Dr. Bob: My husband and I love to pick up our 2-year-old daughter by her hands and swing her in between us when we are walking. My mother-in-law, a nurse, said that that could cause injury to her elbow. We see parents doing that all the time. What could go wrong?
Answer: During the course of my career, I have seen many cases of elbow injury from this type of action. When the child is picked up and swung, she could suffer dislocation of the elbow. This type of injury is called “nursemaid’s elbow.” The head of the radius bone (the shorter of the two forearm bones) slips out of the ligament that holds the bone in the elbow joint. Usually the child reports immediate pain and tends to keep the elbow bent and the arm close to the chest. The discomfort can be quite painful.
Fortunately, this type of injury can be treated relatively simply in a doctor’s office. After assessing the child to make sure no other injuries are present, a specific movement can put the bone back in place. The pain usually quickly subsides, and movement is restored.
While no long-term consequences are usually present, this type of injury is certainly painful enough and traumatic enough to be avoided. I would discourage you from doing this and agree with your mother-in-law. As a pediatrician, I always cringe when I see families doing this and hope that the child will not suffer from a nursemaid’s elbow. I recommend avoiding this type of play activity.
Dr. Bob: My teen-age son is very active with basketball. Last year, he suffered from knee pain that sidelined him from action. The pain was located below his kneecap and very painful. His doctor said that he needed to rest. He showed us the x-ray, but I don’t understand what the problem is.
Answer: You are describing a fairly common overuse injury in young athletes, boys aged 10-15 and girls 8-13. There are a couple of fancy names – apophysitis of the tibial tubercle and Osgood-Schlatter disease (the latter named after two doctors who independently described the condition in 1903). The tibia is the larger bone between the knee and the ankle. There is a prominence of the tibia just below the knee (the tibia tubercle). The tendon (fibers that connect muscles to bones) of the quadriceps muscle (the front part of the upper leg) forms the kneecap tendon (patellar tendon) and attaches to the tibial tubercle. The tibial tubercle is actually an apophysis (an area of bone development that later becomes a part of the bone).
When the young athlete puts extra stress on this developing tissue, the apophysis can become inflamed, leading to swelling and tenderness. There is now rather pinpoint tenderness right below the kneecap over the tibial tubercle. The physical findings are fairly characteristic. The x-ray findings are equally characteristic. But like anything in medicine, other things can cause similar findings so expert evaluation with your pediatrician is indicated.
The treatment is predominantly rest. Once the constant strain on the apophysis is relieved, the inflammation resolves. Ice and ibuprofen can help in the short-term. How long the rest period needs to be can be determined by the physician. I hope that he is getting better. Typically, once the healing has occurred, your child can re-engage in sports with appropriate caution.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.