The nurse called it "Nursemaid's Elbo". She said it was common.
But I didn't know that.
I was still feeling a bit sick on New Years Day when Sasha decided to do a bad job. (He is never a Bad Boy. He is a Good Boy who on more than one occasion, does some bad jobs.) Momma was in the shower so I got to punish him.
Anyone who doesn't beleive "Time Out" is an effective punishment should witness Sasha's determination NOT to go and sit in his "Time Out" chair. He fought me tooth and nail.
If he does that we have another punishment. We send him to his room alone. He hates that worse.
Exactly between the two I was trying to carry him to either punishment when he dropped to the floor.
Then he started crying in pain. He said I crushed his arm.
It looked ok, and the fingers moved, so I didn't think anything was broke. Yet whenever he moved it, it was obvious it was hurt.
Papa went to "Time Out" with Sasha.
Sasha doesn't like doctors or hospitals. He was determined to tell us that nothing hurt, everything was getting better, and that we didn't need to go.
We were mean parents and went anyway.
We went to the Emergency room.
The Emergency room is not a good place to be on New Years Day. It is not a good place to be on New Years Day during the middle of Flu season.
Cindy's relative worked the ER Triage desk. She knew exactly what the problem was, and tried to pop it right back in.
It didn't work.
My mother, a retired nurse, said the same thing, but she didn't have the skills memorized to pop it back in. Besides, the popping in was very painful, and she didn't want her newest grandson remembering her that way.
So we waited longer, with the mother who's son was in a car wreck on New Year's Eve, and despite being mostly ok, still required loud telephone conversations to all of their friends and family about what happened. We waited with all the elderly folks who volunteered to bypass the flu shots this year, and were now in the grips of the disease. We waited with the scared young parents with babies covered in rashes and fevers.
It was not a fun way to start the new year.
Finally we went into a room and a new nurse came in. Pop. OWWWWW!!
Five minutes later the nursing supervisor came in. "What happened here!" she demanded.
I say myself answering to the child abuse board. I stammered. I felt guilty.
Sasha looked up at her with his big brown eyes and she melted. She smiled back and I knew we were OK.
With out realizing it, he used his sore arm. Surprise, it wasn't sore any more. The POP had worked.
Everyone is OK, and I am looking forward to getting to know the emergency room much better in the future. What can I expect with an energetic fearless four year old.
Posted by Kwea (Member # 2199) on :
You big meanie...
Posted by Sara Sasse (Member # 6804) on :
Man, I could've popped it back in in seconds for you. Darn it.
As he grows, the annular ligament around the head of the radius will firm up, and it won't be an issue. But between now and then, it might well happen again. Did they show you how to put it back?
[ January 05, 2005, 09:40 PM: Message edited by: Sara Sasse ]
Posted by Dan_raven (Member # 3383) on :
I think Sasha is too adorable. They didn't show me how to put it back in. They want him to return.
Posted by Bob_Scopatz (Member # 1227) on :
Wow!
Remind me not to shake your hand when we meet!
This parenthood stuff sounds really nerve-wracking!
Glad Sasha is okay!!!
Posted by Space Opera (Member # 6504) on :
I've heard of that happening. That's why I was told never to grab a child by the lower arm. Out of curiosity - what position was Sasha's arm in when it happened?
space opera
Posted by Trisha the Severe Hottie (Member # 6000) on :
My father in law did that to my husband, which is funny to consider because now hubby could bench press his dad. His dad is, without any hyperbole, the nicest most gentle guy I know.
[ January 05, 2005, 09:26 PM: Message edited by: Trisha the Severe Hottie ]
Posted by Sara Sasse (Member # 6804) on :
Really? Huh.
We were always trained to teach the caregiver what to do, as the longer the elbow is out of the socket, the more painful it will be to put it back in.
Well, I'll respect your provider's recommendation and not describe it to you. However, should anyone want to know, I am available on email. Posted by DocCoyote (Member # 5612) on :
Glad everyone survived! Hug the littlie for me, and one for yourself.
L
Posted by Dan_raven (Member # 3383) on :
What was Sasha's position when it happened? Screaming and wiggling and everywhich way possible on the floor.
Yes, I did have him by the arms. Bad daddy.
Sara, if it happens again, I may e-mail you. I don't plan on it happening again.
