Red flags & when to go in person for Nursemaid’s Elbow (Radial Head Subluxation) - Triage

Audience: pediatric

Nursemaid’s Elbow, also called Radial Head Subluxation, is a common injury in young children where the elbow joint partially slips out of place. It often happens when a child’s arm is pulled or twisted suddenly. This injury can cause pain and make the child avoid using the affected arm. Many cases can be safely evaluated and managed through telemedicine, where a healthcare provider guides parents or caregivers on what to observe and when to seek in-person care. However, some signs mean the child needs urgent medical attention. These include severe pain, swelling, deformity, or if the child cannot move the arm at all. This guide helps families understand when telemedicine is appropriate and when to go to a clinic or emergency room. It also explains what to prepare for a tele-visit and what to do afterward. Remember, telemedicine advice is educational and not a substitute for in-person evaluation when serious symptoms are present.

Red flags — go in person / ER

• Severe pain or inconsolable crying after injury — seek emergency care immediately.
• Visible deformity, swelling, or bruising around the elbow — go to a clinic or emergency room.
• Inability to move the arm or signs of numbness/weakness — urgent in-person evaluation needed.

What telemedicine can do

• Initial assessment of typical Nursemaid’s Elbow symptoms via video.
• Guidance on home care and monitoring.
• Advice on when to seek in-person care.

What telemedicine cannot do

• Performing physical manipulation to reduce the subluxation.
• Diagnosing fractures or other serious injuries.
• Managing severe pain or neurological symptoms requiring urgent care.

What is Nursemaid’s Elbow?

Nursemaid’s Elbow, or Radial Head Subluxation, happens when the radius bone in the elbow partially slips out of its normal position. This usually occurs in children under 5 years old due to a sudden pull or twist on the arm, such as when lifting or swinging a child by the hands. The injury causes pain and limits the child’s ability to move the arm normally. It is a common and generally treatable injury with prompt care.

Common Signs and Symptoms

Children with Nursemaid’s Elbow often hold the affected arm slightly bent and close to their body. They may refuse to use or move the arm and show signs of discomfort or mild pain. Swelling and bruising are usually minimal or absent. The child may cry or be fussy but often feels better once the arm is gently repositioned by a healthcare provider.

When to Use Telemedicine for Nursemaid’s Elbow

Telemedicine can be helpful to assess the situation, especially if you notice typical signs like the child holding the arm still and mild discomfort. A healthcare provider can ask questions, observe the child’s arm movement via video, and advise on next steps. Telemedicine is useful for initial guidance and deciding if in-person care is needed.

Red Flags: When to Go In Person Immediately

Certain signs mean the child needs urgent in-person evaluation:

If any of these occur, seek emergency or clinic care promptly.

Preparing for a Telemedicine Visit

Before your tele-visit, try to have the following ready:

This preparation helps the provider assess the injury more effectively.

Aftercare and Follow-Up

After a telemedicine visit, follow the provider’s advice carefully. This may include:

Proper care helps the child recover quickly and prevents repeated injuries.

How to prepare for your tele-visit

• Ensure a stable internet connection and a device with a camera.
• Have the child’s affected arm visible and accessible for examination.
• Prepare to describe how and when the injury occurred.
• Have a caregiver present to help hold the child if needed.
• Note any symptoms such as pain level, arm movement, and behavior changes.

After your tele-visit

• Follow the healthcare provider’s instructions carefully.
• Watch for any worsening symptoms or new red flags.
• Avoid pulling or swinging the child’s arm to prevent re-injury.
• Schedule in-person follow-up if symptoms persist or worsen.
• Seek emergency care if any red flags develop after the tele-visit.

FAQs

What causes Nursemaid’s Elbow?

Nursemaid’s Elbow usually happens when a child's arm is pulled or twisted suddenly, such as when lifting or swinging them by the hands. This causes the radius bone in the elbow to slip out of place.

Can Nursemaid’s Elbow heal on its own?

Sometimes, the arm may return to normal position naturally, but it is best to have a healthcare provider evaluate and treat it to reduce pain and prevent further injury.

Is telemedicine enough to treat Nursemaid’s Elbow?

Telemedicine can help assess symptoms and guide care, but the actual repositioning of the elbow often requires an in-person visit to a healthcare provider.

When should I take my child to the emergency room?

If your child has severe pain, cannot move the arm, shows swelling or deformity, or has numbness or weakness, seek emergency care immediately.

How can I prevent Nursemaid’s Elbow?

Avoid pulling or swinging your child by the arms. Instead, lift or carry them under the arms or around the torso to reduce risk.

Sources

1. Radial Head Subluxation (Nursemaid's Elbow) — MedlinePlus | U.S. National Library of Medicine.
2. Nursemaid's Elbow — Mayo Clinic.
3. Radial Head Subluxation — American Academy of Pediatrics (AAP).
4. Radial Head Subluxation — National Library of Medicine.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical evaluation and treatment. If your child shows any red flags or if you are concerned about their condition, seek immediate in-person care from a healthcare professional.