Tennis Elbow in Children?

There are some kids, between 2-5 years old, who might complain of pain over the outside of their elbow, a common site of complain for tennis elbow. However, is it possible? Chances are, the child might be suffering from either a subluxed or dislocated radial head from the annular ligament that holds the radial head to the ulnar. 

How does it happen?
Some children enjoy getting swung around in circles by adults. When the child is swung around, the centrifugal force created by this swinging and with the adults holding onto the kids palm or wrist, this could cause the radial bone to be pulled out of position. The subluxation or even dislocation of the radial head is due to the laxity of the annular ligament of the radial head as the ligament is not fully developed and the strength of the ligament is still weak. Other common causes are forcefully pulling the child upwards either in a bid to prevent them from falling or forcing them up a sidewalk.

Signs and Symptoms
The child will most commonly cry out in pain almost immediately. The child be reluctant to move their arm. They may dangle their arm by the side of their body and in certain cases, their forearm might be turned inwards. The pain site is at the forward-facing outer corner of the elbow but some may feel that the pain is similar to the site of a tennis elbow. Immediate action would need to be taken as a delay of more than 12 hours may result in longer management and even a cast may be required to treat the problem.

This condition is normally diagnosed based on the event(s) that had led to the incidence of the pain.There are some assessments of the arm where the doctor or physiotherapist can confirm the diagnosis. X-rays are usually not required unless the doctor or physiotherapists feels that there could be other problems like a fracture. 

Management

Commonly, most of these subluxation or dislocations can be easily relocated by either a Doctor or physiotherapist. We would slowly rotate the child’s wrist and forearm as we slowly bend the elbow. Pressure would also be applied on the radial head to get the position right. Ice should be applied immediately to the elbow to manage pain and swelling as excessive pain and swelling will cause muscle spasm which will affect the relocation and healing. Once the radial head is relocated, the pain would almost decrease immediately. There might be some cases that the pain might still persist for a few more hours. In cases where the dislocation was severe, the child might be put in a sling or a splint for a few days.

Prevention
Once the radial head has been relocated, the child generally can return to full activities and would not have any complications as they grow older. However, once the radial head has been dislocated, precaution has to be taken not to pull the child upwards or forcefully swing them around by their wrist.
The following should be remembered to prevent such an incident from occurring:

1. Never forcefully pull a child, below the age of 5, by their wrist.
2. Lift the child from under the arm rather than pulling them from the wrist.