Nursemaid’s Elbow

What is nursemaid’s elbow?

Nursemaid’s elbow happens when the radius (one of the bones in the forearm) slips out of place from where it normally attaches to the elbow joint. It is a common condition in children younger than 4 years of age. It is also called pulled elbow, slipped elbow, or toddler elbow. The medical term for nursemaid’s elbow is radial head subluxation.

What causes nursemaid’s elbow?

A sudden pulling or traction on the hand or forearm causes nursemaid’s elbow. This can happen when a parent reaches out and grabs a child about to fall or to walk into the street. This causes the radius to slip out of the ligament holding it into the elbow. It can happen when an infant rolls himself or herself over, from a fall, or from pulling or swinging a young child by the hand.

What are the symptoms of nursemaid’s elbow?

The following are the most common symptoms of nursemaid’s elbow. However, each child may experience symptoms differently. Symptoms may include:

  • Immediate pain in the injured arm
  • Refusal or inability to move the injured arm
  • Anxiety

The symptoms of nursemaid’s elbow may resemble other conditions or medical problems. Always talk with your child’s healthcare provider for a diagnosis.

How is nursemaid’s elbow diagnosed?

The diagnosis of nursemaid’s elbow is made with a physical exam and often an X-ray by your child’s healthcare provider.

It is important to call your child’s healthcare provider immediately, or promptly take your child to the emergency department, if you suspect an injury.

Treatment for nursemaid’s elbow

Specific treatment for nursemaid’s elbow will be discussed with you by your child’s healthcare provider based on the following:

  • Your child’s age, overall health, and medical history
  • The extent of the condition
  • Your child’s tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment may include:

  • Acetaminophen (for pain), as directed by your child’s healthcare provider
  • Prompt medical treatment while providing reassurance for your child

The injury can usually be reduced (fixed) by your child’s healthcare provider often with ease and occasionally without the need for X-rays (unless other type of injury or fracture is suspected).

Once the elbow has sustained this type of injury, it is more likely to happen again. If it does, call your child’s healthcare provider or return to the emergency department for further evaluation and treatment. Most children outgrow the tendency for nursemaid’s elbow by the age of 5.

Prevention of nursemaid’s elbow

Here are tips for preventing nursemaid’s elbow:

  • Avoid pulling or swinging your child by the arms or hands.
  • Avoid lifting your child up by his or her arms or hands.

Talk with your child’s healthcare provider for more information.

Crutch Walking

Crutch Walking

If ordered by the doctor, your child will be fitted for crutches and be taught how to use them by a trained healthcare professional.

Measurement of crutches

  • The top of the crutches should be about 2 finger widths below the armpit (make sure the shoulders are relaxed).
  • When the arm is hanging straight down, the hand piece should be at the level of the wrist.
  • Hold the top part of the crutch firmly between the chest and the inside of the upper arm. Do not allow the top of the crutch to push up into the armpit. It is possible to damage nerves and blood vessels with constant pressure. Support the weight with the hands on the hand rests. The hand rests should be padded.
  • When standing still, it will be safer to stand with the crutches slightly ahead and apart. Remember, do not let the top of the crutches push up into the armpit; stand straight.

Walking (nonweight bearing)

  • Put the crutches forward about 1 step’s length.
  • Push down on the crutches with the hands, hold the “bad” leg up from the floor, and squeeze the top of the crutches between the chest and arm.
  • Swing the “good” leg forward. Be careful not to go too far.
  • Now step on the “good” leg.

Walking (partial-weight bearing)

  • Put the crutches forward about 1 step’s length.
  • Put the “bad” leg forward, level with the crutch tips.
  • Take most of the weight by pushing down on the handgrips, squeezing the top of the crutches between the chest and arm.
  • Take a step with the “good” leg.
  • Make steps of equal length.

Sit to stand

  • Make sure to keep the crutches nearby so they can be reached when needed.
  • Hold the hand grips of both crutches in 1 hand. Use the crutches with 1 hand and the side of the chair with the other hand. Make sure the chair is stable. If necessary, have someone stand behind you.
  • Stretch the “bad” leg out straight.
  • Push on chair, crutches, and the “good” leg; stand up.
  • Keep the weight off the “bad” leg. Balance. Place the crutches in place for walking.

Stand to sit

  • Walk straight up to the chair.
  • When a step away from the chair, turn until your back is toward the chair using the “good” leg and the crutches. (Move the crutches, then step, crutches, step…a little at a time.) Never pivot.
  • Move backwards until the chair touches the back of the “good” leg.
  • Remove the crutches from under the arms.
  • Hold both crutches in 1 hand and reach for the chair with the other hand.
  • Stretch the “bad” leg out in front.
  • Sit down slowly.

