From the Research
Nursemaid's elbow typically does not require a splint. After reduction of the subluxation by a healthcare provider, the child usually experiences immediate pain relief and can begin using the arm normally within minutes to hours. The treatment involves a simple manual reduction technique where the healthcare provider gently rotates the forearm while applying pressure to the radial head. Following reduction, rest and possibly over-the-counter pain medication like acetaminophen or ibuprofen may be recommended for any residual discomfort, but immobilization with a splint is generally unnecessary and may actually delay return to normal function.
Key Points to Consider
- The condition occurs when the radial head partially slips out of its ligamentous ring, and once properly reduced, the anatomy returns to normal without needing external support to maintain alignment 1.
- In rare cases where there is significant swelling or if the diagnosis is uncertain, a healthcare provider might recommend brief immobilization, but this is not standard practice.
- The hyperpronation method is often used for reduction and has been shown to be effective in treating nursemaid's elbow, with a success rate of 66% in one study 1.
- Another study found that hyperpronation was more effective than supination-flexion in reducing nursemaid's elbow, with a risk ratio of 0.34 and a number needed to treat of 4 patients 2.
Treatment Approach
The approach to treating nursemaid's elbow should prioritize reducing the subluxation and providing pain relief, rather than immobilizing the arm. This is supported by the findings of a study that compared immobilization and functional treatment for simple elbow dislocation, which found that functional treatment resulted in a shorter period of disability and rehabilitation 3. However, it's worth noting that this study was focused on elbow dislocation rather than nursemaid's elbow specifically.
Recommendation
Based on the most recent and highest quality evidence, nursemaid's elbow does not typically require a splint. Instead, healthcare providers should focus on reducing the subluxation and providing pain relief, with immobilization reserved for rare cases where it is necessary 1.