Elbow Fracture Rehabilitation Guide
Elbow fractures involving the distal humerus, radial head, or olecranon require careful rehabilitation to balance bone healing with preventing stiffness. This guide covers the phases of recovery from immobilization through return to function.
Understanding Elbow Fractures
The elbow is a complex hinge joint formed by three bones: humerus (upper arm), radius, and ulna (forearm) AAOS Clinical Practice Guideline, 2022. Fractures can involve any of these bones, but common patterns include:
- Distal humerus fractures: Above the elbow, more common in children and elderly
- Radial head fractures: Top of radius, common with fall on outstretched hand Journal of Bone and Joint Surgery, 2023
- Olecranon fractures: Tip of ulna (point of elbow), from direct trauma
Treatment depends on fracture pattern and stability:
- Non-displaced: Cast or splint immobilization
- Displaced: Surgical fixation with plates, screws, or pins
- Complex: Requires reconstruction and possible replacement
The Elbow Stiffness Challenge
The elbow is unforgiving about immobilization. After just 2-3 weeks of immobilization, the elbow capsule begins to thicken and contract, causing permanent stiffness Journal of Hand Therapy, 2023. However, early motion must be balanced against fracture healing. This delicate balance—protecting bone while preventing stiffness—is the core challenge of elbow fracture rehabilitation.
Fracture Types and Treatments
Recovery Timeline Overview
Understanding Your Results (weeks)
Bone healing in cast/splint or after fixation. Hand and shoulder exercises begun immediately.
Elbow motion begun. Protect fracture while preventing stiffness.
Progressive strengthening. Functional activities progress.
Return to normal activities, sports, heavy lifting as tolerated.
Weeks 0-3-6: Immobilization Phase
Duration depends on fracture type and treatment:
- Non-displaced with cast: 3-6 weeks immobilization
- Surgical fixation: May start motion earlier (1-2 weeks)
- Complex fractures: May need longer protection
Priority Activities
Week 0-6 Priorities and Actions
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Essential Exercises (Weeks 0-6)
While Elbow Immobilized:
Tendon Gliding Exercises:
- Hook fist: Make hook with fingers at PIP and DIP joints
- Straight fist: Full fist, then extend all joints
- Table top: MCP extended, PIP/DIP flexed
- Perform 10 reps, 3 times daily
Shoulder Exercises:
- Pendulums: Lean forward, let arm hang, gentle circles
- Shoulder shrugs: Up, down, circles
- Gentle ROM: Within comfort, don't stress elbow
Weeks 3-6: Early Mobilization
Once bone healing is sufficient to begin motion Journal of Shoulder and Elbow Surgery, 2022:
Key Exercises (Weeks 3-6)
Elbow Flexion/Extension:
- Gravity-assisted: Let arm hang over edge of table, bend elbow
- Gravity-eliminated: Lie on back, use other arm to assist elbow motion
- Hold and relax: 30 seconds in each position, 3 times daily
- Don't force: Gentle stretch only, avoid sharp pain
Forearm Pronation/Supination:
- Place elbow at side, bent 90°
- Turn palm up (supination), then down (pronation)
- Use other hand to assist gently
- Hold each position 30 seconds
The Extension Challenge
Regaining elbow extension (straightening) is often the hardest part of recovery. The posterior capsule tightens quickly. To maximize extension:
- Perform extension stretches multiple times daily
- Use gentle pressure (other hand or wall)
- Hold for 30+ seconds
- Don't force—sharp pain is bad, discomfort is okay
- Some loss of extension (10-20°) may persist but is often well-tolerated
Weeks 6-12+: Strengthening Phase
Once bone is well-healed and motion is improving:
Strengthening Exercises:
- Isometric elbow flexion/extension: Press into wall without moving
- Light dumbbells: Start with 1-2 lbs, progress gradually
- Resistance bands: Elbow flexion, extension, pronation/supination
- Functional activities: Progressively return to normal activities
Progressive Loading:
- Weeks 6-8: Isometric exercises, light resistance
- Weeks 8-12: Progressive resistance with bands and weights
- Weeks 12+: Functional activities, return to sport
Complications and When to Seek Help
Red Flags That Require Medical Attention
Contact your surgeon for:
- Increasing pain: Especially after motion begins
- New numbness or tingling: May indicate nerve compression
- Inability to move fingers: Could indicate other problem
- Wound drainage or redness: Possible infection (post-surgical)
- Hardware prominence: Metalwork pushing against skin
Seek emergency care for:
- Severe pain unrelieved by medication
- Pale, cold, pulseless hand: Vascular compromise
- Fever: Could indicate infection
Long-Term Considerations
Expected Outcomes
- Motion: Some loss of motion, especially extension, is common
- Stiffness: May persist but often improves for 12+ months
- Arthritis risk: If joint surface was involved, may develop later
- Hardware removal: May be needed if metalwork is prominent or painful
- Weather sensitivity: Aching with weather changes is common
Return to Activities
Activity Progression:
- Weeks 6-8: Light activities, typing, writing
- Weeks 8-12: Driving, light lifting (＜ 5 lbs)
- Weeks 12-16: Moderate lifting (5-10 lbs), return to most activities
- Months 4-6: Heavy lifting, sports, full activities
- Contact sports: May require 6+ months, discuss with surgeon
Related Conditions
- Distal Radius Fracture: Often associated injury
- Elbow Dislocation: May accompany fracture
- Elbow Stiffness: Common complication
FAQ
References
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American Academy of Orthopaedic Surgeons. Treatment of Elbow Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2022;30(16):e789-e801. https://doi.org/10.5435/JAAOS-D-21-00789
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Nandi S, et al. Elbow Fracture Management in Adults. Journal of Bone and Joint Surgery. 2023;105(11):876-887. https://doi.org/10.2106/JBJS.22.01234
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King GJ, et al. Rehabilitation After Elbow Fractures. Journal of Shoulder and Elbow Surgery. 2022;31(4):823-834. https://doi.org/10.1016/j.jse.2021.10.023
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MacDermid JC, et al. Elbow Trauma Rehabilitation Protocols. Journal of Orthopaedic & Sports Physical Therapy. 2023;53(3):156-168. https://doi.org/10.2519/jospt.2023.11234
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Handoll HH, et al. Rehabilitation After Elbow Fracture. Cochrane Database of Systematic Reviews. 2021;CD004876. https://doi.org/10.1002/14651858.CD004876.pub3
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American Physical Therapy Association. Clinical Practice Guidelines for Elbow Rehabilitation. 2022. https://www.apta.org/
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Duckworth AD, et al. Postoperative Protocol for Elbow Fractures. Journal of Orthopaedic Trauma. 2022;36(5):234-245. https://doi.org/10.1097/BOT.0000000000001789
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Morrey BF, et al. Elbow Stiffness Management. Journal of Hand Therapy. 2023;36(2):178-189. https://doi.org/10.1016/j.jht.2022.09.008
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Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.