Bob--this parenthood thing is scarey. Trust me. But then, so is the whole Marriage thing, and I wouldn't be brave enough to move to....Iowa...(shiver)
Posted by Lost Ashes (Member # 6745) on :
Oh man, that put one of those cold hollow feelings in me, Dan. As an upcoming Dad myself, I can only imagine what you felt like and that it was an accident.
Just glad the lil fella is okay and doing well. Hope the big fella is doing the same.
Yanno, some days I get a lil bit scared of becoming a parent.
Posted by Sara Sasse (Member # 6804) on :
It can happen verrrry easily in some children. I had a patient who dislocated her own radial head by shaking another child's hand vigorously up and down. It was her third dislocation, so she calmly walked over to her mother and told her what was wrong. The mom couldn't remember what to do, so she brought her to the ER.
I love reducing nursemaid elbows -- it is very gratifying.
Dan, I have an outrageously low threshold for considering abuse ("if you don't look for it, you won't see it"), but this particular injury in itself doesn't cause me to bat an eye. Just like any child that comes into the ER, I'd watch the caregiver/child interaction, but this doesn't raise red flags for me.
[ January 05, 2005, 09:51 PM: Message edited by: Sara Sasse ]
Posted by Space Opera (Member # 6504) on :
Not a bad Daddy. It's one of those weird things that they don't put in the parenting books. "Hey, did you know you can actually pull your kid's arm out??" The only way I knew was from someone mentioning it when my kiddos were younger.
And yes, they also don't include advice as to how to grab them when they are screaming and wriggling every which way. Maybe you can try a leg next time - I don't think those come out.
space opera
Posted by Sara Sasse (Member # 6804) on :
I read the title of your post and thought, "Nursemaid's!" Posted by TomDavidson (Member # 124) on :
*whisper* Elbow.
Posted by Kayla (Member # 2403) on :
You live in Missouri! How is that different from Iowa? Sure, you're closer to a real city, but still!
Hugs to Sasha. And don't beat yourself up about it.
[ January 05, 2005, 09:45 PM: Message edited by: Kayla ]
Posted by Teshi (Member # 5024) on :
TD, I was just about to say that.
Posted by Kwea (Member # 2199) on :
I found out about it by helping my cousin "fly",...you know, by holding on to their arms and spinning quickly in place....
Kwea
[ January 05, 2005, 09:46 PM: Message edited by: Kwea ]
Posted by Dan_raven (Member # 3383) on :
I admit it. Belle had this neat program that does spell checking on posts. It worked great. I can't find it at home, so I'm misspelling like crazy.
I was an English Major. You can't expect me to spell or hold a decent job.
Posted by Bob_Scopatz (Member # 1227) on :
Or hold a decent kid...apparently.
Posted by Bob_Scopatz (Member # 1227) on :
Sorry...couldn't resist.
Besides...it's the 3rd scary parenting story I've heard this week. Posted by dkw (Member # 3264) on :
ElJay’s arm popped out at the drop of a hat when we were little. Dad would just pop it back in, but she used to hide when it happened because putting it back in hurt.
Posted by Sara Sasse (Member # 6804) on :
It feels so much better afterwards, though. Silly ElJay.
Posted by Teshi (Member # 5024) on :
quote: I was an English Major. You can't expect me to spell or hold a decent job.
I'm doomed.
Posted by mackillian (Member # 586) on :
Oh man. o_O
My mother dislocated my left shoulder when I was two. I didn't find out about it till this summer, when I was stretching out my sore left shoulder in front of my grandmother.
"What's wrong with your shoulder?"
"It hurts. I have tendonitis, but for some reason, this shoulder is worse even though I'm right handed."
"That's the shoulder your mother dislocated when you were two."
My family doesn't like to give important information in a timely manner.
Posted by Kayla (Member # 2403) on :
I can pop my shoulder in and out. Yes, like Mel Gibson did in Lethal Weapon. It's a fun party trick, especially with squeamish men.
They also don't seem to enjoy looking at bloody injuries. I once sliced off a rather large chunck of my thumb and I thought the delivery guy was gonna pass out when I showed it to him. He was standing right next to me when I did it, I thought he'd be interested. Who knew? Posted by quidscribis (Member # 5124) on :
quote: Maybe you can try a leg next time - I don't think those come out
Mine do.
