PETERSEN: Vermont Chapter

This is Enoch.

He is typically a happy boy.  He’s rough-and-tumble like a little boy ought to be, uses a deep voice with pursed lips to imitate a man’s voice and believes his dad has superhuman powers.  He becomes a new animal every hour and runs on all fours until he’s panting, he knows a true tackle is done with the full body, not the arms, and unabashedly dunks his head under water so he can pretend to be a shark. 

A couple of days ago, Chase and Enoch were rough housing as they often do when Chase comes home from the hospital.  Chase held Enoch by the forearms and danged the boy behind him.  All at once Enoch’s demeanor changed, he no longer represented that playful innocence he usually displays.  He began crying and guarding his left arm, he was scared.  We checked the wrist but found the pain generated from his elbow.  Enoch had just experienced the SUBLUXATION OF THE RADIAL HEAD in his left arm.  Not a complete dislocation, but the bone in his arm (on the side of the thumb) had slipped out of its place.  Giving Enoch, “NURSEMAIDS ELBOW.”

The center picture shows the subluxation

Radial Head Subluxation is when “The annular ligament (what helps hold the elbow joint together) is generally weak in young children. Thus, when longitudinal traction (see picture below) is placed on an extended pronated arm, the radial head may slip into the radiocapitellar articulation, resulting in subluxation.  (See above figure) Subluxation of the radial head is a minor injury with a peak incidence in children aged 2-3 years. Radial head subluxation does occur in patients younger than 6 months as well as in older children. This injury typically results from a quick pull on a child’s arm.¹ Often this occurs as the child is holding hands with a caregiver who lifts the child by the hand or tries to prevent a fall.

(this is an example of longitudinal traction)

This is how Enoch felt after it happened.

The good news is that it’s easy to fix.  I thought I’d include instructions on how to fix (reduce) a subluxed elbow since many of you readers have your own little children or are around little children often.  It’s good to know, considering its so common, like CPR.

“To treat a radial head subluxation, the annular ligment is reduced to its anatomic position (straight-arm, palm up).  Stabilize the elbow from below, applying light pressure over the radial head with the thumb.  Supinate the forearm firmly.  This action may produce a sence of mechanical blockage, followed by a palpable pop at the elbow.  If supination alone does not produce the pop and improve pronation and supination, hold the forearm in the supinated position while fully flexing the elbow.”

We gave Enoch Tylenol, filled his mouth with candy to distract him and Chase performed his medical training flawlessly.  He fixed the boy’s elbow and joy was restored to the Petersen plantation.  Although the event took place several days ago, Enoch still says to Chase, “Thanks for fix’n my e’bow Dad.” whenever they’re playing around.  

The peak incidence of radial head subluxation is 27 months of age. As children grow, their bones become larger and more defined. In addition, ligaments become stronger and thus provide a better support system. Nursemaid elbow is rarely seen in children older than 6 years of age unless the child is involved in prolonged hanging by the hands or prolonged lifting of heavy objects. (The appellation “nursemaid elbow” stems from this injury occurring when women were forced to carry heavily filled milk buckets for long distances. Currently, airport baggage handlers are those most likely to sustain such an injury.)