Elbow (Olecranon and Radial Head) FractureElbow Fracture (Elbow (Olecranon & Radial Head) Fracture)
Elbow (Olecranon and Radial Head) Fracture — Overview
Elbow fractures—most notably radial head fractures (Mason Types I–IV from axial valgus load during a FOOSH) and olecranon fractures (Mayo Types I–III with triceps traction)—are extraordinarily prone to post-traumatic stiffness (arthrofibrosis) and heterotopic ossification because of the highly congruent 3-joint capsule and sensitive brachialis/anterior capsule.
An elbow fracture (olecranon or radial head fracture) is a break in the bony point of the elbow or the rotating head of the forearm bone. Because the elbow stiffens faster than almost any other joint, gentle, pain-free active movement is the key to recovery.
Primary Causes & Biomechanics
Key Points You Should Know
- •Axial load transmitted through a pronated, slightly flexed forearm (radial head) or direct fall onto the point of the elbow with triceps contraction (olecranon)
- •High propensity of the anterior elbow capsule to undergo myofibroblastic hypertrophy and contracture if immobilized >2–3 weeks
- •Strict precaution against aggressive passive stretching which provokes intra-articular micro-hemorrhage and Myositis Ossificans / Heterotopic Ossification
- •Active Movement, Never Forceful Wrenching: You should move your elbow gently with your own muscles; never let anyone forcefully push or hang heavy weights on a stiff elbow!
- •Turning the Palm Up and Down: Keeping your elbow tucked at your waist while turning your palm up and down keeps the radial head gliding smoothly.
- •Protecting the Triceps Repair: If the back point of your elbow (olecranon) was operated on, avoid pushing yourself up from a chair with that arm early on.
Assessment Methods
1. Goniometric ROM & Postural / Kinematic Analysis
Elbow flexion-extension (Functional arc: 30°–130°; Normal: 0°–145°) and forearm supination-pronation (Functional arc: 50°–50°; Normal: 85°–85°).
2. Special Clinical Provocation & Neurological/Functional Tests
Distal radioulnar joint (DRUJ) pain screening (Essex-Lopresti interosseous membrane lesion in radial head fractures!), ulnar nerve screening in the cubital tunnel, and triceps extensor mechanism check.
3. Standardized Clinical Outcome Scales & Imaging Criteria
Mayo Elbow Performance Score (MEPS), QuickDASH, and AP/lateral/radiocapitellar elbow radiographs.
1. Range of Motion & Posture Check
Your physiotherapist gently evaluates how comfortably and smoothly your elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints) moves and checks your overall posture.
2. Muscle Strength & Functional Movement Check
Your muscle balance, walking or reaching comfort, and specific gentle movement tests are evaluated without triggering sharp pain.
3. Typical Symptoms & Daily Impact Review
Lateral elbow pain during forearm rotation (radial head fracture) or posterior elbow swelling and tenderness (olecranon fracture), accompanied by loss of full elbow straightening (extension deficit).
Treatment Options & Phase-Based Protocol
✨ Enriched GIF Exercise & Precaution GuidePhase 1: Acute Symptom Modulation, Tissue Protection & Early Activation
- •Phase 1 Clinical Focus & Tissue Protection: Early Protected Motion Phase (Weeks 1–3): Avoid prolonged immobilization (>2 weeks in Mason I); perform active/active-assisted elbow flexion-extension (protecting >90° flexion and active extension in early olecranon ORIF), isolated forearm supination-pronation with elbow at 90°, and Six-Pack tendon gliding.
- •Pain, Edema & Neuromuscular Modulation: Targeted physical modalities, relative load management, and early protected mobility of the elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints) without provoking mechanical or inflammatory irritation.
- •Proximal & Distal Kinetic Chain Maintenance: Maintain active mobility and circulation in adjacent joints while protecting the primary healing structures in Elbow (Olecranon & Radial Head) Fracture.
