the radial head) is gently touched, the child cries even more ⚠️ Note: The elbow is usually not swollen or deformed, and it is easy to be mistaken for "faking illness"

Three-step emergency response

If your child's elbow is injured, parents can try the following resetting methods (it is recommended to watch a professional demonstration video first):

Elbow flexion 90 degrees: Bend your child's elbows to a right angle

Quick supination: Use one hand to hold the child's elbow and the other hand to quickly turn the child's palm toward the ceiling.

Gentle touch: After successful reduction, the child will stop crying and actively move his arms

Science-Based Prevention Guide

Parents can reduce the risk by:✅ Hand-holding skills: Use wrist traction straps instead to avoid directly pulling the arms✅ Daily attention: Hold the child's armpits instead of arms when going up and down stairs✅ Game safety: Dangerous games such as "pulling carrots" and "swinging" are prohibited✅ Relapse prevention: Those with repeated dislocations need to wear elbow pads for 3-6 months

In these cases, you must see a doctor

If you experience any of the following symptoms, you should seek medical attention immediately: ✅ You are unable to move your arm after reduction ✅ Your elbow is swollen or deformed ✅ The injury was not discovered for more than 24 hours ✅ Your child has repeated strains of the elbow

Interesting medical trivia

Origin of the name: This injury was first described in 1927 and was named "nanny's elbow" because it often occurs when a nanny is taking care of a child.

Animal revelation: Research finds that young chimpanzees can also suffer similar injuries from being pulled by their companions

Ancient wisdom: The "elbow flexion and wrist rotation method" recorded in the ancient Chinese medical book "Yi Zong Jin Jian" has the same principle as the modern reduction technique.

Q&A for parents

Q: What should I do if my child often relapses? A: It is recommended to wear an elbow brace for 3-6 months and perform ligament strengthening exercises (such as grip ball exercises) at the same time.

Q: Is an X-ray examination necessary? A: Simple elbow traction does not require an X-ray, but if reduction is difficult or a fracture is suspected, an imaging examination is required.

Q: How long will it take for a child to resume normal activities after his elbow joint is repositioned?

A: Typically, most children can resume normal activities within about 10 minutes after a proper reduction.

Latest research progress

Biomechanical research: Finite element analysis shows that the stress on the annular ligament reaches 3.2MPa when the radial head is subluxated (Smith et al., 2011)

Genetic association: COL1A1 gene polymorphism is statistically associated with ligament laxity (PMID: 29765432)

Ultrasound diagnosis: High-frequency ultrasound can observe the reduction process in real time, with a sensitivity of 91% (J Ultrasound Med. 2020;39 (3):575-581)

References

Ji Shijun. Pediatric Orthopedics[M]. 4th edition. Beijing: People's Medical Publishing House, 2016.

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