Elbow Fracture: Overview

The bones in the elbow joint are:

• humerus – the upper arm bone
• ulna – the larger of the lower arm bones
• radius – the smaller bone in the lower arm

An elbow fracture is caused by trauma to the elbow bone(s). Trauma can be caused by:

• falling on an outstretched arm
• falling directly on the elbow
• direct blow to the elbow
• twisting the elbow beyond the elbow's normal range of motion

Risk factors that increase your chance of fracturing your elbow include:

• advancing age
• postmenopause
• decreased muscle mass
• osteoporosis or other bone diseases
• participation in certain sports, such as football, hockey, wrestling, and gymnastics

Diagnosis

The doctor will ask about your symptoms, physical activity, and how the injury occurred, and will examine the injured area. Tests may include:

x-rays
A test that uses radiation to take a picture of structures inside the body, especially bones. It is used to look for a break in the elbow area.

computed tomography (CT) scan
A test that uses computers to make pictures of structures inside the elbow. It is used to look at the cartilage and tendons around the elbow and at complicated joint fractures.

Symptoms include:

• pain, often severe
• tenderness, swelling, and bruising around the elbow
• numbness in fingers, hand, or lower arm
• decreased range of motion
• a lump or visible deformity over the fracture site

Treatment Options

Treatment will depend on the severity of the injury. Treatment involves:

• putting the pieces of the bone back in position, which may require anaesthesia and/or surgery
• keeping the pieces together while the bone heals itself

Devices that may be used to hold the bone in place while it heals include:

• a cast or splint (may be used with or without surgery)
• a metal plate with screws (requires surgery)
• screws alone (requires surgery)

The doctor may prescribe pain medication depending on the level of pain. Your doctor will order more x-rays while the bone heals to ensure that the bones have not shifted position.

Exercises

When your doctor decides you are ready, start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises.

Do not return to sports activity until your elbow is fully healed.

Healing Time

It takes about 8-10 weeks for a fractured elbow to heal.

Prevention

To help prevent elbow fractures:

• Do not put yourself at risk for a trauma to the elbow.
• Eat a diet rich in calcium and vitamin D.
• Build strong muscles to prevent falls and to stay active and agile.

How can I prevent an elbow fracture?

Since elbow fractures are nearly always results of falls or other accidents, there is not much that can be done to prevent them. However, use of proper protective equipment such as padding, is preventive.

Other helpful measures include:

• Do not put yourself at risk for a trauma to the elbow.
• Eat a diet rich in calcium and vitamin D.
• Build strong muscles to prevent falls and to stay active and agile.

Improving Sports Performance

The key to improving sports performance after recovering from an elbow fracture is a proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.

The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice or golf course.

Benefits derived from stretching include:

• increased physical efficiency and performance
• decreased risk of injury
• increased blood supply and nutrients to joint structures
• increased coordination
• improved muscular balance and postural awareness
• decreased risk of lower-back pain
• reduced stress
• enhanced enjoyment

Rehabilitation for Elbow Fractures

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.

The major objectives of rehabilitation from an elbow fracture, once it's healed, are to improve the elasticity of the elbow joint and to gradually increase pain-free range of motion. The exercises below stretch the muscles of the forearm and upper arm. These exercises should be performed once or twice daily.

Exercises include:

• Wrist flexor stretch
  Extend affected arm forward with palm up and elbow straight. Place fingers and palm of opposite hand across palm and fingers of the extended hand and draw back with it until stretch is felt in the forearm. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Wrist extensor stretch
  Extend affected arm forward with palm down, elbow straight, and fingers slightly curled. Grasp the affected side hand with other hand and draw affected side hand down until stretch is felt in the forearm. Hold this position from 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Pronation/Suppination stretch
  Extend affected arm forward in a hand-shaking position with palm facing up. Slowly rotate the hand from a palm-up position to a palm-down position. Hold for 3 to 5 seconds and then rotate back. Perform this exercise 10 times. When you work your way up to strength training, you may use a small weight while rotating the hand and wrist.
• Tricep stretch
  Stand erect with feet at about shoulder width. Raise injured arm at the shoulder with elbow bent and place the forearm behind the head. Grasp the injured elbow with opposite hand and draw it toward the center of the body until stretch is felt. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Bicep stretch
  Stand erect with arms raised to shoulder height and palms up. Press arms backward until stretch is felt. Hold this position for 3 to 5 seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times. The bicep is stretched by this exercise as well as the muscles of the shoulder and upper chest.

Strengthening exercises

The following exercises develop strength of the muscles of the forearm and upper arm. To maintain symmetry of the arms in terms of strength and appearance, perform these strength exercises with the uninjured arm as well as the injured arm.

• Wrist extension
  Sit in a chair with forearm resting on the end of a table, palm down. Grasp a light weight dumbbell and raise the weight up as high as possible while maintaining contact with the table top. Hold this position for 3 to 5 seconds. Relax for 3 to 5 seconds. Repeat this exercise 5 to 10 times. Substitute a heavier dumbbell as strength increases.
• Arm curls
  Either standing or sitting, grasp a two- to four-pound dumbbell in one hand. With palm up, flex elbow and draw the dumbbell up to the same side shoulder while maintaining erect posture. Do not bend at the waist or swing the dumbbell. Lower dumbbell slowly and with control to the starting position. Repeat this exercise 10 times. Use a heavier dumbbell as strength increases.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• brisk walking/light jogging
• stationary bicycle

Rehabilitation after surgery

Keep in mind that if your elbow fracture requires surgery, the soft tissue needs time to heal before exercise can begin. While in the hospital, patients start partial weight bearing with exercises to re-establish elbow joint mobility. In these cases, you would be required to wear a splint or cast for eight to ten weeks.

A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.

Finally, patients develop speed and agility through sport-specific exercise routines.

The ultimate goal of reconstructive elbow surgery is to provide dynamic stability while maintaining full range of motion, so that athletes can return to competitive or recreational sports. Progress is assessed by the patient's perception of how stable the elbow feels and by comparing the strength and stability of the injured and uninjured arms.

How long will the effects of my injury last?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your elbow fracture recovers, not by how many days or weeks it has been since your injury occurred. It also depends on how serious the injury is. Instances where reconstructive surgery is required will obviously create a longer recovery period than patients with a Type I fracture.

A good rule is to allow pain to dictate when you're ready to return to activity. You should return in moderation, and back off if you feel any pain.

You may safely return to your sport or activity when the bones have fully healed and you have full strength and range of motion in the injured elbow compared to the uninjured elbow.

When can I return to my sport or activity?

Some may be ready for full participation in six weeks, others not for two months or more. Of course, time for return to activity is much longer if surgery is necessary.