Phase 2: Progressive Mobility, Motor Control & Targeted Strengthening
- •Phase 2 Progressive Mobilization & Motor Control: Progressive ROM & Wrist/Scapular Phase (Weeks 3–6): Active wrist flexion-extension, scapular retraction, and gentle active-assisted end-range holds to restore the functional 30°–130° elbow arc.
- •Biomechanical Alignment & Co-Contraction: Restore balanced agonist-antagonist force couples, joint centration, and multi-planar neuromuscular control across the elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints).
- •Myofascial Extensibility & Endurance: Address secondary compensatory tightness and build local muscular endurance within safe, symptom-free biomechanical parameters.
Phase 3: Functional Integration, Proprioception & Long-Term Prevention
- •Phase 3 Functional Integration & Long-Term Prevention: Isotonic Strengthening & Functional Return (Week 6–12): Soft putty grip strengthening, gentle forearm flexor/extensor stretching, and progressive biceps/triceps strengthening once radiographic union is complete.
- •Proprioceptive Balance & Dynamic Loading: Progress to task-specific closed-chain, balance, and functional movement patterns tailored to daily life, occupational, or athletic demands.
- •Self-Management & Relapse Prophylaxis: Establish lifelong ergonomic habits, home exercise maintenance, and early warning-sign awareness to prevent recurrence.
Step 1: Calming Pain, Protecting the Area & Gentle Starter Motion
- •Active Movement, Never Forceful Wrenching: You should move your elbow gently with your own muscles; never let anyone forcefully push or hang heavy weights on a stiff elbow!
- •Calm Protection & Gentle Start: During the initial stage of Elbow Fracture, avoid painful overloading and perform the gentle, pain-free starter movements shown below to support circulation and comfort.
- •Respecting Your Body's Signals: Every movement should stay within a comfortable, non-painful zone—never force through sharp or radiating pain.
Step 2: Restoring Flexibility & Building Supporting Muscle Strength
- •Turning the Palm Up and Down: Keeping your elbow tucked at your waist while turning your palm up and down keeps the radial head gliding smoothly.
- •Step-by-Step Flexibility & Support: As acute sensitivity settles, gradually build mobility and strengthen the supporting muscles around the joint at a steady, controlled pace.
- •Posture & Breathing Coordination: Keep your posture upright and breathe smoothly (never hold your breath!) during every repetition.
Step 3: Safe Daily Habits, Stamina & Preventing Recurrence
- •Protecting the Triceps Repair: If the back point of your elbow (olecranon) was operated on, avoid pushing yourself up from a chair with that arm early on.
- •Confident Return to Daily Life: Integrate your stronger muscles and improved balance into walking, stairs, work, and recreational activities.
- •Preventing Future Flare-Ups: Continue your core protective habits and key maintenance exercises even after symptoms resolve.
Animated (GIF) Therapeutic Exercise Guide
Animated clinical exercise protocol with biomechanical angles, target muscle groups, and dosage parameters (Click image to enlarge)
Step-by-step animated exercise demonstrations you can safely perform at home (Click image to enlarge)
🔍 Enlarge1. Isolated Humeroulnar Active/Active-Assisted Flexion and Extension ROM
1. Full Elbow Bending and Straightening
Controlled full-arc elbow flexion and extension with the humerus stabilized in neutral alignment. Prevents anterior capsular contracture (extension loss) and restores biceps/triceps reciprocal excursion. Specifically indicated in Elbow (Olecranon & Radial Head) Fracture rehabilitation to optimize elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints) biomechanics and neuromuscular control.
Keep your upper arm comfortably close to your body. Slowly bend your elbow to bring your hand toward your shoulder, hold for 3 seconds, then slowly straighten your elbow as far as comfortable. Perform smoothly within a comfortable, pain-free range to support your Elbow Fracture recovery.
