Physical Therapy After an Elbow Fracture

Physical therapy for a broken elbow can help you restore elbow range of motion, strength and overall functional use of your arm. An elbow fracture can be a painful injury. It can lead to decreased mobility in your arm, shoulder, or wrist. An elbow fracture also can limit your ability to work, perform household chores, or participate in recreational activities.

Physical therapy aims to restore joint mobility and strength, as well as your range of motion so that you can return back to normal or near-normal activity.

Common signs of a broken elbow include:

• Pain in the elbow, upper arm, or forearm
• Swelling around the elbow
• Bruising or discoloration around the elbow
• Loss of motion around the elbow or forearm
• Deformity (such as a lump or bump) near the elbow or arm

If you suspect you have suffered an elbow fracture, you must seek medical attention immediately. Failure to report to your doctor or local emergency department may cause permanent damage or loss of function in your arm and hand.

The elbow is a joint where the arm bone (humerus) meets the bones of the forearm (radius and ulna). The bony end of the ulna is called the olecranon process. This is the bone that you feel when you are leaning your elbow on a table. The bones of the elbow are connected together by ligaments on the inner and outer part of your arm.

It may seem obvious, but the most common cause of elbow fractures is trauma to your arm near your elbow. This can be due to falls on your elbow or outstretched arm, automobile accidents, or sports-related injuries.

An injury typically happens suddenly, often are due to a blunt force impact that fractures either the radial head (located at the top of the smaller forearm bone), the distal humerus (the lower part of the upper arm bone), or the olecranon (ball of the elbow joint), compound fractures and dislocations can also occur.

A fracture with dislocation is especially problematic, causing long-term pain and stiffness. Moreover, many people will develop excessive ossification (bone growth) and joint impairment.

An X-ray is used to diagnose an elbow fracture. The X-ray can show the placement of the bones and can help your doctor decide the best way to fix your fractured elbow. Occasionally, a type of X-ray known as computed tomography (CT) scan may be used to get a better view by creating cross-sectional images of the joint along the length of the injury.

After a diagnosis of a fractured elbow is made, your doctor will reduce the fracture. This is the process where your elbow bones are put in the correct position so that optimal healing can take place. Reduction of a fractured elbow can be done manually.

If the fracture is severe, your surgeon may recommend an open reduction internal fixation (ORIF). This involves an incision to manually realign the bones, followed the insertion of screws, plates, or wires to hold the bones in the correct position.

After your elbow fracture is reduced, you may be required to wear a brace or a sling. Occasionally a cast will be applied, although it is felt that immobilization of an elbow fracture with a cast may cause severe stiffness and permanent loss of mobility.

A major problem with an elbow fracture is stiffness that limits the range of motion. Sometimes, this stiffness persists long after the fractured bones have healed. Therefore, your doctor may have you start physical therapy soon after the injury to help introduce an early motion to your healing elbow.

Your physical therapist may work with you to help you regain normal use of your elbow and arm. He or she may use many different physical therapy treatments and modalities to help you quickly return to normal activity. Some impairments that you may work on in physical therapy may include:

One of the main goals of physical therapy after an elbow fracture is to restore normal range of motion (ROM) to the elbow. The elbow is a complex joint that allows you to bend your arm or turn your hand over. Restoring the full ROM of the elbow and forearm is paramount to regaining normal use of your arm.

As a rule, the early introduction of ROM therapy achieves not only better but faster results. A 2014 study from the University of Rochester showed that even elderly people who started ROM exercises soon after immobilization required 6.5 days of therapy versus 17 days for those who delayed.

If your ROM loss is severe, your physical therapist may have you wear a dynamic splint. This is a spring-loaded splint worn throughout the day that provides a low-load stretch to your elbow joint to help improve your ROM. The splint can be used to improve flexion (bending) or extension (straightening) of your elbow.

After an elbow fracture, pain and swelling in your elbow may keep you from using your arm. You may also be required to wear your arm in a sling, thus limiting the use of your elbow, wrist, and hand.

If you have had an ORIF to reduce your elbow fracture, the muscles around the surgical incision may need time to heal. This period of disuse may cause a significant loss of strength around your elbow, shoulder, wrist, and hand.

Your physical therapist can teach you strengthening exercises for your shoulder and elbow. He or she can also prescribe exercises to help improve wrist and hand strength that can help you regain normal use of your arm.

If you are wearing a sling, your physical therapist can also teach you the proper way to wear the sling and can ensure that it fits properly. He or she can also prescribe exercises for your hand to make sure your grip strength returns to your pre-injury levels.

After an elbow fracture, you may experience swelling around your elbow. Your physical therapist can help you manage the pain and swelling with various modalities like electrical stimulation and ice. A recent case report found that managing an elbow fracture with shortwave diathermy (a heating modality) and joint mobilizations helped restore normal ROM in a patient with an elbow fracture.

If you have had an ORIF to reduce your elbow fracture, your physical therapist can help you manage the scar tissue that may be present as a result of the surgery. Scar tissue massage and mobilization may be necessary to help improve scar mobility. Your physical therapist can teach you self-massage techniques that you can perform at home.

Most people should be able to return to normal activities within four months. For some, full healing can take up to a year after injury. It is quite common to still experience some mild loss of mobility after this time, so it is very important to continue the range of motion and strength exercises that you learned in physical therapy.

An ounce of prevention is worth a pound of cure, so keep going with your home exercise program after PT has come to a close. Be sure to discuss with your doctor what outcome is expected in your specific situation with your elbow fracture.

Physical therapy after an elbow fracture can be helpful in safely starting early mobility. It can also help you restore normal strength and function in your arm while helping to manage the pain and swelling that you may experience.

Working closely with your doctor and physical therapist can help you quickly and safely return to normal activity after an elbow fracture.