An olecranon fracture is one of the more common bone breaks in the shoulder, arm, and hand. This is because the olecranon is so superficial or close to the skin. These injuries can have complications, so it is best to get treatment if you suspect a fracture. Read on to learn more about olecranon 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 forms 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 move 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 olecranon
The olecranon is the part of the ulna that connects to the humerus to make the humeroulnar joint. It helps to provide the flexion and extension movement of the elbow. The olecranon is a very superficial bone, and you can easily feel it under the skin. It is the bony point in the back of the elbow. One of the attachments for the triceps muscle is to the olecranon. The triceps is the main muscle used to extend (straighten) the elbow.
“OpenStax AnatPhys fig.11.25 – Muscles that Move the Forearm – English labels” by OpenStax, license: CC BY. Source: book ‘Anatomy and Physiology’, https://openstax.org/details/books/anatomy-and-physiology.
What is an olecranon fracture?
An olecranon fracture is a fracture or break of the olecranon. Olecranon fractures are fairly common and account for about 10% of all upper extremity fractures. The upper extremity includes the shoulder, arm, and hand. Most olecranon fractures occur in people 50 and older. There are several different mechanisms of injury for this type of break. These include:
- A fall directly onto the elbow
- Receiving a blow to the elbow from something hard, like a baseball bat or car door.
- Falling on an outstretched arm
- The arm tenses to break the fall and the pull of the triceps breaks the olecranon. This is known as an avulsion fracture. This type of olecranon fracture is more common in older adults with osteoporosis.
- A stress fracture of the olecranon can occur in throwing athletes.
What are the symptoms of an olecranon fracture?
There are several symptoms associated with an olecranon fracture. These include:
- Pain with elbow movement
- Inability to straighten the elbow
- Pain and tenderness at the elbow
- Swelling at the tip of the elbow
- Bruising at the elbow might occur
- The elbow might look unusual or deformed
- Might have numbness and tingling in the fingers
- A feeling of instability of the elbow
Are there usually other injuries that occur with an olecranon fracture?
Other injuries can occur with olecranon fractures. These injuries include:
- Other ulnar fractures
- Fracture of the radius at the elbow
- Ligament damage
- Elbow dislocation
Will I need surgery?
The answer is maybe. These fractures are prone to displacement because of the triceps attachment at the olecranon. This means that the piece of bone that is broken off of the olecranon has a tendency to move. This is due to the pull of the triceps on the fractured piece of bone. A forceful activation of the triceps can pull the piece of bone out of position. This could change whether or not surgery would be necessary.
If the fracture is displaced 1-2mm or less and the person can completely straighten the elbow, then surgery is not warranted. The arm is placed in a sling or cast for 7-10 days followed by gentle mobility exercises to limit stiffness. A caveat to this is the person’s age. Conservative management is also often used for the low-demand elderly even if the fracture is significantly displaced. The person will still be able to use the elbow with little pain. However, the strength of the triceps will be heavily compromised.
If the fracture is displaced 3mm or more or there is instability at the joint, then surgery would be required.
Are there any potential complications?
There are several complications that could occur with an olecranon fracture. These include:
- Elbow stiffness – This is the most common complication after this fracture. Because the olecranon makes up part of the humeroulnar joint, stiffness after fracture, especially in extension, is expected. Early motion exercises are necessary to maintain the mobility of the elbow joint. A large portion of people who sustain an olecranon fracture will lose about 10-15 degrees of elbow extension. However, this usually does not significantly hinder them in any way.
- Elbow arthritis – Osteoarthritis can develop in the elbow joint after an olecranon fracture. This is because the olecranon makes up part of the joint surface. This may not become apparent until many years after the injury.
- Nonunion – This means that the fracture is not healing and there is little chance of it healing without surgical intervention.
- Malunion – This occurs when the bone heals in an abnormal position. It may make the bone look bent and affect the function of the joint.
- Ulnar nerve neuritis – The ulnar nerve runs near the olecranon. It could be irritated and cause weakness and numbness and tingling in the hand.
- Heterotopic ossification – This is the formation of bone in an area that is not bone. Bone might form in muscle, tendon, ligament, or other soft tissue. This is the result of a substantial traumatic injury.
Who should I see?
- Physician – If you suspect that you have sustained an olecranon 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. Olecranon fractures are notorious for elbow stiffness that led 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. 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 olecranon is the part of the ulna that connects to the humerus to make the humeroulnar joint. It helps to provide the flexion and extension movement of the elbow.
- One of the attachments for the triceps muscle is to the olecranon. The triceps is the main muscle used to extend the elbow.
- An olecranon fracture is a fracture or break of the olecranon.
- Swelling, pain, and difficulty moving the elbow are symptoms of an olecranon fracture.
- These fractures are prone to displacement because of the triceps attachment at the olecranon.
- 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
https://www.ncbi.nlm.nih.gov/books/NBK537295/
https://emedicine.medscape.com/article/1231557-treatment#d23