Arm, elbow and hand injuries are common among children, especially among active kids. Injuries can happen when children accidently fall, bump against a person or object, or from unintentional accidents and sports injuries.  Nursemaid's elbow is a common dislocation injury in toddlers.  Older children are more likely to suffer from fractures.  These fractures most commonly occur at the growth plates and may be difficult to diagnose even with X-rays.

Elbow injury

The elbow is one of the most common areas for injury in children. Around 8% of fractures affect the elbow. Elbow injuries are common in boys especially during summers. A common elbow injury in children is called little league elbow (LLE). It affects children who are involved in sports with throwing such as baseball, softball, etc. According to AAP, the most affected group of LLE are pitchers (the ones who throw the ball a lot, for those of you who don't play baseball!). However, it can also affect children who are involved in frequent forceful throwing of any type.

Little league elbow is a syndrome which occurs due to repetitive throwing motions affecting the medial elbow.  It occurs when repeated stress is applied to the elbow resulting in tissue breakdown and repair. Recurring micro trauma to the elbow leads to LLE.  LLE develops gradually with symptoms of progressive pain in the medial elbow (the side facing the body), decrease in throwing effectiveness and decrease in throwing distance. Aggravation of the condition can lead to arthritis, chronic elbow pain and instability of the elbow joint. 

Prevention and Treatment

As with most injuries, prevention is better than cure. Children involved in frequent pitching sports can be prevented from LLE by limiting the number of pitches and/or reducing the number of practices or outings. To treat children who exhibit symptoms of LLE, RICE (rest, ice, compression and elevation) treatment is administered. Resting the elbow without moving is important to avoid increase in pain, swelling and further injury. Ice packs can be applied to relieve pain. Ice packs should be covered with a towel and then placed on the elbow. The elbow should be covered with an elastic bandage and the ice pack applied in an interval of every 20 minutes. The elbow should be elevated above the heart level to drain any accumulated fluid. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be administered to reduce pain. The child should seek medical evaluation if pain is severe or persists more than a week.

Elbow dislocation

Elbow dislocation is the most common joint dislocation in children following shoulder dislocations. Children who fall onto an outstretched hand with the extension of the elbow, may dislocate the humerus bone, most often posteriorly (to the back). Elbow dislocation results in pain, swelling and decreased movement of the elbow joint. It is common in children less than 5 years and elbow dislocation may require an immediate treatment in the emergency department (ED). Tests may be performed such as X-ray to see the kind of the dislocation occurred and may possibly be placed in a sling. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be given to relieve pain.

Nursemaid elbow

Nursemaid elbow is a common orthopedic injury among toddlers (1-3 years of age) and sometimes among older children (usually less than 5 years old). This injury occurs when a kid’s hand is pulled unintentionally in a hurry or when the child is swung by the hand. It is called ‘radial head subluxation’ in medical terms and ‘pulled elbow’ which is common usage.

Toddlers’ ligaments are usually loose and their bones are not fully ossified (hardened), even innocent pulls can cause injury making the bones to slip and come out of place. This injury can be easily treated and is not a permanent injury. The symptoms of nursemaid elbow injury are:

• Excessive crying by the child
• Refusal to use the arm
• The child supports the affected arm with the other hand and places it along the chest
• The child does not use the affected arm even after he/she stops crying
• The child does not lift the arm or make any movement with the affected arm

If the child continues to complain about pain when moving the hand, it requires an immediate medical attention to put the bones back in its place. If there is excess swelling or any kind of deformity, parents should take the child to the ED for further medical evaluation.

Arm injury

Injuries to arm include the muscles, bones, ligaments and joints. It can be in the form of fractures (breaking of the bones), dislocations (bones slipping out of the joints), sprains (ligament stretches and tears), strains (muscles being pulled) and bruises (direct blow to the muscles or the bones).

Seek medical care if:

• The injury is severe
• There are any suspected fractures
• There is chronic pain
• There is a split in the skin that does not easily stay together or is large or deep
• The joint near the injury cannot be moved
• There is excess bleeding

If the injury is moderate with swelling or persisting pain even after the administration of the pain killer, seeing a doctor is necessary. Doctor consultation is also crucial when the child is below 1 year or if the parents feel that the child might have a dislocation or a fracture.

For mild injuries parents can administer RICE treatment and the injured area can be rested. Resuming school or activities should be given a break until the child is completely well. However, parents can take the child to the doctor if they have any other concerns regarding the injury or if the child’s pain last more than 2 weeks.

Hand injury

Hand injuries occur commonly due to 2 reasons: unintentional accidents or sports injury. Unintentional accidents such as crush injury or bicycle spoke injury are common. Parents should seek medical care when there is excess pain, limited movement of the hand or fingers or excess swelling. 

Sports injury such as mallet injury occurs while playing basketball or volley ball. Mallet injury occurs when the joint in the finger is hit forcibly (by the ball against the finger head on) causing deformity. The injury however will be painless but may exhibit symptoms of crooked finger or finger bent at the last joint. The child will find it difficult to extend. Parents should take the injured child to the doctor for further medical evaluation to see if the injury is a tendor rupture or avulsion fracture.  

 

Written by: Irene J.

Edited by: Michael K. Davis, MD

Reference

1.  Len Funk, 2005, Elbow: Elbow injuries in children, http://www.orthoteers.com/(S(1f1ltw555x13y255e2qywczi))/mainpage.aspx?section=13&article=108
2.  American Academy of Pediatrics, 2001, Risk of Injury From Baseball and Softball in Children, PEDIATRICS Vol. 107 No. 4 April 2001, pp. 782-784.
3.  Benjamin H.J and Boyarsky .I, 2009, Sports Medicine: Upper Limb: Little League Elbow Syndrome, http://emedicine.medscape.com/article/97101-overview
4.  Lattanza LL, Keese G, 2008, Elbow instability in children. Hand Clin. Feb 2008; 24(1):139-52. [Medline], http://www.medscape.com/medline/abstract/18299027
5. Chicharoen. N and Kwon N.S, 2009, Clinical Procedures > Musculoskeletal Procedures, Joint Reduction, Elbow Dislocation, Posterior, http://emedicine.medscape.com/article/109168-overview
6. Barton D. Schmitt, M.D, 2010, Arm Injury, Pediatric HouseCalls Symptom Checker, http://www.lpch.org/healthLibrary/ParentCareTopics/arminjury.html