Trauma & Sports

Nursemaid's Elbow: Pulled Elbow in Toddlers

Name: Child Won't Move Arm: Nursemaid's Elbow, What to Do | Milan
Creator: Dott. Daniele Priano
Published: 2026-01-15

Child won't move arm after being pulled. Benign subluxation, resolves with quick reduction maneuver. Pediatric orthopaedic Milan.

Medically reviewed: April 2026·Dott. Daniele Priano

In short

Pulled elbow — also known as «nursemaid's elbow» — is a transient subluxation of the radial head typical of children under 5-6 years, usually after a pull on the arm. The child holds the limb still alongside the body. It is a benign condition and the reduction manoeuvre, performed by experienced staff, solves it in a few seconds.

When an evaluation can be useful

Recurrent episodes of pulled elbow, to evaluate prevention
You have doubts about what to do after an episode resolved in the ER
Pain or movement limitation persist hours after the manoeuvre

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.

Book a paediatric orthopaedic evaluation

Visits in Milan at Pini and CTO, subject to availability.

When not to wait

Significant pain not improving after the manoeuvre
Obvious swelling or bruising of the elbow
Trauma with direct fall on the elbow (not a simple pull)

If you recognise one of these signs, contact your paediatrician or the emergency service.

Quick Answers

What is nursemaid's elbow or 'pulled elbow'?

It is a small displacement of the radial head within its surrounding ligament, typically occurring in young children (under 5–6 years) after a **sudden pull on the hand or wrist**. The child abruptly stops using the arm and holds it still alongside the body. It is a benign condition, which resolves in a few seconds with a maneuver performed by the doctor.

Can nursemaid's elbow recur?

Yes, some children are particularly prone to recurrences, especially in the first years of life. The risk decreases progressively with age, as the joint structures of the elbow strengthen. The basic rule to reduce recurrences is simple: **never pull or lift the child by the hands or wrists**, but always under the armpits or by the trunk.

Is an X-ray necessary for nursemaid's elbow?

In most cases no. If the story is typical (a pull on the arm followed by refusal to use it) and the reduction maneuver succeeds immediately, imaging is not needed. X-rays are used only in cases of **diagnostic doubt**, of more important trauma (fall, direct blow), or if the child does not resume using the arm after the maneuver.

See all 5 questions →

Nursemaid's elbow — also called pulled elbow — is one of the most common reasons a young child is brought in for an urgent evaluation. It typically occurs when a child under 5–6 years is suddenly pulled by the hand or wrist, for example to prevent a fall, and abruptly stops using the arm, holding it still alongside the body with the elbow slightly bent and the palm turned downward.

It is a benign condition, due to a small displacement of the radial head within its surrounding ligament. It is not a true fracture and does not leave long-term consequences. The child does not move the arm not because it is "broken", but because every movement causes pain.

The diagnosis is essentially clinical and based on the story told by parents and direct observation: imaging is usually not necessary and is reserved for cases in which the trauma mechanism or the clinical examination raises a different suspicion. A simple maneuver performed by the doctor typically solves the situation in a few seconds: shortly afterwards, the child spontaneously starts using the arm again as before.

⚠️ Evaluate within 5–7 days: if the child does not start using the arm again within a few hours of the episode, an orthopaedic evaluation within the first 5–7 days is appropriate. A prompt visit allows confirmation of the diagnosis, exclusion of fractures or other associated injuries, and performance of the reduction maneuver under the best conditions, keeping all treatment options open.

💪The Resolving Maneuver

Nursemaid's elbow is common under age 5 and occurs when the forearm is pulled abruptly. It's not a fracture but a radial subluxation. With a simple maneuver, pain disappears immediately and the child resumes using the arm within minutes.

When to seek evaluation

Child refusing to use the arm after being pulled
Arm held still alongside the body with elbow semi-flexed
Crying when the arm is moved
History of pulling or lifting by the hand or wrist
Previously documented episodes of nursemaid's elbow

What is evaluated

Detailed account of the trauma mechanism
Observation of arm posture and the child's behavior
Physical examination of the elbow and upper limb
Exclusion of fractures or other injuries
Imaging reserved for clinically unclear cases

Treatment options

Reduction maneuver performed by the doctor in the office or ER
Spontaneous restoration of movement in the vast majority of cases
No need for cast or brace after reduction
Guidance to parents to prevent recurrence

Frequently Asked Questions

What is nursemaid's elbow or 'pulled elbow'?▼

Can nursemaid's elbow recur?▼

Is an X-ray necessary for nursemaid's elbow?▼

What can I do at home before going to the doctor?▼

Avoid insisting on moving the child's arm and do not try 'do-it-yourself' reduction maneuvers. The advice is to **keep the child calm**, avoid pulling the arm again and bring them in for evaluation. Sometimes the arm may even reduce spontaneously on the way: in that case the child will simply start using it again as if nothing happened.

After the reduction maneuver, are any follow-up checks needed?▼

Generally no. Once the child starts moving the arm normally again, no further checks or immobilization are needed. If, however, the arm remains painful or unused after the maneuver within a short observation period, it is appropriate to repeat the assessment and consider further work-up.

Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.