🔍 Enlarge2. Proximal & Distal Radioulnar Joint (PRUJ/DRUJ) Supination and Pronation
2. Elbow-at-Side Palm Up and Palm Down Rotation
Isolated forearm rotation with the elbow flexed at 90° and adducted against the trunk to eliminate compensatory glenohumeral rotation. Restores radial head spinning and distal radioulnar translation. Specifically indicated in Elbow (Olecranon & Radial Head) Fracture rehabilitation to optimize elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints) biomechanics and neuromuscular control.
Keep your elbow bent at a right angle and tucked closely against your waist. Slowly turn your palm upward toward the ceiling, hold for 3 seconds, then turn your palm downward toward the floor. Perform smoothly within a comfortable, pain-free range to support your Elbow Fracture recovery.
🔍 Enlarge3. Radiocarpal & Midcarpal Active/Eccentric Flexion and Extension
3. Table-Edge Wrist Bending Up and Down
Controlled sagittal plane wrist flexion and extension with the forearm supported on a table edge and digits relaxed. Restores radiocarpal/midcarpal roll-and-glide mechanics and stimulates aligned collagen synthesis in forearm tendons. Specifically indicated in Elbow (Olecranon & Radial Head) Fracture rehabilitation to optimize elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints) biomechanics and neuromuscular control.
Rest your forearm on a table with your wrist hanging comfortably over the edge. Slowly lift your hand upward toward the ceiling, hold for 3 seconds, then lower it gently downward. Perform smoothly within a comfortable, pain-free range to support your Elbow Fracture recovery.
🔍 Enlarge4. Progressive Isotonic Grip & Pinch Strengthening with Extensor Co-Contraction
4. Soft Therapy Ball / Putty Squeeze
Graded isometric squeeze of therapeutic putty or a soft ball with the wrist held in 15°–20° functional extension. Rebuilds extrinsic digital flexor strength alongside synergistic wrist extensor stabilization. Specifically indicated in Elbow (Olecranon & Radial Head) Fracture rehabilitation to optimize elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints) biomechanics and neuromuscular control.
Hold a soft therapy ball or sponge in your palm while keeping your wrist straight. Squeeze gently without triggering sharp pain, hold for 5 seconds, and slowly relax your fingers. Perform smoothly within a comfortable, pain-free range to support your Elbow Fracture recovery.
🔍 Enlarge5. Scapulothoracic Retraction & Depression (Middle/Lower Trapezius & Rhomboids)
5. Shoulder Blade Squeeze (Postural Alignment)
Adduction and depression of the scapulae via the middle/lower trapezius and rhomboids while inhibiting upper trapezius overactivity. Corrects anterior scapular tilt, widens the subacromial outlet, and unloads the anterior thoracic column. Specifically indicated in Elbow (Olecranon & Radial Head) Fracture rehabilitation to optimize elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints) biomechanics and neuromuscular control.
Sit or stand tall. Keep your shoulders relaxed away from your ears, gently draw your shoulder blades together and slightly downward toward your back pockets, hold for 5 seconds, and release. Perform smoothly within a comfortable, pain-free range to support your Elbow Fracture recovery.
🔍 Enlarge6. Six-Pack Differential Flexor Tendon Gliding (FDS & FDP Excursion)
6. Step-by-Step Finger Tendon Gliding (Hook, Straight & Full Fist)
Sequential progression through Straight Hand, Tabletop (intrinsic-plus), Hook Fist (maximum FDS/FDP differential glide), Full Fist, and Straight Fist positions. Prevents peritendinous adhesions within the carpal tunnel and fibro-osseous digital sheaths. Specifically indicated in Elbow (Olecranon & Radial Head) Fracture rehabilitation to optimize elbow complex (ulnar olecranon process, radial head/neck, and humeroulnar/proximal radioulnar joints) biomechanics and neuromuscular control.
Start with your fingers straight, then bend at the knuckles (tabletop), curl just the fingertips (hook fist), make a gentle full fist, and open wide again—holding each position for 2–3 seconds. Perform smoothly within a comfortable, pain-free range to support your Elbow Fracture recovery.