Stairs

  • Use 1 crutch and the stair rail if present (only if the railing is stable and there is someone to carry the other crutch). Use 2 crutches if there is no stair rail.
  • It does not matter which side the stair rail is on.
  • If both crutches can be held in 1 hand safely, you can use both crutches on 1 side and the railing on the other.

Up stairs

  • Walk close to the first stair and hold onto the stair rail.
  • Hold onto the rail with 1 hand and the crutch with the other hand.
  • Push down on the stair rail and the crutch and step up with the “good” leg.
  • If not allowed to place weight on the “bad” leg, hop up with the “good” leg.
  • Bring the “bad” leg and the crutches up beside the “good” leg.
  • Remember, the “good” leg goes up first and the crutches move with the “bad” leg.

Down stairs

  • Walk to the edge of the stairs in the same way.
  • Place the “bad” leg and the crutches down on the step below; support weight by leaning on the crutches and the stair rail.
  • Bring the “good” leg down.
  • Remember the “bad” leg goes down first and the crutches move with the “bad” leg.
  • Use the same rules when going up and down curbs or doorsteps.

Precautions

  • Take care on slick or wet surfaces (for example, the kitchen and bathroom).
  • Be careful of throw rugs; they should be taken up.
  • Never hop around holding on to furniture; it may slide or fall.
  • Keep the crutches near you so they are always in reach.
  • Wear low-heeled shoes that will not slip off (for example, sneakers).
  • For the first few days, a strong belt may be worn to allow someone to assist you.
  • Be careful of ramps or slopes, as it is a little harder to walk.
  • If falling, throw the crutches out to the side and use your arms to break your fall. To get up, get into a sitting position. Back up to a stool or low chair. Put your hands backwards on to the chair. Bend the “good” leg up. Pull with your hands and push with the “good” leg to get up onto the chair.
  • If not allowed to take weight on the “bad” leg, hop up with the “good” leg.
  • Do not remove any parts from your crutches, including the rubber tips.

Helpful hints

  • A bedside toilet may be used.
  • Ask teachers in school to let your child out of class a little early to avoid crowds on the stairs.
  • Keep the “bad” leg up on a stool when sitting.
  • Carry schoolbooks in a backpack to leave both hands free.
  • Avoid leaning on the underarm pieces.

Cast Types and Maintenance Instructions

Photo of girl with cast on arm

What is a cast?

A cast holds a broken bone in place as it heals. Casts also help to prevent or decrease muscle contractions, and are effective at providing immobilization, especially after surgery.

Casts immobilize the joint above and the joint below the area that is to be kept straight and without motion. For example, a child with a forearm fracture will have a long arm cast to immobilize the wrist and elbow joints.

What are casts made of?

The outside, or hard part of the cast, is made from two different kinds of casting materials.

  • Plaster (white in color)
  • Fiberglass (comes in a variety of colors, patterns, and designs)

Cotton and other synthetic materials are used to line the inside of the cast to make it soft and to provide padding around bony areas, such as the wrist or elbow.

Special waterproof cast liners may be used under a fiberglass cast, allowing the child to get the cast wet. Consult your child’s doctor for special cast care instructions for this type of cast.

What are the different types of casts?

Below is a description of the various types of casts, the location of the body they are applied, and their general function.

Type of cast Location Uses
Short arm cast Applied below the elbow to the hand. Forearm or wrist fractures. Also used to hold the forearm or wrist muscles and tendons in place after surgery.
Long arm cast Applied from the upper arm to the hand. Upper arm, elbow, or forearm fractures. Also used to hold the arm or elbow muscles and tendons in place after surgery.
Arm cylinder cast Applied from the upper arm to the wrist. To hold the elbow muscles and tendons in place after a dislocation or surgery.
Illustrations of arm casts, 3 types
Click Image to Enlarge
Type of cast Location Uses
Shoulder spica cast Applied around the trunk of the body to the shoulder, arm, and hand. Shoulder dislocations or after surgery on the shoulder area.
Minerva cast Applied around the neck and trunk of the body. After surgery on the neck or upper back area.
Short leg cast Applied to the area below the knee to the foot. Lower leg fractures, severe ankle sprains/strains, or fractures. Also used to hold the leg or foot muscles and tendons in place after surgery to allow healing.
Leg cylinder cast Applied from the upper thigh to the ankle. Knee, or lower leg fractures, knee dislocations, or after surgery on the leg or knee area.
Illustrations of leg casts, 3 types
Click Image to Enlarge
Type of cast Location Uses
Unilateral hip spica cast Applied from the chest to the foot on one leg. Thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
One and one-half hip spica cast Applied from the chest to the foot on one leg to the knee of the other leg. A bar is placed between both legs to keep the hips and legs immobilized. Thigh fracture. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
Bilateral long leg hip spica cast Applied from the chest to the feet. A bar is placed between both legs to keep the hips and legs immobilized. Pelvis, hip, or thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
Illustrations of hip spica casts, 3 types
Click Image to Enlarge
Type of cast Location Uses
Short leg hip spica cast Applied from the chest to the thighs or knees. To hold the hip muscles and tendons in place after surgery to allow healing.
Illustration of child wearing a short leg hip spica cast
Click Image to Enlarge
Type of cast Location Uses
Abduction boot cast Applied from the upper thighs to the feet. A bar is placed between both legs to keep the hips and legs immobilized. To hold the hip muscles and tendons in place after surgery to allow healing.
Illustration of child wearing abduction boots
Click Image to Enlarge

How can my child move around while in a cast?

