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Old 10-03-2010, 09:31 PM   #1
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repeated nursemaids elbow???

My 3 yo DD has had several incidences (over the last year and a half) of nursemaids elbow (4 times for her left, the last time they couln't get it to stay back in and one time with ther right arm). The docs seem pretty unsure if where to go from here, maybe casting her left arm for a few weeks to see if it helps. But since the ped, ortho admitted he had never seen a case like this before, I just thought I would ask and see if anyone else's kiddo has had this problem and what the treatment was is any.

FTR her elbow seems to dislocate with very little force, if she hold on to something and falls, just her body weight, all 26 lbs of her, seems to do it.

TIA!

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Old 10-04-2010, 07:44 AM   #2
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Re: repeated nursemaids elbow???

My oldest had this problem. The first incident was my fault. She was falling onto a concrete floor, I was 18 and had no idea that jerking her up to keep her head from hitting her head would hurt her elbow. Talk about feeling guilty. I still do.

After that, it seemed like everytime she tried to pull herself up on something, it would pop out. I learned how to rotate it to pop it back in from the doctor, but I couldn't stand seeing how much it hurt her. They first did an Xray to look for an occult fracture. None there so they casted it.

I can't remember how long the cast was on now, but after it came off it never happened again. Good luck Mama.
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Old 10-04-2010, 10:22 AM   #3
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Re: repeated nursemaids elbow???

I work in Pedi Ortho, and when I've seen kids where we struggled to get it back in, we would cast them for 2 weeks, with their elbow bent and with their palm facing upwards. That forces everything back in place and by leaving it like that, it seems to tighten the ligaments up. I have also however seen kids who are older need surgery to tighten up that ligament and reconstruct it, but that is usually due to a break in the forearm that causes the elbow to dislocate, and the break healing wrong, not people who just dislocate. I would think as she gets older you will see less of a problem.

Hope that helps!
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Old 10-04-2010, 12:39 PM   #4
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Re: repeated nursemaids elbow???

thanks this is helpful. they actually wanted to cast it last week (on Friday) but she completely wigged out and so they just splinted it again and said they will try again on Thrusday of this week to cast it. Also they x-rayed her at the ER and were unable to tell if there was a break as well.

Ryder since you work in a pedi ortho pffice. I have to ask, do I have the only 3 yo that won't comply with a cast? I mean she is all happy go lucky and then if anyone comes near her arm she flips out. I have tried bribes etc... I hate to ask but do they ever just sedate them a little (just enough totake the egde off) and get the cast done that way?
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Old 10-04-2010, 04:12 PM   #5
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Re: repeated nursemaids elbow???

I just wrote a nice long response and deleted it! Here goes again!

I have never seen a 3 year old that is awake that sits nicely and lets us put a cast on. Ok, maybe i've seen a few, but out of hundreds of casts I've put on, there are a handful at that age that sit still. It takes a few people to do it right! With the LO on mom or dad's lap, someone else reads a book, or distracts them, so they aren't looking at what we are doing, someone else to hold the arm still and another person to actually cast them! It is not easy! The only time I have ever seem sedation for just a cast the kids have had major developmental issues/non-verbal/aggressive. However, with your little one, they do have to do a "reduction" to cast her. We will often sedate if we have to manipulate the bones. So I don't think it is out of line for you to ask. That being said, we are a major pedi ortho center, with 27 MD's in our department, so we do this stuff A LOT! http://www.childrenshospital.org/cli...geS1173P0.html

One thing to caution you on, if you can, make sure she has no direct tenderness along her forearm as well that would be indicative of a fracture. We see children with long term complications all the time that need surgery to fix elbows that are chronically dislocated that were not fixed right after injury. This website is a tough read, but has great pictures of what I am worried about..
http://boneandspine.com/fractures-di...lassification/
It sounds like if she had this before and it was just a small fall it is unlikely, I just wouldn't want you or your LO to go through something that is so preventable.

Hope that helps, please let me know if you have any other questions, I'd be happy to help
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Old 10-04-2010, 07:55 PM   #6
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Re: repeated nursemaids elbow???

DD has this problem. We try really hard not to jerk her arm or drag her by the arm. I had her at the orthopedic surgeon (she had other feet issues, so we were already there), and he just showed us how to put it back, and said not to worry about it, but to not hold her hand when she is being difficult to prevent it.
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Old 10-04-2010, 09:11 PM   #7
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Re: repeated nursemaids elbow???

Kristen - It is good to know I am not the only one! we do not hold her hand, she holds onto my pants while crossing streets/parking lots and never pick her up by her arms. Other than the very first time (she fell while I was holding her hand crossing a parking lot, I felt, well still feel horrible about it), she has always had it pop out while she was playing/falling on her own. In the past we have been able to reduce it at home, just this very last time, it would not stay back in place...


Ryder - I looked at the link about fractures. If there is a fracture it is very near the elbow joint. they did an x-ray and couldn't see a fracture, but the fat pad was swollen. The dr. said this could be from either the repeated dislocations or a break in any of the three bones that meet at that joint.

Her elbow is a bit swollen a the joint not really down her forearm and bruised still, but overall it doesn't look too bad. She never had any swelling or bruising with the other dislocations.

I am hopeful that all will go well on Thursday and they will be able to treat her. the doctor we saw last week was very young (I found out afterwards that he has only been with the practice since August). He told me if I couldn't just make her sit absolutely still, that they couldn't put the cast on. Mind you there was no one else there to help hold/distract her and my 7 month old was screaming (I thought it would be easier to have her in the stroller in case I needed to help hold G, but L hates the stroller, it was a a lose-lose). I scheduled this weeks appointment with another much more experienced doctor (he actually treated my DS's broken foot last year and was great) so I feel more comfortable.

Wish me luck.
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Old 10-05-2010, 09:11 AM   #8
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Re: repeated nursemaids elbow???

Did they say if she is still dislocated at this point? A fat pad is usually a supracondylar fracture (the bottom part of your humerus or upper arm), or radial head fracture (radial head is what dislocated during a nursemaid's elbow). If you xray those kids about 3 weeks after injury, you can see lots of healing bone, but you never actually saw the fracture initially. That is probably why she is swollen and bruised. As long as her elbow is back in, she just needs a cast for a few weeks. If they can't cast her, and she will keep a splint on, in reality it is probably just as good. it is such a small fracture that usually heals well.

I hope they find a way to cast her on Thursday, I think that will be easiest for you all. Maybe give her a good dose of motrin 1/2 before her appt. But do take solace that most kids will outgrow this as their ligaments tighten up with age. Good luck!!
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Old 10-11-2010, 03:13 PM   #9
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Re: repeated nursemaids elbow???

I was away all weekend, but thought of you. I hope your DD's appt went easy and she is doing well!!
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Old 10-15-2010, 01:45 PM   #10
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Re: repeated nursemaids elbow???

Just wanted to send your way. My niece had this pretty bad. Just about everyone who ever babysat her ended up in the ER with her to get it popped back in. It is pretty darn scary the first time you see it yourself ( I couldn't stop crying watching her in so much pain then POP it went back in and she would be smiling in minutes). She eventually had it happen so much that she learned to pop it back in herself. So far it's been a year since the last time anyone has seen it pop out so maybe it is finally correcting itself.

and I hope you guys got everything figured out for your little one and I hope it heals and quits popping out.
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