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On the inner and outer sides of the elbow, strong ligaments hold the elbow joint together and work to prevent dislocation.

There are two joints in the elbow:

• The humeroulnar joint between the ulna and humerus allows for bending of the elbow.
• The radiocapitellar joint, made up of the radius and part of the humerus, allows for rotation of the forearm so that the hand can be turned palm up or palm down.

The radiocapitellar joint is involved in nursemaid's elbow.

(Left) The bones of the elbow and forearm shown with the palm facing forward. (Right) The ligaments of the elbow. In young children, the annular ligament may be weak, making it easier for the radius to slip out of place.

Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Nursemaid's elbow occurs when there is a partial separation of the radiocapitellar joint. Because a young child's ligaments—the strong tissues that attach bones to each other—are not fully formed, even a mild force on the joint may cause it to shift, or partially dislocate.

The annular ligament surrounds the radius and may be particularly loose in some young children, which may lead to nursemaid's elbow recurring over and over again.

Nursemaid's elbow often occurs when a caregiver holds a child's hand or wrist and pulls suddenly on the arm to avoid a dangerous situation or to help the child onto a step or curb. The injury may also occur during play when an older friend or family member swings a child around holding just the arms or hands.

Nursemaid's elbow is rarely caused by a fall. If a child injures the elbow when falling onto an outstretched hand or directly onto the elbow, it may be a broken bone rather than nursemaid's elbow.

Because moving the injured arm may be painful, the primary symptom of nursemaid's elbow is that the child will hold the arm still at his or her side, and refuse to bend or rotate the elbow, or use the arm.

A pediatrician, family medicine physician, emergency room physician or orthopaedic surgeon can typically make the diagnosis of nursemaid's elbow based on how the injury occurred and the manner in which the child holds his or her arm.

Although an x-ray image is not required for your doctor to diagnose nursemaid's elbow, he or she may order one to make sure there are no broken bones.

In most cases of nursemaid's elbow, the doctor will gently move the bones back into normal position. The medical term for this procedure is "reduction."

The doctor will hold the child's wrist or forearm and turn the hand so that it faces palm up. While putting pressure near the top of the radius bone with his or her thumb, the doctor will slowly bend the elbow. A faint pop or click may be heard when the joint goes back into place.

It is important for parents to understand that, once a nursemaid's elbow has occurred, there is a high likelihood of recurrence. For this reason—as well as to prevent an initial occurrence—there are guidelines parents and caregivers can follow that may prevent the injury.

• To safely lift a child, grasp gently under the arms. Do not lift children by holding the hands or arms.
• Do not swing a child by holding the hands or arms.
• Avoid tugging or pulling on a child's hands or arms.