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Thu, 30 May 2002 20:33:21 -0500

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Dave:

This condition is "pulled elbow", sometimes called "nursemaid's elbow" in
Britain.

In a 1-5 year old, pulling the child by one arm can cause  dislocation of
the radial head behind the annular ligament, at the elbow.

I usually spend time, getting the parents confidence and understanding,
before attempting the reduction. The reduction is quite a painful process,
better with some analgesia.  The children usually cry out with the
reduction, but become normal toddlers within a few minutes.

Since the average layperson (and many health care workers) are unaware of
the risks of lifting/swinging a toddler by one arm, we don't consider this
child abuse, rather it is bad luck.   The parents need to be informed about
the risk of recurrence.

For more information, try these sites from Google.

For pictures and information about the reduction, see this site.

My advice:  Splint the child's arm in a position of comfort, protect the
arm, consider acetaminophen and send to hospital for reduction within a few
hours.  The child should be able to return to the theme park that afternoon.

Barry Armstrong
General Surgeon
Dryden, Ontario, Canada

-----Original Message-----
From: Dave Eging
Subject: Pediatric Injuries

Hello All,

I am new to this list and I thought I would take this opportunity to ask a
question that I still have not gotten a straight answer for yet. I work in a
Theme Park setting and I deal mostly with children, I have had instances in
the past where a parent has brought in their child having pain after lifting
them by the arm. The parents all claim that they heard or felt a "pop" prior
to the child having pain in the affected extremity. I was wondering what the
best course of treatment should be if you are presented with something of
this nature. Given that the child is reluctant to let you touch or move the
injured extremity, would your best course of action be to immobilize the
area completely and send them for and x-ray or try and determine the range
of motion and then decide how you are going to splint? Another question is
if it is in the elbow, do you splint the elbow in a straight position or do
you splint it with a bend at the elbow and then put them in a sling? I know
this may seem like something that is obvious but as I have said before I
never really have gotten a straight answer yet, thanks for any help you can
give me.

Dave

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<BODY>
Dave: This condition is "pulled elbow", =
sometimes called=20
"nursemaid's elbow" in Britain. In a 1-5 year old, pulling the =
child by=20
one arm can cause&nbsp; dislocation of the radial head behind the =
annular=20
ligament, at the elbow.&nbsp; I usually spend time, getting the =
parents=20
confidence and understanding, before attempting the reduction. The =
reduction is=20
quite a painful process, better with some analgesia.&nbsp; The children =
usually=20
cry out with the reduction, but become normal toddlers within a few=20
minutes.&nbsp;&nbsp; Since the average layperson (and many health =
care=20
workers) are unaware of the risks of lifting/swinging a toddler by one =
arm, we=20
don't consider this child abuse, rather it is bad luck.&nbsp;&nbsp; The =
parents=20
need to be informed about the risk of recurrence.
 For more information, try <A =

href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.google.com/search?sourceid=3Dnavclient&amp;querytime=3D=
Fx2WjB&amp;q=3Dpulled+elbow">these=20
sites from Google</A>. For pictures and information about the =
reduction,=20
<A =
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.rch.unimelb.edu.au/clinicalguide/pages/elbow.php">see =
this=20
site.</A> My advice:&nbsp; Splint the child's arm in a position =
of=20
comfort, protect the arm, consider acetaminophen and send to hospital =
for=20
reduction within a few hours.&nbsp; The child should be able to return =
to the=20
theme park that afternoon.
<DIV>&nbsp;</DIV>
<DIV>Barry Armstrong</DIV>
<DIV>General Surgeon</DIV>
<DIV>Dryden, Ontario, Canada -----Original=20
Message----- From: Dave Eging Subject: Pediatric =
Injuries Hello=20
All, I am new to this list and I thought I would take this =
opportunity to=20
ask a question that I still have not gotten a straight answer for =
yet. I work=20
in a Theme Park setting and I deal mostly with children, I have had =
instances=20
in the past where a parent has brought in their child having pain =
after=20
lifting them by the arm. The parents all claim that they heard or =
felt a=20
"pop" prior to the child having pain in the affected extremity. I was =

wondering what the best course of treatment should be if you are =
presented=20
with something of this nature. Given that the child is reluctant to =
let you=20
touch or move the injured extremity, would your best course of action =
be to=20
immobilize the area completely and send them for and x-ray or try and =

determine the range of motion and then decide how you are going to =
splint?=20
Another question is if it is in the elbow, do you splint the elbow in =
a=20
straight position or do you splint it with a bend at the elbow and =
then put=20
them in a sling? I know this may seem like something that is obvious =
but as I=20
have said before I never really have gotten a straight answer yet, =
thanks for=20
any help you can give =
me. Dave </DIV></BODY></HTML>

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