Private pulled elbow clinic in London, same-day paediatrics.

How it happens

• a sudden pull on an outstretched arm — lifting a child by the hands, swinging them, or a tug as they pull away
• a child being pulled up by one arm from the floor or out of a car seat
• occasionally a roll or a minor tumble
• commonest between one and four years old, and rare after five as the ligament tightens

What you will see

• the child suddenly stops using the arm, holding it close to the body, slightly bent, palm facing backwards
• crying at the moment it happens, then often settling — children are frequently not in obvious pain afterwards, just unwilling to move the arm
• no swelling, no bruising, no deformity
• they will use the other hand for everything, and resist you moving the affected arm
• they can usually still move the fingers and wrist normally

What we do

After examining the arm and shoulder to make sure nothing else is injured, the elbow is corrected with a quick, specific movement — either rotating the forearm palm-up while bending the elbow, or rotating it palm-down. There is often a small click. It takes a few seconds and is briefly uncomfortable.

• Most children start using the arm again within 5 to 30 minutes.
• Occasionally a second attempt is needed, or a different technique.
• X-rays are not usually required where the history is typical and there is no swelling or bruising.
• If the arm is still not being used after 30 minutes or so, imaging is arranged to exclude a fracture.
• No sling, splint or follow-up is normally needed afterwards.

Preventing it happening again

• Once it has happened, it is more likely to happen again until the child is around five.
• Lift under the armpits or around the chest, never by the hands or forearms.
• Avoid swinging a child by the arms, however much they enjoy it.
• Take extra care when a toddler pulls away suddenly in the street — hold the upper arm or use reins.
• Tell grandparents, childminders and nursery, who may not know.