Types of Arm Injuries and Their Characteristics
Fractures (Broken bones)
Greenstick fracture: one side breaks, the other bends. Very common in children due to flexible bones. Often in the forearm long bones.
Supracondylar humerus fracture: breaks just above the elbow, typical in 5–7-year‑olds, often from falls with hyper‑extension. Can affect nerves and circulation.
Forearm fractures: involve radius and ulna. Younger children often heal with casting; older kids may need surgery due to stronger bone and muscles.
Monteggia fracture: ulna break with radial head dislocation at the elbow. Happens when falling on an outstretched, rotated arm.
Lateral condyle elbow fracture: break of the outer elbow edge, often involving the growth plate. Common at ages 5–10.
Medial epicondyle fracture: break of inner elbow edge, often with dislocation.
Radial head/neck fracture: injury at the top of the radius just below the elbow, common about age 9–10.
Clavicle fracture: broken collarbone, the most frequent fracture in children. Often from falls on the shoulder or hand outstretched.
Dislocations and Subluxations
Nursemaid’s elbow (radial head subluxation): ligament slips at the elbow due to a sudden pull on the arm. Typical in toddlers/pre‑schoolers (1–4 years, up to 7). Arm is held slightly bent, palm down, and not used.
Elbow dislocation: the ulna and humerus move out of alignment. Seen in older children (10–15 years), often with associated fractures like medial epicondyle injury.
Overuse Injuries
These develop gradually from repeated stress, especially in sports, and often affect growth plates.
Little League Elbow (medial apophysitis): inflammation of growth plate on the inner elbow from repeated throwing.
Osteochondritis dissecans (OCD): small bone/cartilage pieces separate in the elbow due to reduced blood flow. Seen in older active children (throwers, gymnasts, swimmers).
Tendonitis: inflamed or torn tendons from repetitive stretching.
Bursitis: inflamed fluid‑filled sac cushioning joints.
Stress reaction of growth plates: widening or irregularity of the physis from repeated stress.
Other Soft Tissue Injuries
¾ Sprains: overstretch or tear of ligaments (bone to bone).
¾ Strains: overstretch or tear of muscles or tendons (muscle to bone).
¾ Muscle or bone bruises: caused by a direct blow.
¾ Skin injuries: cuts, scrapes, bruises.
Signs, Symptoms, and When to Seek Medical Attention
General Symptoms of Arm Injuries
• Pain that worsens with movement, improves with rest (especially in overuse injuries)
• Swelling, warmth, redness or bruising
• Tenderness in the injured area
• Restricted movement or refusal to use the arm
• Visible deformity such as crooked bone alignment
• Tingling, numbness or weakness (may signal nerve involvement)
• Clicking, popping or grinding sensations
• Difficulty with daily activities such as playing, eating, or sleeping
Warning Signs Warranting Medical Evaluation
Urgent Emergency (go to A&E / call 999) if any of the following occur:
• Visible bone protruding through the skin or major uncontrolled bleeding
• Change in arm shape (crooked or deformed)
• Something embedded in the wound (glass, splinter)
• Child under 2 with serious arm injury
• Complete loss of movement at shoulder, elbow or wrist
• Large deep cut needing many stitches
• Multiple broken bones or serious trauma
• Pale or cold fingers, tingling or numbness (signs of nerve or blood vessel injury)
Seek care today (NHS 111 / minor injuries unit) if:
• Arm cannot be moved due to pain after one hour even after painkillers
• Swelling not improving or increasing
• Wound with no up‑to‑date tetanus vaccine or animal/human bite
• Persistent tingling, numbness or cold/pale fingers
• Severe pain, especially with activity or touch
• Child looks or acts very unwell
Contact your GP/our team within 24 hours (or during office hours) if:
• Very large bruise or swelling
• Pain lasts beyond three days for minor injuries
• Injury limits school or sports activities
• Pain occurs frequently or has unclear cause
Developmental Milestones Related to Movement – When to Worry
Contact a health visitor or GP if a child:
• Has lost previously learned movement skills
• Is very stiff or floppy and has difficulty moving limbs or changing position
• Moves arms or legs in unusual, repetitive or jerky ways
• Favours one side of the body or arm for tasks
• Has difficulty standing or walking between 12–24 months (e.g. not pulling to stand, lots of falls)
• At age 2 or older, uses hands to climb up legs (Gowers sign)
• At age 3 has not started to run or jump
• At age 4 finds it hard to go upstairs, trips frequently or complains of pain when moving
• At age 5 has trouble balancing, walks on tip‑toes or falls often
Diagnosis and Treatment Approaches
Diagnostic Methods
• Physical examination includes assessment of pain, swelling, alignment, movement and nerve or blood vessel status. Injury details are discussed.