Assistive devices for children with casts include:

  • Crutches
  • Walkers
  • Wagons
  • Wheelchairs
  • Reclining wheelchairs

Cast care instructions

  • Keep the cast clean and dry.
  • Check for cracks or breaks in the cast.
  • Rough edges can be padded to protect the skin from scratches.
  • Do not scratch the skin under the cast by inserting objects inside the cast.
  • Can use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast.
  • Do not put powders or lotion inside the cast.
  • Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.
  • Prevent small toys or objects from being put inside the cast.
  • Elevate the cast above the level of the heart to decrease swelling.
  • Encourage your child to move his or her fingers or toes to promote circulation.
  • Do not use the abduction bar on the cast to lift or carry the child.

Older children with body casts may need to use a bedpan or urinal in order to go to the bathroom. Tips to keep body casts clean and dry and prevent skin irritation around the genital area include the following:

  • Use a diaper or sanitary napkin around the genital area to prevent leakage or splashing of urine.
  • Place toilet paper inside the bedpan to prevent urine from splashing onto the cast or bed.
  • Keep the genital area as clean and dry as possible to prevent skin irritation.

When to call your child’s doctor

Contact your child’s doctor or healthcare provider if your child develops one or more of the following symptoms:

  • Fever as directed by your healthcare provider or:
    •    Your child is younger than 12 weeks and has a fever of 100.4°F (38°C) or higher because your baby may need to be seen by their healthcare provider.
    •    Your child has repeated fevers above 104°F (40°C) at any age.
    •    Your child is younger than 2 years old and their fever continues for more than 24 hours or your child is 2 years old and older and their fever continues for more than 3 day
  • Increased pain
  • Increased swelling above or below the cast
  • Decreased ability to move extremity in the cast
  • Complaints of numbness or tingling
  • Drainage or foul odor from the cast
  • Cool or cold fingers or toes
  • If the cast becomes wet or soiled
  • Blister, sores, or rash develop under the cast

Bone Spurs Are a Thorny Problem

If you wonder what that stabbing pain is in your heel, it may be a bone spur.

Bone spur is a general term used to describe a knobby, abnormal bone growth. Bone spurs are also known as osteophytes. Scientists believe bone spurs happen because of osteoarthritis or when the body tries to heal itself after a trauma by replacing bone. The growth is usually small and often unnoticed.

Although bone spurs can form on any bone, they usually happen on joints where 2 bones come together, or where ligaments or tendons attach to bones. Areas that tend to develop bone spurs are the neck, shoulders, elbows, spine, hips, knees and heels. Spurs are not painful, but they can cause pain if they rub on a nerve or other tissue.

Older adults are more prone to developing bone spurs. Spurs can also happen in young athletes or dancers because of the added stress on their muscles, ligaments, and tendons. Pain may happen while the spur is forming, but can settle down. In some cases, pain may continue and get in the way of physical activity.

These are reasons to see your healthcare provider about a bone spur:

  • You discover an abnormal growth.
  • You experience pain associated with the growth.
  • You experience pain or weakness at a joint.
  • You have difficulty walking because of pain in the knees or heel.

Your healthcare provider may prescribe rest, anti-inflammatory medicines or physical therapy if the spur is creating problems for you. These noninvasive treatments usually are effective in treating the bone spur.

In rare instances, surgery may be recommended if the spur and resulting inflammation are creating serious physical problems like prohibiting walking, and the spur is not responding to other forms of treatment.

Bursitis

What is bursitis?

Bursitis is inflammation of a bursa. A bursa is a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body. The major bursae (this is the plural of bursa) are located next to the tendons near the large joints, such as in the shoulders, elbows, hips, and knees.

Shoulder Bursitis

Bursitis is usually a temporary condition. It may limit motion, but generally does not cause deformity.