Movements to Avoid & Strict Precautions
1. Aggressive Passive Stretching, Massage Over the Front of the Elbow, or Carrying Heavy Buckets
1. Forcing the elbow straight, deep massage over the front elbow crease, or carrying heavy buckets to stretch it (causes bone calcification!)
2. Pushing Up From a Chair/Bed (Active Triceps Load) in Early Olecranon Fractures
2. Pushing your body weight up with your arm after an olecranon fracture
3. Prolonged Cast Immobilization Beyond 2–3 Weeks Without Surgeon Indication
3. Keeping the elbow completely immobilized for many weeks when cleared for early motion
4. Axial Weight-Bearing (Push-Ups / Planks) Before Full Bony Healing
4. Doing push-ups or leaning weight onto an extended arm before complete union
Elbow (Olecranon and Radial Head) Fracture — Video Guide
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Condition Overview Video (1 Video)
Summary of pathophysiology, biomechanics, and clinical presentation
What the condition is, why it develops, and its basic mechanism
What Are Elbow Fractures (Olecranon and Radial Head)? How Are They Treated?
Elbow fractures—most notably radial head fractures (Mason Types I–IV from axial valgus load during a FOOSH) and olecranon fractures (Mayo Types I–III with triceps traction)—are extraordinarily prone to post-traumatic stiffness (arthrofibrosis) and heterotopic ossification because of the highly congruent 3-joint capsule and sensitive brachialis/anterior capsule.
An elbow fracture (olecranon or radial head fracture) is a break in the bony point of the elbow or the rotating head of the forearm bone. Because the elbow stiffens faster than almost any other joint, gentle, pain-free active movement is the key to recovery.
Treatment and Exercise Videos
Phase-based physiotherapy protocols, mobilization, and therapeutic exercises
Step-by-step recovery and safe home exercise applications
Exercises After an Elbow Fracture | Home Physical Therapy and Recovery Routine
Phase 1: Acute Symptom Modulation, Tissue Protection & Early Activation: Phase 1 Clinical Focus & Tissue Protection: Early Protected Motion Phase (Weeks 1–3): Avoid prolonged immobilization (>2 weeks in Mason I); perform active/active-assisted elbow flexion-extension (protecting >90° flexion and active extension in early olecranon ORIF), isolated forearm supination-pronation with elbow at 90°, and Six-Pack tendon gliding.
Step 1: Calming Pain, Protecting the Area & Gentle Starter Motion: Active Movement, Never Forceful Wrenching: You should move your elbow gently with your own muscles; never let anyone forcefully push or hang heavy weights on a stiff elbow!
Range of Motion and Strengthening Exercises After Elbow and Arm Fractures
Phase 2: Progressive Mobility, Motor Control & Targeted Strengthening: Phase 2 Progressive Mobilization & Motor Control: Progressive ROM & Wrist/Scapular Phase (Weeks 3–6): Active wrist flexion-extension, scapular retraction, and gentle active-assisted end-range holds to restore the functional 30°–130° elbow arc.
Step 2: Restoring Flexibility & Building Supporting Muscle Strength: Turning the Palm Up and Down: Keeping your elbow tucked at your waist while turning your palm up and down keeps the radial head gliding smoothly.
Clinical Assessment, Goniometry & Special Test Videos
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Elbow and Forearm Goniometric Measurement (Flexion, Extension, Supination, Pronation)
Goniometric ROM & Postural / Kinematic Analysis: Elbow flexion-extension (Functional arc: 30°–130°; Normal: 0°–145°) and forearm supination-pronation (Functional arc: 50°–50°; Normal: 85°–85°).
Elbow Extension (Triceps Brachii) Manual Muscle Test
Special Clinical Provocation & Neurological/Functional Tests: Distal radioulnar joint (DRUJ) pain screening (Essex-Lopresti interosseous membrane lesion in radial head fractures!), ulnar nerve screening in the cubital tunnel, and triceps extensor mechanism check.