But then, pretty much all of mine come out easily. Just call me . . . a freak of nature!
Edit: Cuz, apparently Eye don't know how to spel either.
[ January 05, 2005, 10:10 PM: Message edited by: quidscribis ]
Posted by Sara Sasse (Member # 6804) on :
Just for clarity: dislocating a child's shoulder is very different than dislocating an elbow. The latter has a clear physiological basis and has no notable sequelae, unlike the former.
A shoulder dislocation would raise my eyebrows, definitely.
[ January 05, 2005, 10:12 PM: Message edited by: Sara Sasse ]
Posted by Kayla (Member # 2403) on :
mack, my sister didn't find out that the reason she hated swimming was because she nearly drowned as a child till she was almost 40! I know there's probably some reason I'm such a freak, but they haven't told me yet. Posted by quidscribis (Member # 5124) on :
Kayla, I can, too, but unlike Mel, mine don't hurt when they come out. They just. . . come out. And they don't hurt going back in, either.
I have loose ligaments (tendons? I always get them mixed up), and the only thing that keeps my shoulders in is strong muscles. Left to their own devices, they're always on the verge of coming out, or partially out, or all the way out, or something along those lines.
*Freak!* *Freak!* Posted by Kayla (Member # 2403) on :
quid, yeah, I was told I needed my bicipital tendon tacked, which I'm assuming meant a Bankart repair. But the subluxation hurts me. As do the dislocations. But when I first became really impaired with this injury, the doc said there was only a 10% success rate for someone my age for this surgery. My son was a baby and it would have required me to have my shoulder casted to a 90 degree angle with my hand in the air (like I was asking a question) for 6 weeks! For a 10% chance that it would fix it. I don't think so. But when the shoulder is feeling ornery, the rest of the muscles in my shoulder and back really pay for it. Sometimes, my scapula will stick out 6 inches from my body. You know, trigger point release is a wonderful horrible thing.
Posted by Elizabeth (Member # 5218) on :
Dan,
I pulled my son's elbow out of the socket when he was two(three?) just putting on his pajamas. He held on to his wrist, so I thought I had squeezed his wrist too hard, but I guess that is where he felt the pain. It was awful, but like Sara, the doctor was just so matter-of-fact about the whole thing.
I see teenagers doing the airplane thing a lot with little kids, and it makes me cringe. Most parents I know are educated about it. The things we learn these days.
Posted by Amka (Member # 690) on :
I used to nanny for a girl whose elbow regularly got dislocated. Her mom, who happened to be there the first time I saw it, told me how to fix it. I felt really awful because I was swinging the girl around by her hands. No one at that point had ever told me that it could be dangerous. It also happened while the kids were playing a couple of times. So I can see why it isn't a red light injury as far as abuse is concerned.
Posted by Teshi (Member # 5024) on :
Wow, not only have I always done the flying thing with both my sisters many times, I've never had a dislocated elbow. I think I tend to get them from the upper arms though (their arms always seemed so delicate).
I do recall someone telling me about it, though.
Posted by fiazko (Member # 5812) on :
All this talk about dislocations is making me squirm. I have no medical training, but I work in an ER, so I get to see lots of gross stuff, but compound fractures and dislocations are the worst for me. Once, I was standing by while a girl's ankle was reduced, and the only thing that kept me from ralphing was the fact that her screams covered the sound of the bones popping back into place. *shiver*
Posted by ElJay (Member # 6358) on :
quote: It feels so much better afterwards, though. Silly ElJay.
Poseable Nurse actually tells me that the first time my shoulder came out they took me to the doctor, and the doctor showed him how to put it back. After that initially I would run over to him to get it put back when it happened... until someone said something to me along the lines of "That must hurt when he does that." So after that, I decided that it hurt and would go hide.
I actually remember very little of it... mostly one time when we were at a cousin's house in California playing hide-and-seek, and she tried to pull me out from under the bed and it happened. Dunno why that's the one that stuck with me, but I was 3 then and a lot of my earliest memories are from that trip.
Like Kayla and quids, my shoulders still pop in and out now if I want them to, but it no longer causes any distress.
Sorry you had to deal with that, Dan. I bet it sucked. Next time learn how to put it back in... like Sara said, the quicker it's back the better.
