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Radial head subluxation means that the radius, one of two long bones in the lower arm (forearm), has pulled away from its normal position. The ligament that supports the radial bone then slips into the elbow joint. When this happens, the radial bone can't move back into its normal place.
The radius connects to the elbow joint at one end; the other end connects into the wrist joint.
Radial head subluxation usually occurs in young children. It happens when a young child is pulled or lifted by the hand or wrist while his or her arm is held straight. For example, the bone can pull out of position, or sublux, when you try to lift a child up onto a sidewalk by the hand, pull a resistant child's hand to get him or her to move faster, or hold onto a child's hands and swing him or her around while playing.
Radial head subluxation most often occurs in young children because the socket of the elbow joint and the supporting ligaments are not fully developed. This injury is especially common in children between ages 2 and 3 years, although it can happen anytime between 6 months of age and 7 years. After age 3, children's joints and ligaments gradually grow stronger, making radial head subluxation less likely to occur.
This injury is sometimes called "nursemaid's elbow." Although physical abuse is sometimes the cause of this injury, most often a parent, caregiver, or sibling is simply playing or is trying to help or hurry a child along. But if the injury recurs often, abuse may be suspected.
Symptoms of radial head subluxation include:
Medical attention is needed if your child has symptoms of radial head subluxation.
Your doctor usually suspects the injury from your report of how it happened, your child's symptoms, and results of the physical exam. The doctor will feel different areas of the arm and try to move it into certain positions. Usually X-rays of the elbow are not needed. But your doctor may order one to find out if your child has a more serious injury.
Radial head subluxation should be treated by a doctor.
Allow your child to keep the arm in the most comfortable position until you get medical help.
You can also put an ice pack on your child's elbow. But if your child resists, don't insist. Be careful not to move your child's arm from his or her most comfortable position.
A doctor will move your child's arm to free the trapped ligament and put the end of the radius back into its normal position. The doctor rotates your child's forearm. At the same time, he or she gently bends your child's arm at the elbow up toward the shoulder. Usually, your child starts feeling better right away, although sometimes the pain lingers for a bit. It may take from 30 minutes to a few hours for him or her to move the arm normally.
The doctor may place a sling or splint on your child's arm to wear until all pain is gone. If your child can move the arm normally without pain soon after treatment, a sling or a splint is not needed.
Although your child heals quickly, he or she has a greater chance of having another radial head subluxation, especially in the first few weeks after being injured.
Be sure to follow your doctor's directions on how to care for your child after a radial head subluxation.
Other Works Consulted
Eilert RE (2005). Trauma section of Orthopedics. In WW Hay Jr et al., Current Pediatric Diagnosis and Treatment, 17th ed., pp. 818–820. New York: McGraw-Hill.
Hopkins-Mann C, et al. (2004). Upper extremity injuries section of Musculoskeletal disorders in children. In JE Tintinalli et al., eds., Emergency Medicine, 6th ed., pp. 878–882. New York: McGraw-Hill.
Current as of: June 26, 2019
Author: Healthwise StaffMedical Review: William H. Blahd, Jr., MD, FACEP - Emergency MedicineAdam Husney, MD - Family MedicineKathleen Romito, MD - Family Medicine
Current as of: June 26, 2019
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine
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