The radius is one of two bones that comprise the forearm, the area between the elbow and wrist. The radius is the thinner of the two bones, while the ulna is thicker. These two bones articulate near the wrist and at the elbow, and a membrane called the interosseous membrane spans the space between the long bones. The radial head refers to the proximal end of the radius at the elbow. It articulates with the humerus (upper arm bone) to allow for bending and straightening the elbow and with the ulna to allow you to turn your palm up and down by rotating the forearm.

A fall on an outstretched hand is the most common cause of radial head fractures. It is instinctive to brace yourself with your arm but when doing so, the forces caused by the fall are often transmitted through the wrist and up to the radial head where the bone can fracture or break. Symptoms of a radial head fracture include the following:

• Pain along the outer aspect of the elbow which may radiate up toward the shoulder or down toward the wrist
• Difficulty bending and straightening the elbow or rotating the forearm
• Tenderness over the radial head
• Swelling or bruising over the radial head
• Signs of bony deformity if the fracture is displaced

BASICS ON BROKEN BONES

A closed, minimally displaced and stable radial head fracture is often treated with a sling or splint to immobilize the elbow and forearm for 7-14 days. Follow-up X-rays are often ordered during that time to look for evidence of fracture healing. Following removal of the sling or splint, early and progressive elbow and forearm range of motion is recommended to help gradually restore joint motion.

If the bone fragments are more than minimally displaced, are causing a block to elbow or forearm motion or if the bone or joint is deemed unstable, an open-reduction internal fixation (ORIF) surgery is typically recommended. During this procedure, a surgeon places hardware to stabilize the fractured radius so it heals in good alignment while allowing for the return of elbow and forearm motion.

If you decide to work with a physical therapist to help correct your radial head fracture issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your sessions yet in the comfort of your own home.

PHYSICAL THERAPY FOR A RADIAL HEAD FRACTURE

During the initial healing phase, usually 7-14 days in the case of an uncomplicated radial head fracture, your elbow will be immobilized using a splint or sling. During this time, your physical therapist will focus on the following interventions:

• Strength training, stretching and range of motion of adjacent areas of the body such as the shoulder may be prescribed to prevent stiffness and atrophy while the elbow is healing
• Education on the healing process of bones
• Recommendations on how to adapt daily tasks to the use of one arm

• Active and active-assisted elbow and forearm motions are prescribed early to minimize the effects of immobilization and promote return of full joint range of motion. Your therapist will teach you how to perform these appropriately and how to use pain and stage of healing as a guide
• Strengthening will be an important part of physical therapy following radial head fracture to help arm, forearm and hand muscles regain normal function. You will begin with light isometric exercises wherein the muscle contracts without moving the joint and progress to more intensive exercises as healing progresses
• Weight-bearing exercises will eventually be added to your program to improve stability and proprioception around the elbow joint but this should not be started too early as it can compromise fracture healing.
• Once the fracture has healed well, stretching to achieve end ranges of motion and normalize muscle length will be prescribed
• Sport and work-specific training to help the injured arm return to higher impact and repetitive activities like throwing a ball, push-ups, pull-ups, gardening, carpentry and much more are prescribed in the final phases of rehabilitation