A pulled elbow happens when a toddler’s arm is tugged or lifted by the hand, and a small ring of ligament slips partly off the top of the forearm bone at the elbow.
The child cries once, then won’t use the arm. They hold it still by their side, slightly bent with the palm facing down, usually with no swelling or bruising.
A doctor can usually put it back in seconds with a simple movement, and most children are using the arm normally within minutes.
It’s common between about one and four years old, and it can happen again.
How it happens
- Lifting a child up by the hands or wrists, including up a step or curb
- Swinging a child by the arms
- Pulling a child along when they drop to the ground or pull away
- Sometimes a simple fall or rolling over on the arm in younger babies
It happens because a young child’s ligament ring is loose and the top of the forearm bone is still small and rounded. See elbow anatomy.
It looks dramatic, a child suddenly refusing to use an arm, and it’s usually one of the quickest fixes in children’s emergency care.
What it looks like
- A cry at the moment it happened, then settling
- The arm held still at the side, elbow slightly bent, palm down
- The child won’t reach, play or lift with that arm, and may seem to have a sore wrist or shoulder
- Usually no swelling, bruising or obvious deformity
- Pain when someone tries to turn the palm up
What happens at the doctor
- The history is often enough for the diagnosis. X-rays usually aren’t needed when the story is typical
- A quick movement of the forearm and elbow slides the ligament back. There may be a click and a brief cry
- The child starts reaching and playing within minutes, sometimes up to half an hour
- No sling or cast is usually needed afterward
Don’t try to put it back yourself unless a doctor has shown you how after a previous episode.
When it might be something else
- A fall from a height, such as off a bed, climbing frame or trampoline, rather than a pull
- Swelling or bruising around the elbow
- Pain when the bone is pressed
- The child still won’t use the arm after the doctor’s maneuver
- Fever, or the child is unwell
These need an X-ray to rule out a fracture. See supracondylar elbow fracture and buckle fracture of the wrist.
Preventing it happening again
- Lift young children under the armpits, not by the hands
- Avoid swinging games by the arms or wrists
- Hold the upper arm or the body, not just the hand, when a toddler pulls away
- Children usually grow out of it by around five or six, as the ligament tightens and the bone grows
Get your child seen today if
- They suddenly won’t use an arm after a pull or fall
- There is swelling, bruising or deformity
- The fingers are pale, cold or numb
- They still aren’t using the arm after it was put back
Lift under the arms, never by the hands, and you cut the chance of it happening again.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.