Nursemaid's elbow - revisited

Hi all,
Upon reading about nursemaid's elbow on this forum, I started doing my
own research, and many, many sites called it a "common" injury.
However, I have so far been unable to find out the incidence per year
of the injury. What are they considering "common"? I mean, I've
never heard of the injury until I read this forum, nor have I ever
known anyone with the injury. Small sample statistics aside, I've
swung at least 4 kids by the arms (both, not one), and none of them
have had problems, or been injured, nor was I ever injured by being
swung.

The deal is, I don't really want to stop doing 1-2-3 Wheee with Kivi.
It's fun. I loved it as a child, and so does Kivi. We also enjoy
spinning around, but I can hold her around the torso instead if need
be.

However, as a rational adult and mother, I'm concerned enough about it
to continue my research, because frankly, if there's a big risk of the
injury, then my enjoyment be damned, we'll have to stop.

In my research, I've found that it most often happens when the child
being held by the hand, and the child trips, and the parent holds the
child up, to prevent the fall, or when the child runs off, and the
parent grabs the hand, the child going one direction, the parent, the
other, though the injury can (but more rarely) happens when both arms
are being held.

I also searched on askdrsears.com (Dr Sear's website), and found this:

"PULLED ELBOW
You're in a supermarket, and your child darts from you, or it's time
to go and your child throws a tantrum. You grab your runaway by the
wrist. He yanks one way, you pull the other, and the elbow, which was
not made for this tug-of- war, pops out of the socket. Result: Your
child won't use his arm as it hangs limply at his side. This is a
pulled elbow, which your doctor or emergency room physician can easily
pop back into place without any lasting harm. During swinging play or
if you must grab your child by the lower arm, holding both arms is
unlikely to strain the elbow."

I also found lots of references to if it's happened once, then the
child is prone to repeats, until after age 4 or 5, when the tendency
is outgrown. That tells me that if a child is prone to it, then don't
do it, period. But what about children who aren't? I saw zero
references (and if anyone can find one, please let me know...my search
was by no means exhaustive) to the practice weakening the elbow in the
absence of the injury itself. (ie. do my brothers, stepson, daughter
and myself have weaker elbows now or as kids because we were swung by
both arms, but never actually had nursemaid's elbow?)

Finally, one other thing puzzles me. The most common cause of the
injury is when a child falls, while being held by the hand, and the
parent doesn't let go. Uh...what are we supposed to do? Let go? Let
the kid fall? That seems ... well, counter-intuitive.

I guess I'd like to hear from a Doc on this. CBI? Are you still
reading these boards?

Cathy Weeks
Mommy to Kivi Alexis 12/01

Cathy Weeks wrote:

Finally, one other thing puzzles me. The most common cause of the
injury is when a child falls, while being held by the hand, and the
parent doesn't let go. Uh...what are we supposed to do? Let go? Let
the kid fall? That seems ... well, counter-intuitive.

I use body harnesses on my twins and if they trip the harness supports
the fall.

--
Brigitte aa #2145
edd #3 February 15, 2004
http://www.babiesonline.com/babies/j/joshuaandkaterina/

"Readers are plentiful; thinkers are rare."
~ Harriet Martineau

Cathy Weeks wrote:

Hi all,
Upon reading about nursemaid's elbow on this forum, I started doing my
own research, and many, many sites called it a "common" injury.
However, I have so far been unable to find out the incidence per year
of the injury. What are they considering "common"? I mean, I've
never heard of the injury until I read this forum, nor have I ever
known anyone with the injury. Small sample statistics aside, I've
swung at least 4 kids by the arms (both, not one), and none of them
have had problems, or been injured, nor was I ever injured by being
swung.

The deal is, I don't really want to stop doing 1-2-3 Wheee with Kivi.
It's fun. I loved it as a child, and so does Kivi. We also enjoy
spinning around, but I can hold her around the torso instead if need
be.

However, as a rational adult and mother, I'm concerned enough about it
to continue my research, because frankly, if there's a big risk of the
injury, then my enjoyment be damned, we'll have to stop.

In my research, I've found that it most often happens when the child
being held by the hand, and the child trips, and the parent holds the
child up, to prevent the fall, or when the child runs off, and the
parent grabs the hand, the child going one direction, the parent, the
other, though the injury can (but more rarely) happens when both arms
are being held.

