A radial head fracture is one of the more common fractures in adults. Fracture is just another word for break. As a physical therapist, I usually will not treat a fracture until a few weeks after it occurs. Often there is difficulty in getting full motion back in the elbow. This is because the radial head plays a key role in 2 of the 3 joints of the elbow. Read on to learn more about radial head fractures. Let’s start with anatomy!
The elbow
The elbow joint is where the humerus, ulna, and radius come together. The humerus is the upper arm bone and will form individual joints with the ulna and radius, which are the forearm bones. The radius and humerus form the humeroradial joint and the ulna and humerus form the humeroulnar joint. The radius and the ulna will also form a joint which is called the radioulnar joint. These 3 joints make up the elbow joint.
Movements of the elbow include flexion and extension. Flexion is when the forearm and upper arm come closer together (bending the elbow) and extension is when they are moved farther apart (straightening the elbow). The radioulnar joint allows for the movements of pronation and supination. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
The radial head
The radial head is at the top of the radius. It is a thick, disc-shaped area that joins with the end of the humerus to form the humeroradial joint. The side of the radial head touches the ulna forming the radioulnar joint. The radial head also helps to stabilize the elbow.
What is a radial head fracture?
A radial head fracture is a break of the radius at the radial head. Radial head fractures comprise 20-30% of all elbow fractures in adults. It tends to occur between the ages of 30-60 years old. It is commonly caused by a fall on an outstretched hand. This is called a FOOSH injury. The force from the fall is transmitted from the hand and wrist up the radius to the radial head causing a fracture. It can also be caused by direct trauma to the elbow.
What are the symptoms of a radial head fracture?
There are several symptoms associated with a radial head fracture. These include:
- Pain and tenderness at the elbow
- Decreased ability to move the elbow
- Especially in pronation and supination
- Swelling at the elbow
- Bruising at the elbow might occur
- The elbow might look unusual or deformed
- Might have numbness and tingling in the forearm, hand, and fingers
Are there usually other injuries that occur with a radial head fracture?
There are a few other injuries that tend to occur with radial head fractures. These include:
- Injuries to the ligaments of the elbow joint
- Elbow dislocations
- Fractures to the humerus or ulna
- Wrist fracture
Are there any potential complications?
- Elbow stiffness and limited forearm rotation
- This is the most common complication after this fracture. Because the radial head is a component of two different joints, all motions of the elbow could be stiff. Early motion exercises are necessary to maintain the mobility of the elbow joint.
- Elbow arthritis
- Osteoarthritis can develop in the elbow joint after a radial head fracture. This may not become an issue until many years after the injury.
Will I need surgery?
The answer is maybe. If the fracture is not displaced or minimally displaced, then surgery would not be needed. The arm will be placed in a sling for about a week followed by gentle motion to prevent elbow stiffness. If the fracture is significantly displaced or has multiple fragments, then surgery would be necessary. If the fracture is blocking the motion of the joint or the elbow has dislocated, then surgery would also be needed.
Who should I see?
- Physician – If you suspect that you have sustained a radial head fracture (or some other type of fracture), it is best to go to the emergency room. Because of the potential complications, this fracture should be treated quickly. However, if your fracture has already been treated and you suspect additional injury or complication, then it would be best to see your orthopedist or primary care physician. Additional imaging and inspection might be needed to rule out other conditions.
- Physical therapist – Physical therapy might be needed if you are having difficulty regaining strength and/or motion around the elbow. Elbow fractures are notorious for elbow stiffness that lead to contracture. This means that the elbow no longer has full mobility. Usually, the elbow gets stuck in a flexion contracture and is unable to straighten all the way. However, with a radial head fracture, supination and pronation mobility could be limited as well. Your PT can evaluate you to determine the extent of your mobility and strength deficits and use manual therapy, as well as, stretching and strengthening to help address all problems in and around the elbow.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to allow the bones to heal. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as walking or jogging while your elbow is healing.
- Ice – Ice can help decrease pain and symptoms at the elbow.Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Soft tissue mobilization – Soft tissue mobilization helps release the muscles around the elbow and decreases the tension on the joint. Use a massage ball, lacrosse ball, tennis ball, or your own fingers to massage painful areas all around the elbow. Spend a good 3 to 5 minutes rolling. Do not roll so hard that you bruise the area, but it should be a pretty painful sensation. Roll out the area no more than a few times a week. See the video below.
- Elbow stretches – The elbow might have limited motion in certain directions. Typically, extension or straightening the elbow is the hardest to fully regain. However, depending on the person, then flexion, pronation, or supination might also be tight. See the video below in how to stretch the muscles around the elbow.
- Wrist flexion and extension stretching – You can also need to stretch out the wrist flexors and extensors. These muscles attach at or near the elbow and could be tight. See the video below.
- Strengthening the muscles around the elbow and wrist – Strengthening the muscles around the wrist and elbow are also important in being able to return to your activity. Wait until 6 to 8 weeks after the break or when given clearance by your physician to begin strengthening. Decrease your resistance or number of repetitions if the pain is moderate to severe during the exercise or returns after the exercise. Using dumbbells or resistance bands can increase strength and difficulty. See the video below.
In review
- The elbow joint is where the humerus, ulna, and radius come together.
- The radius and humerus form the humeroradial joint and the ulna and humerus form the humeroulnar joint.
- The radius and the ulna will also form a joint which is called the radioulnar joint.
- These 3 joints make up the elbow joint.
- Movements of the elbow include flexion, extension, pronation, and supination.
- The radial head is at the top of the radius.
- It touches the humerus and ulna to form the humeroradial joint and the radioulnar joint.
- This is a fracture or break of the radial head.
- Swelling, pain, and difficulty moving the elbow are symptoms of a radial head fracture.
- Seek immediate medical help if you suspect a fracture.
- Physical therapy will play a role if there is difficulty in regaining strength and mobility in the elbow.
- There are things you can do once the cast is off or you are cleared by the surgeon.
- Ice
- Soft tissue mobilization
- Elbow stretches
- Wrist stretches
- Strengthening of the muscles around the elbow and wrist
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources