- [Home](https://ortopediaevolutiva.com/en) - [Pediatric Orthopaedics Blog — Dr. Priano](https://ortopediaevolutiva.com/en/blog) - Pulled elbow in children: what to do and when to seek reassessment # Pulled elbow in children: what to do and when to seek reassessment January 5, 2026 3 min read Edited and medically reviewed by [Dr. Daniele Priano](https://ortopediaevolutiva.com/en/about) ![Pulled elbow in children: what to do and when to seek reassessment](https://ortopediaevolutiva.com/blog-images/pronazione-dolorosa-gomito-della-tata-cover-20260908-v2.webp) This English version is based on the original Italian article. For wording nuances, you can refer to the Italian version. ## In short, for parents - • A young child who suddenly stops using an arm may have a pulled elbow, also called nursemaid's elbow. It often follows a pull on the hand or wrist, although the incident may go unnoticed. Prompt assessment is needed: at home, this condition cannot reliably be distinguished from a fracture or another cause of pain. [1, 2] A young child who suddenly stops using an arm may have a pulled elbow, also called [nursemaid's elbow](https://ortopediaevolutiva.com/en/conditions/nursemaids-elbow). It often follows a pull on the hand or wrist, although the incident may go unnoticed. Prompt assessment is needed: at home, this condition cannot reliably be distinguished from a [fracture](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) or another cause of pain. [1, 2] ### Can it resolve on its own? What should I do meanwhile? If your child continues to keep the arm still, do not wait for it to resolve on its own. Seek a service that can assess and treat the child promptly. Let the arm rest in the most comfortable position without forcing movement. Even after a previous episode, do not attempt a reduction using videos or online instructions. [3] **Significant pain, swelling, bruising, deformity, fever or a child who appears unwell require urgent assessment.** A cold or pale hand, or altered sensation, is another warning sign. These symptoms should not automatically be attributed to a pulled elbow; an acute problem should not wait for a routine appointment. [2] ### What happens at the elbow? A pulled elbow is a subluxation of the radial head, involving the annular ligament that holds it in position. It typically affects young children, particularly those aged 1–4 years. It is different from a complete elbow dislocation. [1, 4] The child tends to avoid using the arm and holds the forearm with the palm turned downwards. This posture helps guide the examination but does not establish the diagnosis: a fracture may also occur without obvious swelling. [2] ### When is an X-ray needed? In a typical presentation, the diagnosis is clinical and an X-ray is not always necessary. The clinician considers how the incident happened and examines the whole arm, from the collarbone to the hand. A fall, localised bony tenderness, swelling or an unusual course may require X-rays or other investigations. The absence of a remembered pulling incident does not, on its own, exclude a pulled elbow. [1, 2] ### Reduction and recovery time Reduction is performed by an experienced healthcare professional after checking that the findings fit the diagnosis. Different techniques are available. A recent meta-analysis favours hyperpronation for first-attempt success, but also reports limitations in the quality of the studies. It does not guarantee immediate success in every child and does not justify attempting the manoeuvre at home. [5] After a successful reduction, many children start using the arm again within a few minutes. Recovery of comfortable movement matters more than simply feeling a “click”. If pain or reluctance to use the arm persists, promptly contact the service that treated your child: the diagnosis and treatment may need to be reassessed. [1, 3] Recovery can take longer when the incident happened many hours earlier. Any observation at home must follow an examination and a clear follow-up plan; this is not a reason to delay the initial assessment. [1] ### Once movement has returned With a confirmed diagnosis, successful reduction and full recovery, a cast or physiotherapy is usually unnecessary. Follow the discharge instructions. Contact the clinician again if pain returns or your child stops using the arm. [3, 4] To reduce recurrence, lift your child by supporting them under the armpits and avoid pulling or swinging them by the hands or wrists. Share this advice with other caregivers. Some children are nevertheless prone to further episodes: a new episode needs assessment rather than an assumption that it is identical to the previous one. [3, 4] The [pulled elbow condition page](https://ortopediaevolutiva.com/en/conditions/nursemaids-elbow) covers further questions about the condition. For an acute episode, follow the prompt assessment advice above. *This information does not replace an individual medical assessment.* ### Sources - Royal Children's Hospital Melbourne. [Pulled elbow — Clinical Practice Guideline](https://www.rch.org.au/clinicalguide/guideline_index/Pulled_elbow/). Updated May 2023. - Royal Children's Hospital Melbourne. [Upper limb non-use — Clinical Practice Guideline](https://www.rch.org.au/clinicalguide/guideline_index/Upper_Limb_NonUse/). Updated July 2023. - Royal Children's Hospital Melbourne. [Pulled elbow — Kids Health Info](https://www.rch.org.au/kidsinfo/fact_sheets/Pulled_Elbow/). Reviewed March 2018; the page states that routine review is pending. - American Academy of Orthopaedic Surgeons. [Nursemaid's elbow](https://www.orthoinfo.org/en/diseases--conditions/nursemaids-elbow/). Information for families, reviewed with POSNA. - Aksel G et al. Comparative effectiveness of supination-flexion and hyperpronation maneuvers in radial head subluxation: A systematic review and meta-analysis. 2025. [PubMed, PMID 40086092](https://pubmed.ncbi.nlm.nih.gov/40086092/). DOI: 10.1016/j.ajem.2025.03.011. ## Complete injuries and fractures pathway This page is part of the paediatric injuries and fractures pathway. The main guide covers the overall picture and the warning signs. - [1 Overview: when an injury is urgent How growing bone behaves, what happens in the emergency room and when an orthopaedic review is useful.](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) [Sudden limp](https://ortopediaevolutiva.com/en/emergencies/sudden-limp) - [Nursemaid’s elbow](https://ortopediaevolutiva.com/en/conditions/nursemaids-elbow) - [Video](https://ortopediaevolutiva.com/en/videos/sports-injuries) - [2 Shoulder and arm Clavicle and humerus fractures: often managed without surgery, but the indication depends on age, site and displacement.](https://ortopediaevolutiva.com/en/conditions/clavicle-fracture-children) - [3 Elbow and forearm Supracondylar, forearm and wrist fractures: the most frequent paediatric sites.](https://ortopediaevolutiva.com/en/conditions/elbow-fracture-children) ## In short A pulled elbow may explain a young child's sudden refusal to use an arm. Prompt assessment is needed to confirm the diagnosis and treat it when indicated. Do not perform manoeuvres at home. Recovery should be checked after reduction; persistent pain or reluctance to use the arm requires reassessment. ## When an evaluation can be useful - · questions about prevention after a fully resolved episode - · discussion of recurrent episodes between incidents, while the child is using the arm normally. The aim of the visit is not always to start a treatment: often it is to understand whether the situation can be observed calmly or whether further investigation is needed. [Check availability and book](https://ortopediaevolutiva.com/en/locations)[See how the paediatric orthopaedic visit works](https://ortopediaevolutiva.com/en/visit-guide/journey) [Dr Daniele Priano and his approach](https://ortopediaevolutiva.com/en) · Visits in Milan at Pini and CTO, subject to availability. ## When not to wait - · a child who continues not to use the arm - · persistent pain or reluctance to use the arm after reduction - · swelling, bruising, deformity or an injury suggesting another diagnosis - · fever, a child who is unwell or changes affecting the hand. For an acute episode, seek prompt assessment at a service able to examine and treat your child. After treatment, contact the treating service if recovery is not proceeding as expected. Significant or worsening warning signs require urgent care without waiting for a routine appointment. This information does not replace a medical visit and does not allow a diagnosis at a distance. ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-CTvqnoPa.webp) ### Concerned about your child? If you recognize any of these signs in your child, a specialist assessment can give you clarity. I see children at Gaetano Pini and CTO institutes in Milan. 5.0 · Google & MioDottore [Book a private visit](https://ortopediaevolutiva.com/en/locations#prenota) ### Related Conditions [Fractures and trauma](https://ortopediaevolutiva.com/en/conditions/injuries-fractures)[Nursemaid's elbow](https://ortopediaevolutiva.com/en/conditions/nursemaids-elbow) ### Related Surgery Pages [Fracture treatment](https://ortopediaevolutiva.com/en/surgery/injuries-fractures) ### Related Articles [Kirschner Wire Infection in Children: When Can It Become Osteomyelitis? Read](https://ortopediaevolutiva.com/en/blog/kirschner-wire-infection-children-osteomyelitis-risk)[Proximal humerus fracture in children: when is surgery really needed? Read](https://ortopediaevolutiva.com/en/blog/proximal-humerus-fracture-children-when-surgery-is-needed)[Growth plate fractures: why does follow-up continue after the bone has healed? Read](https://ortopediaevolutiva.com/en/blog/growth-plate-fractures-follow-up-after-healing) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-BiLSxBxW.webp) Author and medical reviewer ## Dr. Daniele Priano [Pediatric orthopaedic care in Milan](https://ortopediaevolutiva.com/en) — Gaetano Pini & CTO [Read full bio](https://ortopediaevolutiva.com/en/about) --- Canonical: https://ortopediaevolutiva.com/en/blog/nursemaids-elbow-in-children Le informazioni cliniche sono divulgative e non sostituiscono una valutazione medica diretta.