I also searched on askdrsears.com (Dr Sear's website), and found this:

"PULLED ELBOW
You're in a supermarket, and your child darts from you, or it's time
to go and your child throws a tantrum. You grab your runaway by the
wrist. He yanks one way, you pull the other, and the elbow, which was
not made for this tug-of- war, pops out of the socket. Result: Your
child won't use his arm as it hangs limply at his side. This is a
pulled elbow, which your doctor or emergency room physician can easily
pop back into place without any lasting harm. During swinging play or
if you must grab your child by the lower arm, holding both arms is
unlikely to strain the elbow."

I also found lots of references to if it's happened once, then the
child is prone to repeats, until after age 4 or 5, when the tendency
is outgrown. That tells me that if a child is prone to it, then don't
do it, period. But what about children who aren't? I saw zero
references (and if anyone can find one, please let me know...my search
was by no means exhaustive) to the practice weakening the elbow in the
absence of the injury itself. (ie. do my brothers, stepson, daughter
and myself have weaker elbows now or as kids because we were swung by
both arms, but never actually had nursemaid's elbow?)

Finally, one other thing puzzles me. The most common cause of the
injury is when a child falls, while being held by the hand, and the
parent doesn't let go. Uh...what are we supposed to do? Let go? Let
the kid fall? That seems ... well, counter-intuitive.


I haven't looked it up and am not an expert, but Adrian
dislocated his elbow twice. In his case, he did it once by
suddenly sitting down while holding hands with an adult and
we have no idea how he did it the second time (he was alone,
so somehow he did it to himself!). *My* feeling is that this
is a minor injury and not something to get too worked up about.
I would avoid hauling a kid around by his or her (single) arm,
but I wouldn't avoid playing games that involve lifting by
*two* arms (like 1-2-3- Wheeee! ;-) *IF* she gets a
dislocated elbow, then I'd worry about cutting out things
like being swung by two arms. I know many kids who've
had pulled elbows once or twice, and none have suffered
any lasting ill effects from it. In fact, the biggest
worry is the third degree you get from the health care
personnel as they try to figure out if you're a child
abuser!

Best wishes,
Ericka

"Cathy Weeks" wrote in message
om...
Hi all,
Upon reading about nursemaid's elbow on this forum, I started doing my
own research, and many, many sites called it a "common" injury.
However, I have so far been unable to find out the incidence per year
of the injury. What are they considering "common"? I mean, I've
never heard of the injury until I read this forum, nor have I ever
known anyone with the injury. Small sample statistics aside, I've
swung at least 4 kids by the arms (both, not one), and none of them
have had problems, or been injured, nor was I ever injured by being
swung.

I know what you mean here. I have 22 first cousins. Our uncles
used to do the airplane ride (1 arm, 1 leg), 2 arm swing, and flip
(pull up on two arms) at every family get together, which was
about once a month. Not once did I see this nurse maid elbow
thing.

So I was shocked when it happened when pulling my 18 month old off the
escalator with one arm. (I was worried it would eat
her toes, and I was holding packages.) The doctor on call met
us at his office. He said this was his favorite thing to fix,
because there were immediate results. And sure enough, 10
minutes later we were walking out, my daughter with one small
toy in each hand. :-)

The second time it happened I was playing volleyball, and
someone watching was doing a two handed swing. Blew
my theory on watching out for the one hand only type stuff.
Dr. on call said take her to the emergency. Took forever
because the doctor on duty couldn't get his daughter's arm
in the day before, and was afraid to try. Finally he got his
nerve up and tada! I've never seen a happier young doctor.

He taught me how to pop it back in. I only tried that once,
when she was pulling on my arm to go in a store she pulled
her arm out. Was able to get it back in fine.

Last time it was the summer before kindergarten. I had a
newborn at home, and hubby finally called me from the
emergency room. A preschool buddy pulled her elbow
out.

All of the doctor's said she would grow out of it. None
said she would have long term problems. She's now almost
14 and doesn't have problems despite lots of pulling and
stuff (she's a dancer).

I'm not sure I'd worry about a child you've been playing
arm games with and it hasn't happened yet. It seems kids
are either prone to it, or they're not.

The deal is, I don't really want to stop doing 1-2-3 Wheee with Kivi.
It's fun. I loved it as a child, and so does Kivi. We also enjoy
spinning around, but I can hold her around the torso instead if need
be.

However, as a rational adult and mother, I'm concerned enough about it
to continue my research, because frankly, if there's a big risk of the
injury, then my enjoyment be damned, we'll have to stop.

In my research, I've found that it most often happens when the child
being held by the hand, and the child trips, and the parent holds the
child up, to prevent the fall, or when the child runs off, and the
parent grabs the hand, the child going one direction, the parent, the
other, though the injury can (but more rarely) happens when both arms
are being held.

