July 31, 2008

Nursemaid's Elbow? How About Ear-Piercing Scream-Inducing Dislocated Elbow?

Some vacation. I find that the days end up so packed with big events, I get behind on the blogging. Like how I didn't get to write about Monday's flat tire at the Spiral Jetty until Tuesday night. And how I'm only getting to K2's Tuesday morning trip to the emergency room now, in the wee hours of Thursday.

It was like 7:30 or 8:00, she'd finished her wake-up bottle and was rolling around on the floor next to me as I did email. [Now that she's figured out how to roll back onto her back, she's started rolling as a form of locomotion.] As she rolled onto her stomach, she got her right arm stuck underneath her at an apparently odd angle, because she was screaming bloody murder in no time.

At first, I thought she pinched herself or something, but she just screamed, inconsolable and oblivious to my picking her up. That's when I saw her arm kind of hanging, immobile; A few long, loud minutes as I tried to see if her arm was broken--though she could still move it, and her hand, she wouldn't, and her screams were pretty even, no matter where I touched--and then I went to wake up the kid so we could go to the hospital. Just then, my mom came in from her morning walk, so K2 and I headed off to Primary Children's Hospital at the University of Utah on our own. Wait, a city with a rabbit-like birth rate has only one pediatric ER? "You'll be there all day," my mom warned.

Short story short, it was the fastest ER visit I've ever had or heard of. AND the valet parking guy refused my tip. We were the only people there at 9AM; triaged immediately, and got X-rays ordered before we checked in. I'm sure the first doctor's exam was to check the kid for signs of abuse. Then she came back with K2's chart to examine her arm more closely and adjust the X-ray order [I'd said I thought it was her shoulder that took the brunt of her weight, so they added a clavicle shot.]

Then the X-ray tech came, led us back, and as she positioned K2's arm on the table, she said she heard a pop. From that moment on, K2 began moving her arm again, though she was still crying. The X-ray showed up clean, and between that, the pop, and the movement, they figured it was Nursemaid's Elbow.

flexion_supination.gif

A partial dislocation of the radius, a bone in the forearm that's very common in kids under 5yo. The name Nursemaid's Elbow sounds so innocuous, and so very out of sync with the excruciating pain involved. But I guess it could be worse; because it can be triggered by an adult yanking or tugging on a kid's arm, or by swinging a kid by his arms, it could have been called Dad's Antics Elbow or something.

Anyway, now that we've joined the Nursemaid's Elbow club--once it happens, the likelihood of recurring is significantly increased--my MD brother and his RN wife tell me they've been popping their oldest kids' elbows back into place for years now. It's a simple maneuver that one doctor described for me--flexion and supination--without demonstrating.

hyperpronation.gif

Looking it up now, it seems that supination is turning the palm upward, and flexion is bending the elbow. If you feel your own arm, turning the palm rotates the radius, which is the bone that dislocates. A 1998 study published by the AAP has a diagram, but it also found that hyperpronation [rotating the palm inward] has a higher, quicker success rate than the flexion/supination move. [Note to self.]

Though she's been fine and the experience had no detectable impact on her, 36 hours later, I find I'm still picking her up and setting her down like she's made out of tissue paper.

A Comparison of Supination/Flexion to Hyperpronation in the Reduction of Radial Head Subluxations [aappublications.org]

12 Comments

Holy moley! I'm glad K2 is okay but what a total drag...

Are second kids typically way more work than first? Because ours is definitely trouble prone compared to his big sis. And bigger and faster. And messier.

Yeah, I did this to my daughter twice. After the second time, they showed us how to do the little "fix" move.

You shoulda called me, I could have walked you through it...

Ah, so that's the origin of the "you shoulnd't lift up too hard on toddler's arms, no matter how much they beg you too so they can take giant steps or jump" advice.

Once I learned to leave my crib, my parents learned the ol' reduce the dislocated shoulder trick, and had the opportunity to practice it many, many times. To this day, I've never been able to develop a throwing arm.

Wait, hospital valet?

When my older son developed nursemaid's on vacation (I had been helping him get into a short-sleeved shirt at the time), it was off the ER as well. Like you, it was the fastest visit on record.

The doc assured me that we could fix this ourselves in the future and I was all, "Not gonna happen. We'll leave this to the experts."

Welcome to the club.

if this keeps her from becoming a professional gymnast, it'll be worth it. though she's probably alredy too old to start training for the olympics.

and yeah, complimentary valet parking for the ER, and free continental breakfast. They were all, "here, take some donuts with you." crazy.

now I want to put that AAP supination diagram on a Onesie

My daughter has had nursemaid's elbow for the last 2 years (she's 4) and we've had to fix it about 10 times! Our ped. said she'd grow out of it as her connective tissue gets firmer and the muscles develop more strength. But he showed me the flexion/supination version, so next time I'll try the other. She typically gets a dislocation from tripping while I'm holding her hand as we walk.

Of course, the last time we thought she had dislocated her elbow, it turned out she had a possible fracture from a fall! But when it's just a dislocation, it's like a miracle when it pops back into place: instantly the pain and screaming are gone.

God bless pediatric ERs.

I do wonder if the pain factor decreases the older the kid gets. I'm ashamed to admit that we let my 2yo walk around with it pretty much all day before we realized that, gee, maybe this deserved some medical attention. I recall that he wasn't happy that day, but by no means was he crying or giving us reason to think that a visit to the ER was needed.

Great moments in parenting.

Is it even possible to go on vacation with kids w/o a trip to the ER, or at least Urgent Care? Just got back from my week at the beach and yes, second day we were in the ER after his eardrum burst. Lee, I'll also ashamedly admit that we went after a night of pain that I stupidly kept hoping ibuprofen would take care of - it's my own great moment in parenting, of the last, umm, month, that is...

We've been to ER twice, a local clinic twice, and a clinic in Japan once for it... and I managed to fix it myself once too. The ER was by far the worst as both times(!) they managed to give us a different piece of paperwork they were supposed to keep thus keeping our kid off the shortlist in triage.

The last time was a total waste anyway; if I'd realised it was nursemaid's elbow I would have rotated her arm myself but it seemed different so we were worried... she managed to do it not by pulling her arm but slipping her elbow sideways over a ridge on the window sill (or so she says -- we weren't in the room). Weird stuff...

I have a 2 year old son that has already had this happen 3 times and when I picked him up from daycare 2nite his other arm is apparently suffering from it now all three timed have been er visits but my ped. keeps telling me that i can do this by myself but am afraid could someone maybe give me some advice 2nite to save me me another unnessary trip to er.

I am A 42 year old male From Canada
I have been Living with Elbow pain Most of my life . From The looks of it i have Nursemaid Elbows , As I say i have been like this all my life , when i was younger my doctors have said : if it does not hurt you dont worry. Well now that im older it cant be fixed. i have a hard time trying to work, i have have to find something else . or get some help money wize.
As i get older i have Pain All Day and night .
I dont Know what i can do i may have to try for disability , but it maybe too late for me,

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