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Elbow

Henoch-Schönlein Purpura (HSP), or IgA Vasculitis, in Children: A Guide for Parents

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Henoch-Schönlein Purpura (HSP), now known as IgA vasculitis, is a type of inflammatory condition known as vasculitis, that affects the small blood vessels in the skin, joints, intestines, and kidneys. It is one of the most common types of vasculitis in children and typically occurs between the ages of 2 and 11 years old. While the exact cause of HSP is unknown, it is believed to be related to an abnormal immune system response, often triggered by a preceding infection.

What symptoms do you get?

Symptoms of HSP can vary but often include:

  • Purpura: Small, raised purple or red spots on the skin, typically on the legs and buttocks, which may be painful or itchy.
  • Joint pain and swelling, particularly in the knees and ankles.
  • Abdominal pain or cramping.
  • Nausea, vomiting, or bloody stools.
  • Kidney involvement, which may lead to blood or protein in the urine, decreased urine output, or high blood pressure.

It’s essential to seek medical advice if your child develops any of these symptoms, especially if they occur suddenly or worsen over time.

How is it diagnosed?

Diagnosing HSP in children usually involves a combination of a physical examination, medical history, and blood and urine tests. Blood tests are done to check for signs of inflammation and to assess kidney function, while urine is tested for blood and protein. Your child’s blood pressure will also be taken.

What is the treatment?

In most cases, HSP resolves on its own within a few weeks to months without specific treatment. However, symptomatic relief may be provided with over-the-counter pain relievers such as paracetamol to alleviate joint pain and discomfort. It’s essential to follow your healthcare provider’s advice closely and attend regular follow-up appointments to monitor your child’s progress as about half of children with HSP will have a further episode. Typically, your child will be followed up at regular intervals for one year.

Rarely, in more severe cases your child may require additional treatments such as medicines to reduce inflammation and protect organ function.

Most cases of HSP will be monitored and resolve without long-term complications. If you have any concerns about your child’s health or if their symptoms are severe or worsening, seek medical advice promptly.

Supracondylar/elbow fracture

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Illustration of a child with a cast immobilized arm in a cast. The child on the left is shown with a bandaged arm in a sling.. The child on the right is wearing a t-shirt over the sling,.
If your child has suffered a break in the bone (fracture) just above their elbow this is called a supracondylar elbow fracture.

If the fracture is undisplaced, this means the bones are still aligned. These fractures can be managed in a collar and cuff or a cast and a sling.

If the bones are out of alignment they are displaced. They may need surgery to have pins inserted which will hold the bones in place while the fracture heals.

They will then be placed in a full cast and a sling will be provided.

The cast and sling should be place under clothing and not passed through a sleeve.

Elbow fracture (broken elbow)

· ·

A side view of a person's arm bent at the elbow, with a blue arrow pointing to the elbow area

What is an elbow fracture?

This means that there is a fracture just above or below their elbow joint. This is normally treated in a cast for 3-4 weeks.

Removal of Cast

Following your fracture, you may be required to have a period of immobilisation in a cast to allow the fracture to heal.

When your Consultant thinks you are ready, they will allow this to be removed. It is important that you then complete some gentle exercises 3-4 times a day to prevent the elbow from becoming stiff.

It is common for your elbow to feel uncomfortable when your plaster cast is removed, and your skin may be dry and flaky. You may bathe your elbow in warm water to help with this, as well as gently massage the area with a plain/non-perfumed moisturiser.

In addition to this, warm water can help to reduce your pain and can make movement feel easier.

Therefore, doing some of the exercises below in the water or after a bath/shower may be a more comfortable way of doing the exercises.

If you have had an operation for your fracture

It is important that you ensure your wound has completely healed with no open or wet patches and stitches should be removed before getting the wound wet. This is to minimise your risk of a post-operative infection.

If you experience any of the following please contact your  General Practioner or the Emergency Department at RHCYP for review:

  • Severe unrelenting or worsening pain
  • Worsening hot/red/swollen wound
  • Fever or temperature
  • A wound that is oozing or smells

What if I need pain relief?

To manage your pain and help get your elbow moving it is advised that you initially take regular simple pain relief. This can be bought over the counter from a pharmacist.

If you have any allergies or conditions which affect the use of pain relief or any questions or concerns please seek advice from your GP or a pharmacist.

Looking after a child with an elbow effusion

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Your child has attended the Emergency Department with an injury to the elbow. The x-ray shows no obvious fracture (break in the bone) however, there is a sign telling us that there is fluid (usually blood) within the joint. This is called an effusion.

What is it?

The elbow is a complex joint in children. It has many growth areas that can be damaged and cause an effusion.

When we see an effusion, we suspect there could be a fracture, however, this is not always the case.

Treatment

We treat an elbow effusion by supporting the arm in a collar and cuff under their clothes. We usually ask your child to wear the collar and cuff for 14 days.

Keeping your child comfortable at home

Pain relief

Your child may be sore for the first few days. The recommended dose of your child’s usual pain relief e.g. paracetamol (calpol) or ibuprofen can be given to keep them comfortable.

If your child complains of pain, give pain relief and encourage them to rest.

Activities

It is important to encourage your child in gentle play or activities for the first 2 weeks. This will help reduce the swelling and pain in the elbow. Please do not allow your child to do sports or gym or be involved in rough play.

Gentle movements

Please encourage your child to gently move their hand, wrist and shoulders several times a day to stop them becoming stiff.

Hygiene

We recommend that you check the skin under the arm twice daily to ensure your child is not developing a heat rash. A gentle wash twice daily with soap and water and thorough drying will prevent this.

Follow up

Please remove the collar and cuff in 14 days. Your child’s elbow will be a bit stiff & sore initially as it has not been moved. You may need to give them some painkillers over the next few days.

We would expect your child’s elbow to be better and be able to fully straighten their arm out in 3 weeks.

If this is not the case, please phone 0131 312 0007 or 0131 312 0008 and ask to make a face-to-face review clinic appointment.

Pulled elbow

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Your child has presented to the Emergency Department with a pulled elbow. This is a very common injury seen in our department, usually in children under school age.

What is it?

A pulled elbow occurs when one of the bones of the forearm (the radius) slides out of the ligament holding it in place at the elbow.

This injury occurs when the arm is pulled, as can happen when the child’s hand is being held and they try to pull away, or if the child is being swung by the arms in play. Sometimes a “click” can be heard at the time of the injury.

When this occurs, the child will naturally be distressed and will hold the arm by their side.

Treatment

Your child will be seen by a doctor or a nurse practitioner who will attempt to move the arm back into its normal position. Full movement of the arm should be restored. This can be confirmed by observing your child in the play area for a few minutes.

In some cases, the child may still be reluctant to move the arm afterwards, in which case a “collar and cuff” (type of sling) will be applied to give the arm support for 1-2 days, followed by a review at our clinic.

Recurrence

This condition can recur; however, it is much less common as children reach school age.

To reduce the chances of this happening again, try to avoid any movement that causes a pulling action on your child’s arm, such as those previously mentioned in this leaflet.

Contact NHS Lothian