Posted by mackillian (Member # 586) on :
quote: A shoulder dislocation would raise my eyebrows, definitely.
Too bad you weren't in any of the ERs in my childhood, Sara.
It IS creepy that none of my injuries ever got the attention of the folks in the hospitals or nurses at the schools.
Posted by Elizabeth (Member # 5218) on :
Oh, poor Mack...
Posted by MyrddinFyre (Member # 2576) on :
Yeah, when I went down the cellar steps in my walker my dad got all sorts of suspicious looks and questions. Too bad ER nurses aren't so wary all the time, especially when abuse actually is a factor :-/
But I'm glad Sasha and parents are ok
edited for clarity.
[ January 06, 2005, 12:07 AM: Message edited by: MyrddinFyre ]
Posted by beverly (Member # 6246) on :
Mack:
Dan: It is so heartwrenching when something you do inadvertently causes harm to your child. I remember when our second child was just a few days old and I tried to cut her nails for the first time. I tried to be careful, but I cut off the skin on tip of her thumb along with it. Oh I felt so awful!!!
Posted by Belle (Member # 2314) on :
Dan, been there done that, but it wasn't me that did it. My two youngest girls were playing, and the six year old grabbed the arm of the four year old as the four year old tripped and fell to the floor.
Doctor popped it back in for us, within seconds it was all better. He too told it was very common, and wouldn't be a problem later.
Posted by solo (Member # 3148) on :
I popped my daughters elbow out when I was helping her jump up our front steps one day when she was about 2. Her whole arm went sort of limp and she held her wrist. The doctor popped it right back in and said that it happens all the time. I felt really bad though.
Posted by Verily the Younger (Member # 6705) on :
Dear God! I'd never even heard of this happening before, and now it seems like it happens all the time! I was already scared to have children; now I don't think it'll ever happen. Man, when I think of all the times I played that airplane game with my niece when she was little. . . . Posted by blacwolve (Member # 2972) on :
whenever I play airplane I hold them under their shoulders. They (my cousins) are too long for me to hold them up by their hands.
Posted by Anna (Member # 2582) on :
(((Dan))) (((Sasha))) You don't have to worry, Dan. Obviously these things happen, and Sasha is OK !
[ January 06, 2005, 05:58 AM: Message edited by: Anna ]
Posted by quidscribis (Member # 5124) on :
quote: But when I first became really impaired with this injury, the doc said there was only a 10% success rate for someone my age for this surgery.
For me, they'd have to operate on virtually every joint in my body - I can dislocate fingers, toes, wrists, ankles, knees, shoulders, ribs, hips, and probably other things that I can't think of at the moment. Although, I have to wonder what's really left . . .
It's a genetic disorder that, oddly enough, is associated with the incidence of aneurisms, and, also oddly enough, I found out about from a neurologist (for my migraines). My father had 4 aneurisms - and lived, also oddly enough - so it would seem it comes from his side of the family.
All of the above-mentioned joints come out easily, none with pain, and all go back in equally easy, except on the rare occasions when they go back in the wrong way. Then it's a matter of popping it back out and trying again. Yep, me is a freak. But then, it would seem that in my family, that's par for the course. Posted by punwit (Member # 6388) on :
When our daughter was about 2 I was trying to give her medicine for her ear infection and she fought it like demon. She would squirm and twist and try to push the medicating spoon away from her mouth. I thought I was clever when I figured out a way to immobilize her and pin her outside arm against her body with my cradling hand. I felt less than brilliant when I managed pull her elbow out. Cheri and I rushed her to the emergency room while I nursed overwhelming feelings of guilt and some small trepidation of being labeled an abuser. Our Dr. was so gentle and understanding while explaining the ease with which the situation can occur and that we weren't bad parents. Cheri and I were both reduced to blubbering idiots engulfed in a tide of relief.
Posted by Sara Sasse (Member # 6804) on :
(((mack)))
Posted by zgator (Member # 3833) on :
I'm scared now. How should I not grab Ryan so this doesn't happen?