I also searched on askdrsears.com (Dr Sear's website), and found this:

"PULLED ELBOW
You're in a supermarket, and your child darts from you, or it's time
to go and your child throws a tantrum. You grab your runaway by the
wrist. He yanks one way, you pull the other, and the elbow, which was
not made for this tug-of- war, pops out of the socket. Result: Your
child won't use his arm as it hangs limply at his side. This is a
pulled elbow, which your doctor or emergency room physician can easily
pop back into place without any lasting harm. During swinging play or
if you must grab your child by the lower arm, holding both arms is
unlikely to strain the elbow."

I also found lots of references to if it's happened once, then the
child is prone to repeats, until after age 4 or 5, when the tendency
is outgrown. That tells me that if a child is prone to it, then don't
do it, period. But what about children who aren't? I saw zero
references (and if anyone can find one, please let me know...my search
was by no means exhaustive) to the practice weakening the elbow in the
absence of the injury itself. (ie. do my brothers, stepson, daughter
and myself have weaker elbows now or as kids because we were swung by
both arms, but never actually had nursemaid's elbow?)

Finally, one other thing puzzles me. The most common cause of the
injury is when a child falls, while being held by the hand, and the
parent doesn't let go. Uh...what are we supposed to do? Let go? Let
the kid fall? That seems ... well, counter-intuitive.

I guess I'd like to hear from a Doc on this. CBI? Are you still
reading these boards?

Cathy Weeks
Mommy to Kivi Alexis 12/01

Cathy Weeks wrote:

Hi all,
Upon reading about nursemaid's elbow on this forum, I started doing my
own research, and many, many sites called it a "common" injury.
However, I have so far been unable to find out the incidence per year
of the injury. What are they considering "common"? I mean, I've
never heard of the injury until I read this forum, nor have I ever
known anyone with the injury.

I think it is just so common that it is often a non-issue. It can happen
and the parent
not even know it or not know it until it is almost totally self-resolved.
The fact that once
it happens to a child that child is more likely to have it happen again
also makes it seem pretty 'common'.
IME, it is much more likely when a child is restrained or held by one arm
not two. A typical scenario is a 2 year old
who drops their legs out from under them in protest or runs for a busy
street and you yank them back. It may seem
counter-intuitive to let a child fall when you are holding their hand but
it isn't a hard habit to break, especially after one
elbow disclocation.
IMO, a little 1-2-3 WHEEE!!!!!! with equal distribution of Kivi's weight
between two parties, not too high off the ground and
not for a long duration is far from the end of the world. As for
spinning, I just hold my children under their armpits or by the arms
above
the elbow.

You know, we all make choices for our children. Some involve some modicum
of risk vs entertainment. 1-2-3 Wheee, trampolines, climbing trees,
go-karts, scooters, swimming in the ocean and on and on and on. Most of
the time everything is fine, sometimes it's not. Life goes on.

Karen

Cathy Weeks wrote:

Hi all,
Upon reading about nursemaid's elbow on this forum, I started doing my
own research, and many, many sites called it a "common" injury.
However, I have so far been unable to find out the incidence per year
of the injury. What are they considering "common"?

I looked around and found that it was called radial head subluxation, and with
that and "incidence" I did come up with the following, which doesn't address
national rates, but does show that it was commonly seen at this particular
emergency department, with almost ten cases per month over a nine-month period:

1: Ann Emerg Med. 1990 Sep;19(9):1019-23. Related Articles, Links
Radial head subluxation: epidemiology and treatment of 87 episodes.

Schunk JE.

Department of Pediatrics, Primary Children's Medical Center, University of Utah
School of Medicine, Salt Lake City 84113.

Radial head subluxation is a frequent upper-extremity injury in children.
Through a prospective study of patients seen in the emergency department, the
epidemiology and treatment were reviewed, and two methods of reduction were
compared. During a nine-month period, there were 87 episodes of radial head
subluxation in 83 children with six cases in infants 6 months old or younger. A
pull mechanism of injury was not identified in 49% of the cases. Girls were
seen more often than boys, the left arm was more frequently involved, and the
incidence of recurrence was 26.7%. The two reduction methods did not differ
significantly in their initial success rate. The presence of a click during a
reduction attempt had a positive predictive value of 92% and a negative
predictive value of 76%. Most children (76.8%) had return of arm use in less
than ten minutes. Slow return of arm use (more than ten minutes) was not
associated with delay in reduction but was associated with age of less than 2
years (P less than .001).

