Elbow fracture

What is an elbow fracture?

An elbow fracture is a crack or break in the humerus, ulna, or radius—the three bones that make up the elbow. It often occurs after a fall or a blow. A suspected fracture requires prompt medical evaluation.

What are the bones of the elbow?

The elbow joint is made up of three bones: the humerus, the ulna, and the radius:

• The humerus (the upper arm bone)
• The ulna (the forearm bone on the little finger side)
• The radius (the forearm bone on the thumb side)

One or more of these three bones may be fractured. Fractures of the radial head and olecranon are among the most common elbow fractures in ^{adults¹⁻²}:

• Fracture of the radial head (the end of the radius near the elbow)
• Olecranon fracture (the bony protrusion at the elbow, which is part of the ulna)

What are the causes of an elbow fracture?

An elbow fracture often occurs after a fall or a blow. A fracture can also occur without a major accident: due to repeated stress on the bone (a stress fracture, in people who throw a lot, for example)³ or in a bone that is already weakened, sometimes following minor exertion or impact⁴. Common causes of elbow fractures include:

• Falling on the elbow or hand
• Impact directly on the elbow (by a heavy object, for example)

Pain that develops gradually, without any obvious injury, can have several causes. Stress fractures are rare, but the absence of an injury is not enough to rule them out. Pain that persists or worsens warrants evaluation.

What are the symptoms of an elbow fracture?

An elbow fracture often causes pain after a fall or a blow. The arm may become weak and difficult to bend or straighten. Swelling or a bruise—a blue mark under the skin—may also appear.

What are the most common symptoms?

Common symptoms of an elbow fracture include pain, stiffness, and difficulty using the arm:

• Elbow pain that developed after a fall or an accident
• Weakness and pain in the arm when lifting loads and clenching the fist
• Pain, stiffness, and difficulty bending and straightening the elbow (often unable to fully extend the elbow)
• There may be swelling and bruising on the elbow

There may or may not be a visible deformity of the elbow.

How to diagnose an elbow fracture?

The doctor will look for a fracture in the elbow based on the circumstances of the injury, an examination of the arm, andan X-ray of the elbow—an image of the bones obtained using X-rays. Some small fractures may not be visible on the initial X-rays. Medical follow-up is still necessary if symptoms persist, even if the first X-ray appears normal.

After an injury, the following signs warrant a medical evaluation to determine which tests are necessary:

• Inability to^fully straighten your elbow5^{, 6}
• Visible deformity of the elbow
• The pain doesn't get better over time.

Being able to straighten your elbow is not enough to rule out a fracture. In the two studies cited, some people who could straighten their elbows still had a fracture. Do not force the movement to test yourself.

Go to the emergency room after an injury if your arm is misshapen, if you feel numbness or tingling, if a bone is protruding through the skin, or if a wound is bleeding heavily. Severe or worsening pain, significant or worsening swelling, or difficulty moving also require immediate medical attention. After the injury, a high fever or a sensation of feeling hot, cold, or having chills also requires medical attention. Call 911 if you need an ambulance. These warning signs following an arm injury should not be ignored while waiting for a physical therapy appointment.

In Quebec, a physical therapist who holds the required certification may order an X-ray for an injury that occurred less than 72 hours ago. The physical therapist must be the first professional to evaluate you for this injury—without a prior medical consultation—and determine that an X-ray is indicated.The Quebec Professional Order of Physical Therapy specifies these conditions. Once a fracture is confirmed, medical care is required.

When should you see a physiotherapist for an elbow fracture?

Physical therapy following an elbow fracture begins based on the range of motion permitted by the medical team treating the fracture. The type of fracture, whether the bone fragments are held in place, and whether surgery was performed are all factors in this decision. A cast and pain alone are not sufficient to determine the right time to begin therapy. Guidelines for radial head fractures and olecranon fractures outline different timelines depending on the injury and its treatment.

A study conducted among adults who underwent surgery for an olecranon fracture linked initial elbow instability and the type of fracture to the recovery of movement and changes in osteoarthritis. Osteoarthritis is a condition that primarily affects cartilage, the smooth tissue that covers the ends of bones in a joint⁷.

What are the reasons for seeing a physical therapist?

A physical therapist can help you regain movement and strength in your arm, while taking into account the limitations caused by the fracture. Ask the medical team when to start the exercises and which parts of your arm you can move.

• If you are not wearing a cast, begin moving your elbow once the medical team gives you the go-ahead. With some simple fractures, you can start moving your elbow early.
• If you are wearing a cast, let the medical staff know if you experience increasing pain or a feeling of tightness. A physical therapist can also advise you on what activities and movements are permitted.
• Even if you are not in pain, keep the cast on as directed. After it is removed, gradually resume movement and build up strength according to the planned schedule.

If you’re not sure what to do, your physical therapist can advise you on which activities are safe and refer you to a doctor if necessary. However, the warning signs described above require immediate medical attention.

What are the physiotherapy treatments for an elbow fracture?

Physical therapy after an elbow fracture helps restore movement, strength, and function in the arm. The program may include exercises, movements guided by the physical therapist, and advice on resuming activities. Each session adheres to the range of motion and weight-bearing limits permitted for the fracture.

