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This Splint Is Meant to Be Temporary. Treat It That Way.
A posterior elbow splint is a long shell along the BACK of the upper arm, elbow and forearm that holds the elbow still at a set angle, usually close to a right angle.
Most adults wear it for a few days to 3 weeks after an elbow fracture, dislocation or elbow surgery, day and night at first, before movement starts. Children’s elbow fractures often stay in for 3 to 4 weeks, cos young elbows rarely stiffen.
SHORT is the key word. The elbow stiffens faster than most joints, so for many injuries the splint gives way to movement within days to a couple of weeks.
Right now you’ve got an arm in a hard shell, a sling, one working hand, and a sore elbow you’re scared to move.
The instinct is to keep it still until it stops hurting. With the elbow, that instinct costs degrees. Held still for more than about 3 weeks, adult elbows tend to end up stiffer, and the last part of straightening is the first thing to go.
Here’s how to get through the splint phase with the rest of the arm in good shape and the elbow ready to move on the day it’s allowed.
What does a posterior elbow splint do?
- Holds the elbow still, which settles pain and swelling after injury or surgery.
- Controls forearm position, palm up, palm down or in between, depending on which structures need protecting.
- Protects a fixation or repair until early movement is safe.
- Can be removable. A custom thermoplastic shell lets exercise sessions start as soon as your surgeon allows. A cast-material back slab from the ER usually stays on until the clinic review.
What is a posterior elbow splint used for?
- Radial head fractures. Usually a few days only, for comfort, with movement often starting within the first week. See radial head fracture recovery.
- Elbow dislocations. Briefly, often up to a week, before movement in a hinged elbow brace or free. See elbow dislocation recovery.
- Children’s elbow fractures. Often 3 to 4 weeks, before or after fixation. See supracondylar elbow fractures in children.
- After elbow surgery, such as distal biceps repair or fracture fixation. Usually 1 to 2 weeks, until the protected movement phase. See distal biceps repair recovery.
- Night extension splinting for a stiff elbow, where the same shell is molded straighter to hold gains overnight. See static progressive splints.
The elbow forgives almost anything except being held still for too long.
How long do you wear a posterior elbow splint?
- Days 0 to 7. Splint on day and night for comfort and protection, out only as instructed.
- Weeks 1 to 3. For many stable injuries, the splint is weaned and movement begins. For repairs and fixations, it’s swapped for a hinged brace or a removable splint.
- Weeks 3 to 8. Movement is the priority. Some people keep a splint for nights only.
- From 6 to 8 weeks. Stiffness that isn’t improving by now needs active management, not more waiting.
Your surgeon may give you different dates. Use theirs.
Think of the splint as a short rest stop inside a window. In my experience the window is OPEN in the first weeks: movement comes back well once it’s allowed. It’s CLOSING from about 6 to 8 weeks if the elbow still isn’t gaining, and it needs splinting and daily work. Months on, with a hard end stop, it’s SHUT to exercise alone. The goal changes, and a release operation may come into it.
Can I take a posterior elbow splint off?
- Only if you’ve been told it’s removable. Cast-material back slabs from the ER are not for taking off at home.
- Showering. If it’s allowed off, keep the elbow at the splint angle, resting against your body. No straightening to reach. If it isn’t removable, cover it with a waterproof sleeve or a bag and keep it out of the spray.
- Got it soaked? Wet padding against skin for days breaks the skin down. Call the clinic for a change.
- Sleeping. Splint on, unless told otherwise. On your back, arm on a pillow, hand a little higher than the elbow.
Skin care inside the splint
- Check the edges daily. The point of the elbow, the forearm bones near the wrist, and the top edge near the armpit.
- Red marks should fade within 20 to 30 minutes of a removable splint coming off. If they last longer, it’s pressing too hard.
- Itching. No chopsticks, knitting needles or rulers down the splint. A hairdryer on the COOL setting blown down the edge helps. (A scratch you can’t see, under a splint you can’t take off, is how a small problem becomes a wound.)
- Keep it away from heat. Thermoplastic softens in a hot car or near a heater and changes shape.
- Change the liner or stockinette when it’s damp with sweat, and let the skin dry fully first.
Exercises while your elbow is in the splint
The elbow rests. Everything else works.
- Fingers. Full fist, then full straight. 10 reps every hour while you’re awake.
- Thumb. Touch the tip of the thumb to each fingertip in turn. 10 rounds, several times a day.
- Wrist, if it’s outside the splint. Up and down, 10 reps, 3 to 4 times a day.
- Shoulder. Gentle movement daily, as your team allows, because a shoulder held protectively in a sling stiffens too.
- Hand raised when resting, above the elbow, to keep swelling down.
When does the elbow start moving?
Your surgeon decides the date. Your job is to be ready for it. Weaning usually goes in steps:
- Step 1. Out for exercise sessions 3 to 4 times a day. Gentle bend and straighten, then palm up and palm down with the elbow tucked at your side. 10 reps each, within comfort.
- Step 2. Off during the day for light use. On at night and in crowds.
- Step 3. Off completely, or swapped for a hinged brace if the repair still needs limits.
If movement stalls, a hand therapist can remold the shell straighter as a night splint, or add a static progressive splint. It’s one of dozens of splints we make. See what a hand therapist does.
Can I work or drive with a posterior elbow splint?
- Driving. No. With one arm in an above-elbow splint you can’t control a car in an emergency, and your insurer will likely agree.
- Desk work. Often within a week, once pain settles, using the other hand.
- Manual work. Waits until you’re out of the splint and cleared. Heavy work after an elbow fracture is commonly 3 months or more.
Go to the emergency room now if
- Severe pain that keeps rising, especially pain when the fingers are gently straightened.
- Fingers that are pale, cold, blue or numb.
- A tight, swollen forearm under the splint.
Severe, rising pain after an elbow fracture, particularly in a child, can signal pressure building inside the forearm. That is an emergency. Don’t wait for morning. See acute forearm compartment syndrome.
Call your surgeon today if
- Tingling in the ring and little fingers that doesn’t settle.
- The splint has cracked, slipped down, come loose or got soaked.
- Increasing redness around a wound, discharge, or a fever.
Get it checked if
- Red marks that last more than 30 minutes, or one sore spot that keeps hurting in the same place.
- You’re past 3 weeks in the splint and nobody has mentioned a plan for movement.
- The elbow isn’t improving by 6 to 8 weeks after movement started.
Rest the elbow briefly, move everything else, and start the elbow moving as soon as it’s safe.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. If you’re still in the splint at 3 weeks, ask your surgeon what the plan is for movement.
Part of: Hand, wrist and elbow splints: which one, why and how long
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.