It was early on in my career. I think I’d been a physiotherapist for a little over a year. I was visiting with family and friends over the holidays and decided to go skating at an outdoor rink one evening. As it generally is with outdoor rinks, the ice wasn’t the greatest and there were cracks and divots all over the place.
There were mostly adults skating, but I noticed a man with a little boy who was probably about four years old. The little boy was obviously just learning to skate and so the man was holding his hand. He was basically trying to run on his skates as little kids will do when they don’t know how to glide. At one point he hit a crack and started to lose his balance. That’s when it happened. The man made a crucial mistake by doing something that many people would do instinctively.
As the boy was falling down the man pulled straight up quickly and very hard on the boy’s hand to stop him from falling. He succeeded in keeping him upright but the boy started screaming immediately. In that moment I knew exactly what had happened but I stood there frozen. Had it happened now I wouldn’t hesitate to go right over and tell the man what I think had just occurred and that he should go straight to the hospital, but I was so green at the time I didn’t have the confidence to do so.
What I knew with absolute certainty was that the man had just dislocated the boy’s elbow. The elbow is the second most commonly dislocated joint in the human body, right behind the shoulder. The elbow is a joint involving three bones – one bone in the upper arm (the humerus) and two bones in the forearm (the radius and the ulna). One of the main reasons we have two separate bones in the forearm is to allow for rotation of the forearm where the two bones sort of flip one over the other (think a movement like turning a doorknob).
What likely happened to this little boy is that when the man pulled up on his arm as he was falling down, the radius pulled out of its place in the joint. This specific injury, called radial head dislocation, is a particular issue in young children. It happens most commonly when an adult pulls up on the forearm or hand of a small child. The reason small children are so vulnerable to this injury is obviously the height factor (it’s hard to pull up on the forearm of your 5’11” sixteen year old son), and the fact that the muscles around the elbow aren’t yet strong enough to protect the joint when this happens. When we yank up on their arm our muscle power is too much for their little joint.
How many times have you seen an adult walking with a young child and pulling up on their hand? The toddler stumbles and the adult yanks upwards to stop them from falling. The preschooler slips on the ice and the adult yanks up forcefully on the arm. These are perfect conditions to dislocate the head of the radius.
I still feel badly that I stood there on that cold evening and watched that man leave with the little boy without saying anything. I often wonder if he got checked out and his injury diagnosed and treated properly. This is very important because if it goes untreated it can cause all sorts of problems down the road.
So if you have or care for young children, please train yourself not to yank up on their arms when they fall. Instead, just tense your own arm and hold it steady so you form a stable anchor for them to hang onto with their own muscle power. Better yet, just go with them. Rather than pulling up, go down with them slowly so you can break their fall a little bit. The other option is to just let go and let them fall if the situation is safe (i.e. they are just going to fall on their bottom and are not going to go clattering down a flight of stairs).
If your instincts have taken over and you have pulled up forcefully on the arm of a child who is falling, please take them to get checked out if they complain of any pain. Elbows are complex joints and we definitely don’t want to be messing them up so young. Besides, it’s hard to give your siblings a good rib poke without them.