Physical Therapy Guide to Elbow Fracture
An elbow fracture is a bone break that occurs in the middle of the arm, in the area of the elbow joint. Its main cause is trauma, such as falling on the elbow, or falling on an outstretched hand. An elbow fracture can happen to anyone. Recent studies have identified a high number of fractures among children, women, and the elderly. Children have the highest rate of elbow fracture: 30 out of every 10,000 children in the United States are affected. Elbow fractures are diagnosed in 7.4 out of every 10,000 American adults, with lower-income adults also highly affected. Athletes frequently experience elbow fractures.
Physical therapists design individualized treatment programs for people with elbow fractures that help improve elbow movement and strength, ease swelling, and restore use of the arm for daily living and athletic activities. They also help prevent problems in other arm areas (hand, wrist, shoulder) that can occur when the elbow is immobilized in a cast or splint.
What is an Elbow Fracture?
Elbow fractures are bone breaks that can happen in any of the 3 bones in the area of the elbow joint (humerus, radius, or ulnar bones). Often, a person will feel or hear a snap or pop in the elbow area at the time of the injury. An elbow fracture can happen from falling on or being hit in the hand, wrist, elbow, or shoulder. The fracture can be a crack in the bone, a bone chip, or a more serious splitting of the bone.
There are 3 types of bone fractures:
- Type I. A "nondisplaced" fracture, where the bone has a break, but is still in its normal position.
- Type II. A fracture where a fragment of bone is shifted from its normal position.
- Type III. The most serious type of fracture, with multiple breaks of the bone.
Type I and II fractures usually are treated without surgery, but Type III fractures usually require surgery. Fractures can take 2 to 8 weeks or more to heal, depending on their severity and on each affected individual’s general health.
Physical therapy can help speed recovery from all types of elbow fracture, including those that require surgery.
Elbow Fracture: See More Detail
How Does It Feel?
If you have an elbow fracture, you may experience:
- Moderate to severe pain. It’s usually too painful to move the arm.
- Tightness, stiffness, or cramping in the arm.
- Swelling, throbbing, redness, or numbness in the area.
- A grinding or catching sensation at the elbow.
- An unusual shape to the bones in the area (deformity).
- Tenderness to touch. The area also may feel hot.
- Numbness in the elbow, forearm, wrist, or hand. If you experience sudden numbness and weakness in your forearm or hand after an elbow fracture, it could indicate nerve compression. See a physician immediately!
How Is It Diagnosed?
If a physical therapist suspects that you have an elbow fracture, your therapist will refer you to a physician, who may order an x-ray. Your physical therapist can check for damage to other joints and muscles, and make sure that the nerves and blood vessels in your arm have not been affected by the broken bone.
In most cases, people with fractures visit a physician with a specialty in managing bones and joints (orthopedist). Depending on the type of fracture, the physician might prescribe a cast or a sling, or, with severe fractures, surgery.
How Can a Physical Therapist Help?
Following an elbow fracture, your physical therapist will design an individualized treatment program to help improve your elbow movement and strength, ease swelling, and restore use of your arm for daily living and athletic activities.
While Your Elbow Is in a Cast or a Sling
While your bone heals, your arm will be in a cast or a sling to keep it still and allow healing. This is also the case if you have had surgery. During the healing process, it is important to prevent as much stiffness, weakness, or swelling as possible. Depending on the amount of activity that is allowed by your physician for your type of fracture or surgery, your physical therapist will prescribe exercises to keep your shoulder, wrist, and hand moving while you are in the cast or sling.
Your physical therapist will help you stay as independent as possible by teaching you how to perform your daily activities—such as dressing, working on a computer, housekeeping, and even exercising—while wearing a cast or a sling. Under your physical therapist’s guidance, you can exercise your other arm and legs to maintain and build your fitness level during the healing process.
When the Cast or Sling Is Removed
When your cast or sling is removed, your elbow will most likely be stiff and your arm will be weak, especially if you have had surgery. Your physical therapist will help you prevent permanent loss of movement in the elbow, so don't delay your visit! Your therapist will examine your elbow and select treatments based on your particular physical problems, goals, level of physical activity, and general health.
Your physical therapist may prescribe treatments to help you:
Reduce Pain and Swelling. Your physical therapist may use different types of treatments and electrothermal modalities, such as specialized massage, electrical stimulation, and cold packs to reduce pain and swelling.
Improve Your Ability to Move. Your physical therapist will choose specific activities and treatments to help restore normal movement in the elbow and arm. These might begin with "passive" motions that your therapist performs for you to gently move your elbow joint, and progress to active exercises and stretches that you do yourself.
Increase Flexibility. Your physical therapist may gently apply hands-on treatment (manual therapy) to enable your joints and muscles to move more freely with less pain. These techniques can include stretches and therapeutic massage techniques.
Increase Strength. If your physical therapist finds any weakness in your arm or hand muscles, your therapist will choose, and teach you, the correct exercises and equipment to steadily restore your strength and agility. You might use equipment, such as therapy bands, therapy putty, and hand weights to help strengthen your arm.
