Radial Head Dislocation and Subluxation (Nursemaid's Elbow)
Basics
Description
- Subluxation more common in children. In both adults and children, typically associated with distracting force across elbow or trauma; dislocation more common in men subject to high-force injury
- Dislocation of the radial head and fracture of ulna shaft is termed a Monteggia fracture.
- Atraumatic radial head dislocation is usually due to congenital anomalies.
- Categorized based on direction of dislocation: anterior, posterior, lateral
Epidemiology
Incidence
Isolated radial head dislocation is rare. Subluxation (annular ligament displacement) occurs in children between the ages of 6 months and 5 years—mean age of 2 years; slightly more common in girls (1,2)[A]
Prevalence
Subluxation has the highest incidence between 12 and 35 months. The left arm is more commonly involved (60%; distracting force applied by right arm–dominant adult to left arm of child). Obesity may be an associated factor (many affected children >75th percentile for weight). The recurrence rate is ~1% (3)[B].
Etiology and Pathophysiology
- Isolated radial head dislocation is uncommon; most typically associated with complete elbow dislocation or elbow fractures in high-force traumatic injuries
- Proximal ulnar malalignment combined with annular ligament tear affects elbow biomechanics leading to radial head subluxation (4).
Genetics
No genetic correlation to injury
Risk Factors
- Cerebral palsy
- Osteogenesis imperfecta
- Osteochondroma
- Fibrous dysplasia
Commonly Associated Conditions
- Elbow dislocation
- Elbow fracture
- Obsessive-compulsive disorder (OCD) lesion seen in pediatrics
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Citation
Domino, Frank J., et al., editors. "Radial Head Dislocation and Subluxation (Nursemaid's Elbow)." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688241/all/Radial_Head_Dislocation_and_Subluxation__Nursemaid's_Elbow_.
Radial Head Dislocation and Subluxation (Nursemaid's Elbow). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688241/all/Radial_Head_Dislocation_and_Subluxation__Nursemaid's_Elbow_. Accessed October 12, 2024.
Radial Head Dislocation and Subluxation (Nursemaid's Elbow). (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688241/all/Radial_Head_Dislocation_and_Subluxation__Nursemaid's_Elbow_
Radial Head Dislocation and Subluxation (Nursemaid's Elbow) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 12]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688241/all/Radial_Head_Dislocation_and_Subluxation__Nursemaid's_Elbow_.
* Article titles in AMA citation format should be in sentence-case
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T1 - Radial Head Dislocation and Subluxation (Nursemaid's Elbow)
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ED - Baldor,Robert A,
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ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
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DB - Medicine Central
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