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The scenario is usually similar: the guardian walks the child’s hand, the child suddenly leaps up or stumbles, and the guardian pulls the hand involuntarily. That’s enough. The child experiences severe elbow pain and requires medical attention. There is a great deal of remorse, because none of the guardians wanted to hurt the child. We calm down, the so-called Nursing elbow (de Chassaignac disease) is a very common musculoskeletal injury in young children and is directly related to its age.
- Doctors agree that the caregiver’s elbow is a permanent injury during their shifts
- Usually, it is not the guardian’s fault, but an unfortunate coincidence
- Interestingly, elbow subluxation most often occurs between the ages of 2 and 3, due to anatomical conditions
- More information can be found on the Onet homepage
Nurse’s elbow – what is this disease?
Nursing elbow (Nursing elbow, de Chassaignac disease)by definition: subluxation of the radial head due to a force acting axially upwards, with subsequent dislocation of a fragment of the annular ligament. As a result of pulling the child’s hand vertically upwards, there is an interposition between the articular surfaces of the head of the radial bone and the head of the humerus. Simply put, because between the ages of 2 and 3, the head of the radial bone is not yet fully formed, when subjected to vertical force, it can literally slide out of the joint, where it joins the humerus. It causes great pain and requires an attitude.
Although there are different opinions about this injury in the literature, two-year-olds are most at risk. In children of this age, the head of the bone is not yet fully developed and the ligament surrounding it is not very stable. It doesn’t take much force to unhappily subluxate.
In what everyday situations is the most common trauma?
- When the child falls or trips when the parent tries to hold his hand
- During a sudden breakaway of a child walking by the hand
- When the child stumbles down the stairs by the hand
- During games where the child jumps up violently and is held by straightened arms
Sometimes individual physical conditions mean that the child has a greater risk of such an injury – e.g. in the case of greater clearance within the ligament.
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What are the symptoms of a babysitter’s elbow?
First of all, the baby experiences severe pain, which most often causes uncontrolled crying. The pain is located near the elbow and radiates towards the wrist. Usually, no distortion in the joint area or swelling can be seen. The hand hangs down alongside the body, with the thumb pointing towards the body. The elbow is somewhat locked, slightly bent and cannot be moved by the child. It happens that the child has an arm slightly bent and pressed against the body (as in a sling).
How is such an injury treated?
Fortunately, repairing the damage is quite a routine procedure, however, due to the pain experienced by the young patient, the procedure should be performed under anesthesia. After proper diagnosis and excluding other injuries or damage to the limb, the doctor should straighten a subluxated elbow. Usually, in the diagnosis of de Chaassaignac’s disease, even X-ray images are not needed.
After adjusting the elbow joint and inserting the bone head under the ligament, your child should feel immediate relief. It is recommended to briefly save the sore hand. In practice, full efficiency returns within a dozen or so minutes or within the first hours of the medical assistance provided. Most often limb immobilization is not used, and if the arm is in a sling, the children themselves quickly give it up.
In some people, an elbow subluxation may turn out recurrent around 5 to 6 years of age. At this age, the annular ligament surrounding the head of the radial bone begins to strengthen and the susceptibility to injury increases again.
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Be careful with games
Although the colloquial name of the injury itself – nurse’s elbow – refers to the caregivers’ guilt, it is an unfair stereotype. The most common mechanism for the occurrence of an injury is when the child stumbles or falls while walking with the hand, and the caregiver tries to hold them down and prevent them from falling. This action has nothing to do with jerking or pulling the baby’s hand while walking. However, one should not forget about the extremely popular game, which can end in unnecessary tears. Many small children even love to make a swing with their parents. Adults, seeing how much fun it is to play for a child, willingly accept such play, helping the child to jump and swing in this position. There is a risk that a child may be injured while playing. This is where it is very easy to find the right conditions for a subluxation: the child’s arms are straight and up, and a jerk occurs when landing from a jump.