• X‑rays are used for suspected fractures but may miss certain injuries in very young children (especially cartilage injuries or growth‑plate injury).
• MRI may be needed for soft tissue or cartilage assessment (e.g. OCD).
• CT scan provides detailed imaging in complex fractures.
• Doppler ultrasound may assess blood flow where pulse is weak or absent.
General Treatment Principles
• Use the RICE protocol (Rest, Ice, Compression, Elevation) for sprains, strains and minor injuries.
• Pain relief with paracetamol or ibuprofen is recommended, following correct dosing.
• Immobilisation (slings, splints, casts) stabilises fractures and supports healing.
• Cast care: keep dry, do not bend or tamper, never insert objects for itching.
• Reduction (realignment) may be done manually or under sedation.
• Surgery may be required for displaced fractures, injuries involving joints or nerves, or failed conservative treatment—pins or rods may be used temporarily.
• Physical therapy helps rebuild strength, flexibility and movement once healing begins.
• Gradual return to activities is essential; rest is crucial for overuse injuries.
• Vitamin D supports bone healing and health.
Specific Treatment Notes
• Nursemaid’s elbow: corrected quickly with a gentle manoeuvre (hyperpronation or supination‑flexion), with immediate relief.
• Supracondylar humerus fractures: non‑displaced may be treated with casting; displaced fractures often require pinning surgery to avoid complications like Volkmann’s contracture.
• Overuse injuries: rest is vital; anti‑inflammatory medication and physical therapy may be used. Prevention involves proper technique, breaks, warm‑ups and limiting single‑sport training.
• Fractures in younger children often heal in 3–6 weeks; stress fractures may take 6–8 weeks. Older children often need more precise alignment and may take longer.
Prevention Strategies
• Teach and encourage proper sports technique, especially for throwing.
• Always include warm‑up and cool‑down sessions in practice.
• Ensure regular rest days (1–2 per week) and avoid year‑round single‑sport participation.
• Use suitable protective equipment (arm pads, elbow guards).
• Never pull or swing a child by their arms or hands; lift under their armpits to protect their joints.
• Promote good ergonomics and posture when using digital devices; encourage breaks to avoid repetitive strain.
Clinical Pearls / Key Points
• Children’s bones are more flexible, making greenstick and buckle fractures common.
• Supracondylar humerus fractures require checking pulses and nerve function because complications can be serious.
• Nursemaid’s elbow is easily treated but often recurs; avoid pulling a child by their arm.
• Early rest and prevention protects young athletes from overuse injuries.
• Recognising red flags, especially changes in shape, mobility, sensation or bleeding, is vital for prompt care.
• Developmental delays combined with arm symptoms may signal more than just injury.
Patient FAQs
What is the RICE protocol?
RICE stands for Rest, Ice, Compression and Elevation. It helps reduce swelling and pain in minor injuries like sprains and strains.
How long does a greenstick fracture take to heal?
Most heal within a few weeks (often 3–6 weeks), with good stability due to children’s healing capacity.
Can nursemaid’s elbow happen again?
Yes—ligaments stretch each time, so recurrence is possible especially in toddlers. Older children are less likely to have it.
When should I be worried about limb pain in my child?
Be alert if pain is accompanied by swelling, inability to use the arm, fever or limb weakness. Developmental flags such as walking difficulties or persistence of pain also warrant evaluation.
Call‑to‑Action
If your child has sustained an arm injury, contact NHS 111 or your local Minor Injuries Unit if symptoms fall into “amber” criteria. For urgent concerns or “red flag” symptoms, go to A&E immediately or call 999.
Visit www.TheArmDoc.co.uk for printable exercise guides and advice on arm injury recovery. To book an appointment, phone 020 3384 5588 or email Info@TheArmDoc.co.uk.
Disclaimer
This guide provides general educational information and should not be used as a substitute for medical advice. Always consult a qualified healthcare provider for personal diagnosis or treatment.