Your physical therapist will assess the following, to the extent permitted by the treatment of the fracture:

• Your ability to bend and straighten your elbow, and then turn your palm up or down
• Symptoms related to the nerves, which transmit sensory and motor signals, and their response when the arm moves within the permitted range
• The quality of your movements
• Your strength and your arm's ability to remain stable during permitted movements

What will your physical therapist do based on the results of the evaluation?

Your physical therapist will tailor the exercises and advice to the specific issues observed and to the healing process of the fracture:

• Guide the movements of your elbow with their hands, when permitted, to help you move with less pain
• To offer you appropriate exercises to work:
  
  • Controlling elbow movements
  • Elbow stability and strength
  • Elbow mobility
• Adapt the exercises to help you move with less pain
• To teach you how to balance your daily activities and leisure time while you're recovering
• To advise you on comfortable positions and everyday movements.

After a fracture, the bone heals and then undergoes a lengthy reorganization process to regain its^{strength.⁸, ⁹} Depending on the stability of the fracture and medical advice, limited movement may be resumed before this reorganization process is complete.

In a study of 180 people with a simple fracture of the radial head, the groups that resumed movement immediately or after two days achieved better outcomes than the group that was immobilized for seven days. The group that waited two days had the best outcomes in terms of range of motion, strength, and elbow function. However, starting immediately caused more pain during the first three days. These results support early, appropriate movement; they do not establish a standard timeline for all elbow fractures.

What to do at home for an elbow fracture?

At home, protect your elbow and follow the medical team’s instructions regarding support, movement, and weight-bearing. Protecting your arm and doing the permitted exercises can be part of the same plan.

If you suspect a fracture, have the arm examined promptly. In the meantime, support it with a sling or triangular bandage, without forcing the elbow into any particular position. Do not use the injured arm to carry anything. After the examination, keep the splint, a brace that restricts movement, or the cast on as directed. Perform only the movements that are permitted.

In a study of British medical records involving multiple fracture sites, diabetes was associated with a higher risk of bone healing problems¹⁰.

What other tips can help at home?

Comfortable arm support can reduce discomfort during the day and at night. Follow the advice below, taking into account the instructions for your splint or cast:

• Support your arm with a pillow or armrest, without forcing your elbow into an unnatural position. Use the support recommended by your healthcare team.
• If you experience pain at night or stiffness in the morning, make sure your neck is properly supported by a comfortable pillow. Avoid placing your arm behind your head or under the pillow if this puts strain on your elbow. Keep your arm supported in the position recommended by the medical team.
• Avoid sleeping on the painful side.

Contact the medical team immediately if the cast becomes too tight or too loose, if the pain worsens, if your fingers change color or become numb, or if there is a foul odor or discharge coming from the cast. A high fever or a feeling of warmth accompanied by chills also requires immediate medical attention. An inability to move your fingers requires urgent evaluation. These symptoms under a cast or splint must be evaluated before continuing with the exercises.

Sources

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1. Burkhart KJ, Wegmann K, Müller LP, Gohlke FE. Fractures of the Radial Head. Hand Clin. 2015;31(4):533-46. (Back to section: 1)
2. Duckworth AD, Carter TH, Chen MJ, Gardner MJ, Watts AC. Olecranon fractures: current treatment concepts. Bone Joint J. 2023;105-B(2):112-123. (Back to section: 1)
3. Greif DN, Emerson CP, Allegra P, Shallop BJ, Kaplan LD. Olecranon Stress Fracture. Clin Sports Med. 2020;39(3):575-588. (Back to section: 1)
4. Aparisi Gómez, MP. Nonspinal Fragility Fractures. Semin Musculoskelet Radiol. 2016;20(4):330-344. (Back to section: 1)
5. Appelboam A, Reuben AD, Benger JR, Beech F, Dutson J, Haig S, et al. Elbow extension test to rule out elbow fracture: a multicenter, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008;337:a2428. (Back to section: 1)
6. Jie KE, van Dam LF, Verhagen TF, Hammacher ER. The extension test and ossal point tenderness cannot accurately rule out significant injury in acute elbow trauma. Ann Emerg Med. 2014;64(1):74-8. (Back to section: 1)
7. Rommens PM, Küchle R, Schneider RU, Reuter M. Olecranon fractures in adults: factors influencing outcome. Injury. 2004;35(11):1149-57. (Back to section: 1)
8. Bigham-Sadegh A, Oryan A. Basic concepts regarding fracture healing and the current options and future directions in the management of bone fractures. Int Wound J. 2015;12(3):238-47. (Back to section: 1)
9. Claes L, Recknagel S, Ignatius A. Fracture healing under healthy and inflammatory conditions. Nat Rev Rheumatol. 2012;8(3):133-43. (Back to section: 1)
10. Hernandez RK, Do TP, Critchlow CW, Dent RE, Jick SS. Patient-related risk factors for fracture-healing complications in the United Kingdom General Practice Research Database. Acta Orthop. 2012;83(6):653-60. (Back to section: 1)