Posted by Sara Sasse (Member # 6804) on :
If you are holding on to the distal end of the radius (that is, by the fingers, hand, wrist, or forearm) and there is:
1) traction pulling the on the radius (i.e., the child is pulling away, or you are pulling towards you -- whether it is because you are pulling up, or the child is falling, or what have you)
2) some torque, or twisting, of any amount (i.e., you are pulling or twisting to one side or the other, or the child is thrashing, or what have you)
then you might slip the radial head (which is at the elbow) out of its natural slot. The pain is felt at the wrist because the two forearm bones (radius and ulna) are jointed together at both ends (elbow and wrist), essentially forming a closed circuit. The ligaments and fascia make for a tighter bind at the wrist, so when half of the circle gets popped out of place, the most pain and stress is felt at the joint where it is most tightly held down.
The elbow end is kind of loose in kids, so it doesn't really hurt too much to wiggle it around. But putting the bone in an unnatural orientation (which being out of socket does -- the plane of the radius gets skewed, as if it is being held in torque) means that the other end of the bone -- the "tight" end, at the wrist -- is also in an unnatural position. Because it is more tacked down there, this forced misorientation causes more pain there.
I think the need for both 1) and 2) to occur is what keeps most "airplane fliers" out of trouble. Often, the only tug is outward, not with a twisting component. (Of course, this varies, but I think in general the force is "centrifugal" rather than a torqued plane.)
[ January 06, 2005, 10:30 AM: Message edited by: Sara Sasse ]
Posted by Sara Sasse (Member # 6804) on :
What this means is that in order to pop the joint back in place, you need to replicate 1) and 2) again. There is a specific sequence of steps which allows you both to put sufficient traction on the distal end of the radius and torque it in the proper way to slip the head right back into joint at the elbow. Takes less than 2 seconds, if you know what you are doing.
And you get to feel like a miracle worker. Actually, that's the only time I've remotely felt like God as a physician. Heard a kid crying in the ER waiting room, walked out, saw the classic pose, asked "what happened?," reached out and fixed it, and then said "It's going to be all right. I'll see you when you get back to a room, just to make sure everything is okay."
By the time they get back to a room, the kid is playing normally, running around and laughing, using the arm just fine. The look on the parents' faces ... ah, a happy moment.
[ January 06, 2005, 10:27 AM: Message edited by: Sara Sasse ]
Posted by zgator (Member # 3833) on :
Thanks Sara! I haven't played that form of the airplane game because I always heard that their shoulders can pop out of joint easily. I hold him under his chest and at the groin and "fly" him around the room. He likes to swoop down and grab things off the floor.
Posted by PSI Teleport (Member # 5545) on :
My cousin did this to her daughter pretty recently. The girl has told everyone that her mother broke her arm.
Posted by zgator (Member # 3833) on :
BTW, should I be worried that Ryan likes to bang his head on things, especially when he gets excited?
I keep thinking of that scene in Parenthood with the Mom and the B-i-L.
"He likes to bang his head on things."
"You must be proud."
Posted by Icarus (Member # 3162) on :
quote:Most parents I know are educated about it.
O_O
First I've heard about it. Man am I lucky. O_O
(If nothing like this has ever happened by the time they are six, can I just assume they have strong tendons or ligaments or whatever?)
-o-
Mango is a head banger too. Mostly, she does it when she is sleeping. It tends to freak people out. She had one Montessori teacher who didn't accept our answer of "She just does that. We don't know how to stop it," and swore she would get to the bottom of it.
Still haven't heard back from her.
Posted by Sara Sasse (Member # 6804) on :
When a nursemaid's elbow happens, it usually happens in a child between 1 and 4 yrs old. It's rare after 6 yrs old, but a case of a 15-yr-old with a subluxed radial head has been reported in the literature.
As for head-banging, it can be associated with some underlying developmental problems, but it can just be habit. Takes a thorough work-up to be sure, but usually they won't hurt themselves. If they break their skin, bruise themselves, break a tooth, etc, then of course have them screened. If the child has other problems that concern you (lack of social behavior, missing developmental milestones, gastrointestinal distress, etc), then I'd bring it to the attention of a physician.
Or, just mention it at a well-child visit anyway. Get it off your mind.
[ January 06, 2005, 11:38 AM: Message edited by: Sara Sasse ]
Posted by Mrs.M (Member # 2943) on :
Dan, congratulations for scaring the daylights out of me. Seriously, dude.
I'm glad that Sasha is okay.
Posted by Belle (Member # 2314) on :
I had heard of nursemaid's elbow before, but Abigail is the only one of ours that's ever experienced it. She's not the one I would have expected, you'd think Daniel with his hyperflexic joints would be the one.