Bursitis can happen in any bursa in the body, but there are some common types of bursitis, including:

  • Retromalleolar tendon bursitis. This type of bursitis is also called Albert disease. It’s caused by things like injury, disease, or shoes with rigid back support. These put extra strain on the lower part of the Achilles tendon. This attaches the calf muscle to the back of the heel. This can lead to inflammation of the bursa located where the tendon attaches to the heel.
  • Posterior Achilles tendon bursitis. This type of bursitis, also called Haglund deformity, is in the bursa located between the skin of the heel and the Achilles tendon. This attaches the calf muscles to the heel. It is aggravated by a type of walking that presses the soft heel tissue into the hard back support of a shoe.
  • Hip bursitis. Also called trochanteric bursitis, hip bursitis is often the result of injury, overuse, spinal abnormalities, arthritis, or surgery. This type of bursitis is more common in women and middle-aged and older people.
  • Elbow bursitis. Elbow bursitis is caused by the inflammation of the bursa located between the skin and bones of the elbow (the olecranon bursa). Elbow bursitis can be caused by injury or constant pressure on the elbow (for example, when leaning on a hard surface).
  • Knee bursitis. Bursitis in the knee is also called goosefoot bursitis or Pes Anserine bursitis. The Pes Anserine bursa is located between the shin bone and the three tendons of the hamstring muscles, on the inside of the knee. This type of bursitis may be caused by lack of stretching before exercise, tight hamstring muscles, being overweight, arthritis, or out-turning of the knee or lower leg.
  • Kneecap bursitis. Also called prepatellar bursitis, this type of bursitis is common in people who are on their knees a lot, such as carpet layers and plumbers.

What causes bursitis?

The most common causes of bursitis are injury or overuse. Infection may also cause it.

Bursitis is also associated with other problems. These include arthritis, gout, tendonitis, diabetes, and thyroid disease.

What are the symptoms of bursitis?

The following are the most common symptoms of bursitis. However, each person may experience symptoms differently.

  • Pain
  • Localized tenderness
  • Limited motion
  • Swelling and redness if the inflamed bursa is close to the surface of the skin

Chronic bursitis may involve repeated attacks of pain, swelling, and tenderness. These may lead to the deterioration of muscles and a limited range of motion in the affected joint.

The symptoms of bursitis may resemble other medical conditions or problems. Always see a healthcare provider for a diagnosis.

How is bursitis diagnosed?

In addition to a complete medical history and physical exam, diagnostic tests for bursitis may include:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to make pictures of internal tissues, bones, and organs on film.
  • Magnetic resonance imaging (MRI). An imaging test that uses a combination of large magnets, radiofrequencies, and a computer to make detailed pictures of organs and structures within the body.

MRI Scan

  • Ultrasound. An imaging test that uses high-frequency sound waves to look at the internal organs and tissues.
  • Aspiration. A procedure that involves using a thin needle to remove fluid from the swollen bursa to check for infection or gout as causes of bursitis.
  • Blood tests. Lab tests may be done to confirm or rule out other conditions.

How is bursitis treated?

The treatment of any bursitis depends on whether or not it involves infection.

  • Aseptic bursitis. This inflammation results from local soft-tissue trauma or strain injury. The bursa is not infected. Treatment may include:
  • R.I.C.E. This stands for rest, ice, compression, and elevation
  • Anti-inflammatory and pain medicines, such as ibuprofen or aspirin
  • Injection of a steroid into the affected area to help decrease pain and swelling
  • Splints or braces to limit movement of the affected joint

RICE_infographic

  • Septic bursitis. The bursa becomes infected with bacteria. This causes pain and swelling. Treatment may include:
  • Antibiotics
  • Repeated aspiration of the infected fluid (a needle is used to take out the fluid)
  • Surgical drainage and removal of the infected bursa. This is called a bursectomy.

What can I do to prevent bursitis?

Try the following measures to prevent bursitis:

  • Warm up before exercising or before sports or other repetitive movements.
  • Start new exercises or sports slowly. Gradually increase the demands you put on your body.
  • Take breaks often when doing repetitive tasks.
  • Cushion “at risk” joints by using elbow or knee pads.
  • Stop activities that cause pain.
  • Practice good posture. Position your body properly when doing daily activities.

When should I call my healthcare provider?

Call your healthcare provider if you have any of the following:

  • Pain or trouble moving affects your regular daily activities
  • Pain doesn’t get better or gets worse with treatment
  • A bulge or lump develops at the affected joint
  • Redness or swelling develops at the affected joint
  • You have fever, chills, or night sweats

Key points about bursitis

  • Bursitis is inflammation of a bursa, a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body.
  • The most common causes of bursitis are injury or overuse, but it can also be caused by infection.
  • Pain, swelling, and tenderness near a joint are the most common signs of bursitis.
  • Bursitis can be treated with rest and medicines to help with the inflammation. Antibiotics are used if infection is found. If needed, surgery can be done to remove the bursa.
  • You can help prevent bursitis by doing things like warming up before exercise or sports, increasing activity slowly, padding joints, taking rest breaks often, and stopping activities that cause pain.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.