More Details on Rayna's Injury Wednesday evening, Doug was pulling on Rayna's arm when the ulnar bone slipped out of place (an injury young children are prone to because their ligaments are so loose). This was the sixth time Rayna has incurred this injury in the past two years. The first time, an adult friend lifted her by her wrists. We took her to the ER and spent $500 for the physcian to spend literally 60 seconds with her...fifty eight seconds explaining the injury to me and two seconds popping it back into place. He explained to me how to pop it back into place because he suspected it might happen again. It did. The next five times it dislocated with the assistance of her brother (sometimes the right arm, sometimes the left). He cannot seem to remember not to pull her by the hands/wrists. The second through fifth times, I was able to pop it back into place myself very easily with INSTANT relief of her pain and inability to pronate her hand. Wednesday night, I did the same manuever that has worked before, but, this time there was no relief of her pain and no improvement in her ability to use the arm. So, I took her into the ER. The ER physician did the same manuever. She FELT the bone pop back into place, but, still there was no improvement in Rayna's pain or inability to pronate her arm. So, the ER doc X-rayed her elbow. Nothing showed up. She had us wait about an hour to see if there would be improvement after Rayna was medicated with some ibuprofen and allowed to relax. No improvement. Rayna continued to complain of pain in her elbow and wrist. We both assumed that the wrist pain was connected with her elbow injury and not a separate injury. The doctor put her into a plaster splint and sling with the instructions for us to leave her in the splint a couple of days, then, take her out of the splint and see how the arm was after that. The ER doctor was confident that Rayna would be completely back to normal after we took the splint off...but, on the outside chance that she wasn't, we were to take her in to see an orthodpedic surgeon for further evaluation and treatment.

This morning I removed the plaster splint. There was very little improvement. The only improvement is that she no longer is having pain in her elbow...but, she still cannot pronate her arm and she has significant guarding and pain in her WRIST, along with a bit of swelling. So, in to the specialist. This time they X-rayed her wrist. There was one possibly questionable area on her X-ray, but, the doctor thinks she probably does not have a fracture. She thinks that maybe Rayna's wrist is just sprained. She put her in a little velcro splint and said to keep her in it during the day, but to take it off at night. She said that if she begins moving the wrist and not having pain, to leave it off. If there is no improvement in 10 days, then I am to bring her back in to the office again and they will re-X-ray the wrist. There is a type of fracture that isn't visable until the body begins healing the fracture...then, the deposits of new bone are visible on an X-ray (usually 10-12 days after the injury). So, that is where we are at. At least she can move her arm freely now at the elbow without any pain. But, she cannot rotate her hand over (pronate it).

Supposedly, children over the age of five do not get this type of injury ("nurse-maid elbow") any more because by that age the ligaments have tightened up adequately. So...maybe in FOUR MORE MONTHS we can quit having this happen...theorectically. (Except...maybe that means "up to age six"? Didn't think of that until just now. Bummer.)

(My current theory is that maybe Doug twisted her wrist as he was pulling her and she had a double injury...the distal ulnar displacement and a sprain in her wrist. I don't see how she could possibly have a fracture from the simple pulling Doug was doing. I hope not, anyway.)  ¶ 9/29/2006 11:04:00 AM