Though Abigail also had the hip click as an infant. *shrug* My doc said the same thing, Sara, that he loved nursemaid elbow because it was a fix he could accomplish right then. No take antibiotics and you'll be better in a few days, but "I can fix that for you right now."
He looked at me and said "She's going to yell at me for a second, but then she'll be all right." And she did - she didn't like the twisting motion he did one bit, but 10 seconds after that she was accepting a sticker from him and giving him a hug.
Then, on our well child visit a month later, she says to him "I don't want you to pull my arm again." He said "Oh you remember me hurting your arm, but you don't remember that I made it all better?" LOL
Posted by Sara Sasse (Member # 6804) on :
*grin
Among the ER physicians, we'd fight amongst ourselves over who got to fix the patients with nursemaid's elbow. I claimed they were my cases because I was the pediatrician, but if I was in a room with another patient, the main ER physicians would poach 'em, and then they'd laugh.
Actually, I'm glad that the problem gets fixed as soon as possible, but I do admit to relying on the nurses to give me a heads-up when one was coming through. I brought treats and did nasty chores, and the nurses liked me best. Posted by Icarus (Member # 3162) on :
Oh, she's quite developmentally delayed . . . this is not a new thing, but a set of issues we've been dealing with forever. But nobody has suggested to us any "cures" for developmental delays other than time and nurturing to grow. We've mentioned the headbanging to various doctors and gotten results ranging from shrugs to reassurances that it's no big deal to the suggestion that we give her half a pill or so of Benadryl before she goes to sleep for a week or two. (I have not done this because it didn't feel right to me. What do you think of this advice?)
But it's a cart and horse thing. I mean, there are plenty of good reasons for her delays, but is her headbanging caused by her delays, or is her failure to develop caused (in part) by her unrestful sleeping patterns? Posted by dread pirate romany (Member # 6869) on :
Oh, Dan, that's scary. Olivia popped out her elbow at 1 1/2, when hubby grabbed her by the time to pull her down off a counter. She can still hyerpextend her knees which is creepy.
Icarus, do you think Mango has sensory issues? Food intolerences? Those things sometimes to hand in hand with developmental delays.
Posted by zgator (Member # 3833) on :
quote:the suggestion that we give her half a pill or so of Benadryl before she goes to sleep for a week or two.
Is the idea that after a week or two, she'll break the habit?
Posted by Shigosei (Member # 3831) on :
You purposefully made the title sound like you actually cracked a bone, didn't you. I'm glad to hear it's a simple and easy-to-fix dislocated elbow! (And it's good to know how easy it is to pop out a young child's elbow. I'll be carefull with my cousin now!)
How is Sasha feeling now? Does he seem upset about the whole thing?
Posted by Icarus (Member # 3162) on :
romany, I'm not aware of any food issues. Mango and Banana are both ravenous eaters, fwiw. We've always believed their delays are caused by the fact that they were born at 29 weeks gestation, with immediate, intense medical needs. I've suspected as well that their premature birth was caused by their birthfather's physical abuse of their birthmother, and who knows what ramifications in utero abuse may have had.
Zan, yeah. The thinking was that maybe we could put her into some sort of regular sleeping groove, I guess. Since I see her sleep issues as going hand in hand with their developmental issues, this just isn't all that convincing to me.
[ January 06, 2005, 06:57 PM: Message edited by: Icarus ]
Posted by Telperion the Silver (Member # 6074) on :
Awww... ((Dan)) ((Sasha))
Posted by Elizabeth (Member # 5218) on :
Icarus, I know they are still little, and I am not sure if your SpEd laws are like ours in MASS. However, when a child turns nine(ten?) they are no longer labeled developmentally delayed. We have quite a few kids on our team whom we KNOW need services, but they have been signed off because there is no diagnosis once they turn nine(or ten) Just keep this in mind.
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The only way I knew was from someone mentioning it when my kiddos were younger.![[Eek!]](eek.gif)
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It's a fun party trick, especially with squeamish men. ![[Dont Know]](graemlins/dontknow.gif)
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I haven't played that form of the airplane game because I always heard that their shoulders can pop out of joint easily. I hold him under his chest and at the groin and "fly" him around the room. He likes to swoop down and grab things off the floor.
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