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Ligaments are elastic bands of tissue that hold bones in place. Some parts of the body have multiple ligaments, for example the human hand. The hand has eight small bones held in place by multiple ligaments, similar to the ankle. A sprain is simply an injury that causes a ligament to tear, causing pain, bleeding, and swelling. But sometimes, in response to a sudden, strong movement or force, a ligament might be forced out of place. This is called subluxation. Similar to a dislocation, where a bone slips out of place in a joint, the process of placing the ligament or bone back in place is called reduction. Some subluxations and dislocations reduce themselves and some must be reduced by medical personnel. Subluxations and dislocations are more common in young children as their ligaments are looser because it takes a number of years for ligaments to tighten up.

Take, for example, the elbow. The elbow is a joint between the upper arm bone, the humerus, and the two forearm bones, the radius and the ulna. With your hand palm up, the radius is the outer bone and the ulna the inner. The humerus has ligaments that connect it to the shoulder and elbow, but the radius and ulna have similar ligaments plus other ligaments that bind them to each other. At the elbow end of the radius and ulna there is a ligament called the annular radial ligament. This ligament connects them to each other and is very close to the elbow joint. One of the most common childhood injuries is called Nursemaid’s elbow and is commonly seen in children up to about age five. Nursemaid is an antiquated term for nanny. The medical term for Nursemaid’s elbow is elbow subluxation. When a child’s hand is pulled too strongly the annular ligament may slip off the bones into the elbow joint, or subluxate. When a child’s outstretched arm is pulled suddenly, you may hear or feel a “pop.” The child may briefly cry in pain, but the pain quickly subsides. The main symptom of Nursemaid’s elbow is a child’s inability to move the elbow or use the arm. This is because the subluxed ligament interferes with the movement of the joint. The child may refuse to use the arm or sit with it in his/her lap. A medical professional may use one of several techniques to reduce the subluxation, or put the ligament back in its proper place.

Prevention of this injury is simple. Avoid pulling a child’s wrists or hands abruptly, do not swing a child by their hands or wrists, and if a child pulls your hand in one direction, do not pull them back towards you. Always lift small children by the armpits and not the hands or wrists. Some children have very loose ligaments and even gentle traction may cause the injury. In children who have this injury multiple times, the pediatrician can teach the parents how to reduce the injury themselves.

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