--Helen

"Cathy Weeks" wrote in message
om...
Hi all,
Upon reading about nursemaid's elbow on this forum, I started doing my
own research, and many, many sites called it a "common" injury.
However, I have so far been unable to find out the incidence per year
of the injury. What are they considering "common"? I mean, I've
never heard of the injury until I read this forum, nor have I ever
known anyone with the injury. Small sample statistics aside, I've
swung at least 4 kids by the arms (both, not one), and none of them
have had problems, or been injured, nor was I ever injured by being
swung.

I don't know how common it is. Nearly all references on the subject describe
it as "common" without giving a precise number (suggetsing that maybe there
aren't good stats). One textbook I have claims that it accounts for up to
25% of all elbow injuries in children under 7. Now we just need to know how
many that is. It is common enough that just about all pediatricians have
seen at least a few cases.

As some one else pointed out it has many names. "Pulled elbow syndrome" is
another "lay" term. While "subluxation of the radial head" seems to be the
most comon medical term for it I have also seen it described as "acute
annular ligament interposition into the radiocapitellar joint", "annular
ligament displacement", and others.

Basically, the radius (the forearm bone on the same side as the thumb) has a
ligament that loops around the top part (the head) and holds it in place.
Since ligaments are more lax in kids in general and the radial head has a
less bulbous shape in small children it is easier for young kids (usually
under 5) to have it slip out of place. The ligament ends up in the space
between the radius and the humerus (upper arm bone). The common description
is for it to be caused by some kind of rapid jerking motion, such as the kid
who trips while his hand is being held. I saw one case where the kid somehow
manged to fall off his bike and get his arm caught in the chain (I still
can't picture it).

The good news is that it is almost always easy to fix and leaves no
permanent problems. Some have even advocated trying to talk the parent's of
kids with a good history through the reduction procedure before referring
them to the ER. Several procedures have been shown to work (although all
authorities will confidently tell you THE way to do it) suggesting to me
that almost any manipulation of the elbow that is in the right ball park is
likely to do the trick.

The bad news is that there are a few cases that do not reduce easily and
require surgery. It seems that the time until treatment is one important
risk factor for this.


The deal is, I don't really want to stop doing 1-2-3 Wheee with Kivi.
It's fun. I loved it as a child, and so does Kivi. We also enjoy
spinning around, but I can hold her around the torso instead if need
be.

However, as a rational adult and mother, I'm concerned enough about it
to continue my research, because frankly, if there's a big risk of the
injury, then my enjoyment be damned, we'll have to stop.

Personally, I lift my kids (both under 5) by the arms all the time. I am
conscious of the issues and try to not include any rapid or jerking motions.
The bottom line is that everyone just needs to decide for themselves how
much risk they are willing to accept.



I also searched on askdrsears.com (Dr Sear's website), and found this:

.....During swinging play or
if you must grab your child by the lower arm, holding both arms is
unlikely to strain the elbow."

Unlikely - yes. But there are reported cases of having a nursemaid's elbow
on both sides at once!


I guess I'd like to hear from a Doc on this. CBI? Are you still
reading these boards?

I'm doing very little on the computer at all lately - and even less reading
groups. I came and found this message in response to your e-mailing me
(you're now added to the address book BTW). I figured it was better to
respond here than in private e-mail.

--
CBI

"Cathy Weeks" wrote in message
om...
Finally, one other thing puzzles me. The most common cause of the
injury is when a child falls, while being held by the hand, and the
parent doesn't let go. Uh...what are we supposed to do? Let go? Let
the kid fall? That seems ... well, counter-intuitive.

This happened to me with a 3 year old while I was teaching at a daycare.
Talk about horrifying!

We were holding hands walking down the hall and all of a sudden she decided
she didn't want to go anymore and dropped right down to the floor. Her elbow
slipped out. Thankfully (well, for me as the teacher) this had happened
before more than once and her parents were actually worried about *me* being
upset about it! I think it is pretty common.
--
JennP.
mom to matthew 10/11/00
EDD 4/4/04

"Sophie" wrote in message ...
Charlotte had nursemaid's elbow. We ended up in the ER 3 times for it.
What exactly are you asking about it?

Mostly, I want to know the incidence per year. How many kids get it,
so I can figure out what "common" means, so I can make a better
informed decision.

Cathy Weeks
Mommy to Kivi Alexis 12/01

"Sophie" wrote in message ...
Charlotte had nursemaid's elbow. We ended up in the ER 3 times for it.
What exactly are you asking about it?

Sophie! Long-time no see! How are things going?

Cathy Weeks
Mommy to Kivi Alexis 12/01