Improve Endurance. Restoring your arm's muscular endurance is important after an injury. Your physical therapist will develop a program of activities to help you regain the endurance you had before the injury, so you can return to doing the things that you like to do.
Learn a Home Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.
Return to Activities. Your physical therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.
Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
Can This Injury or Condition Be Prevented?
Your physical therapist can recommend a few ways to prevent elbow fractures, including:
- Avoiding hard hits to the elbow, shoulder, or hand.
- Avoiding falls or other trauma to the arm. Your physical therapist is an expert at determining your risk of falling, and can teach you how to perform balance exercises to lower that risk. Your therapist also can teach you how to decrease the risk of falling in your home and community by:
- Clearing floors of loose items and throw rugs.
- Lighting dark hallways.
- Keeping pets away from your feet when walking.
- Practicing simple balance techniques.
- Avoiding walking in icy areas.
- Wearing nonslip shoes/boots during wintry weather conditions.
- Walking carefully near “wet floor” signs.
- Using protective equipment during sports, such as wrist guards or elbow pads.
- Learning safer falling positions and techniques for sports.
- Always warming up before starting a sport or heavy physical activity.
Gradually increasing the amount or intensity of any athletic activity.
Real Life Experiences
Marie is a 35-year-old nurse who works in a hospital. Last night, Marie had to work late, and had difficulty driving home in a freezing rainstorm. She made it back, but as she ran from her car up to her front door, she slipped on a newly formed patch of ice, and fell down hard, landing on her right elbow. The pain was intense. Her neighbor heard her cry out as she fell; he helped her up, and got her back to the hospital.
An orthopedist on call at the hospital x-rayed her elbow and diagnosed a fracture in her ulna bone, in the tip of the elbow. Marie was relieved to hear the injury did not require surgery. The doctor placed Marie’s elbow in a splint, and told her she must wear it all the time, except to wash the elbow once a day. Marie returned home and managed to get a decent night's sleep.
This morning, Marie slept in. Unfortunately, she can’t return to work immediately because she needs to keep her arm immobile, so the bone can begin to heal. To minimize the amount of time she misses from work, she makes an appointment with her physical therapist to start treatment right away.
Marie's physical therapist makes sure not to disturb the elbow joint, while gently testing and moving the shoulder and hand joints to see how they are doing. He listens to Marie’s description of her pain and to her desire to return to work and her favorite hobby, mountain biking, as soon as possible. Although her physical therapist can’t shorten the time it takes the fracture to heal, he can help keep the muscles and other joints in the arm strong and flexible, so that when the fracture is healed, Marie can return to work and sports more quickly than without treatment.
Marie's physical therapist applies hot packs to the muscles in the upper arm and forearm, to help them relax and reduce any stiffness. He also applies electrical stimulation and a cold pack to the area of the fracture, to help reduce pain and swelling. He is careful not to move the elbow until the physician agrees it is safe. He allows Marie to immediately start riding the stationary bike in the clinic, in order to maintain her cardio fitness. He teaches her some simple movements to perform at home with her hand, wrist, and shoulder.
In the next session, he provides therapeutic massage to the muscles in the upper arm and forearm to help reduce stiffness and pain, and maintain flexibility. He teaches Marie some grip-strength exercises to help maintain the strength in her hand.
One week after the fracture, the physician calls Marie's physical therapist and says it’s okay to perform “passive range of motion,” meaning he can gently move her elbow in different directions during her physical therapy session. The elbow is stiff, but regains about 50% of its normal motion with a few treatments.
The next week, the physician allows slow “active range of motion" exercises, meaning Marie is allowed to move her elbow by herself. Her physical therapist teaches Marie how to do this safely and with the least amount of pain possible.
Gradually, Marie is able to increase the number and level of strength exercises for the elbow without pain. Marie's physical therapist adds exercises to reintroduce specific tasks that she has to perform at work, and a few mountain-biking techniques, such as leaning forward on her hands.
At the end of the fifth week, Marie is able to return to work and mountain biking, without any pain or weakness. Her physical therapist recommends that Marie wear an elbow pad while mountain biking, to help prevent future fractures if she falls. Marie also vows she will never run through freezing rain again!
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic problems. Some physical therapists have a practice with an orthopedic focus, and some even specialize in arm and hand injuries.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedics, sports physical therapy, or hand therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with elbow fracture.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of elbow fracture. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Lawrence JT, Patel NM, Macknin J, et al. Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment. Am J Sports Med. 2013;41(5):1152-1157. Article Summary in PubMed.
Draper DO. Injuries restored to ROM using PSWD and mobilizations. Int J Sports Med. 2011;32(4):281–286. Article Summary on PubMed.
Gwinn DE, O'Toole RV, Eglseder WA. Early motion protocol for select Galeazzi fractures after radial shaft fixation. J Surg Orthop Adv. 2010;19(2):104–108. Article Summary on PubMed.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Revised by Andrea Avruskin, PT, DPT, ATC. Reviewed by the editorial board.