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The Most Common Elbow Fracture, and the One Where Resting It Is ALWAYS the Mistake
Most radial head fractures are small, undisplaced cracks that heal in about 6 to 8 weeks without surgery. The sling comes off within days, movement starts in the first week, and most people are back to everyday use by 6 to 12 weeks.
Heavy sport and manual work take 3 to 6 months. After surgery, plan on closer to 6 months.
Maybe you fell on an outstretched hand. The outer side of your elbow hurts, and the thing that really hurts is turning your palm up.
You can probably still bend the elbow, and that seemed “not too bad”, which is why people wait-and-see.
And most of the bad outcomes come not from the fracture but from the six weeks of not moving it afterwards. I know I sound like a broken record: the elbow stiffens faster than any other joint in the arm.
That is the whole story of this injury.
What is a radial head fracture?
The radial head is the top of your forearm bone (the radius) where it meets the elbow. It’s a small disc that SPINS every time you turn your palm up or down, held in place by a ring of ligament, and it’s the most commonly fractured bone in the adult elbow.
Three joints share one capsule in there, which is why a crack in one small bone can stiffen the whole elbow. See elbow anatomy.
How is a radial head fracture diagnosed? (And why the X-ray might look normal)
Radial head fractures can be hairline and hard to see.
What gives them away is indirect: blood filling the joint pushes small pads of fat away from the bone, and those displaced pads show up on a side-view X-ray as dark triangles that shouldn’t be there.
Radiologists call the raised front one the sail sign. A posterior fat pad that’s visible at all is abnormal in any adult elbow.
The practical meaning: if you fell, your elbow is swollen and sore, and the report mentions fat pads or an effusion but no clear fracture, you should be managed as though you have one, with repeat imaging or a scan if things don’t settle.
- X-ray: front and side views. Often enough.
- CT scan: when the fragment looks displaced or the break is in several pieces, to plan surgery.
- The rest of the arm: a good assessment also checks the wrist and the ligaments on the inner side of the elbow. Pain at the wrist on the little-finger side as well as at the elbow is worth mentioning, cos a less common pattern injures the forearm between the two.
Do I need surgery for a radial head fracture?
Not how big the fracture is. It’s whether the fragment is physically blocking rotation.
The radial head has to spin smoothly every time you turn your palm over. A displaced piece of it can jam that rotation mechanically, and no amount of therapy moves a bone that’s in the way.
The complication is that a freshly injured elbow full of blood hurts too much to test properly. So a common and genuinely useful step is draining the joint and putting local anesthetic in, then asking you to rotate.
- Rotation is full once the pain is gone: no mechanical block, treat without surgery.
- It stops dead at a certain point even pain-free: something is jamming, and it needs fixing or removing.
Broadly:
- Undisplaced fractures are managed with early movement, and are straightforward-ish to treat with a patient who actually does the exercises.
- Displaced ones with a block, on the other hand…usually need fixing with small screws or a plate, or the loose fragment removed.
- Badly shattered ones may need the radial head replaced with a metal one, which sounds drastic and works well.
What if the elbow dislocated too?
A radial head fracture combined with a fracture of the coronoid (a small lip of bone at the front of the elbow), plus a dislocated elbow, is called the terrible triad.
The name is not an exaggeration. That combination leaves the elbow genuinely unstable and it needs surgery, usually urgently, with a much longer and more careful recovery.
If your elbow came out of joint as well as breaking, you’re reading the wrong article. Start with elbow dislocation and the stiff elbow after. If the break was at the point of the elbow instead, that’s an olecranon fracture, a different injury with different rules.
Radial head fracture recovery week by week
This is where I spend most of my time with these patients, and where the advice most often contradicts what feels natural.
A broken elbow that isn’t moved for three weeks doesn’t heal quietly. It heals into a MUCH smaller, tighter, stiffer elbow.
For an undisplaced fracture:
- Days 0 to 5: sling for comfort and only for comfort. Out of it several times a day. Ice, elevation. Gentle bending and straightening starting almost immediately, within pain limits.
- Weeks 1 to 3: sling gone entirely. Range of motion work several times daily, especially turning the palm up and down. Using the arm for light everyday tasks.
- Weeks 3 to 6: pushing toward full range. This is the window where stiffness is either beaten or becomes permanent.
- Weeks 6 to 12: strengthening, load, return to most activity. The bone is usually healed by 6 to 8 weeks.
- Months 3 to 6: the finished result, heavier sport and manual work.
After surgery the same principles apply, on a timeline your surgeon sets, and full recovery runs closer to 6 months. Some surgeons use a posterior elbow resting splint for the first days, between exercise sessions.
Exercises for a radial head fracture
For an undisplaced fracture, these usually start in the first week. After surgery, wait for your surgeon’s go-ahead and follow their limits.
- Elbow bend and straighten: sitting, arm supported on a table or pillow, bend as far as comfortable, then straighten as far as comfortable. 10 reps, every 1 to 2 hours while awake.
- Palm up, palm down: elbow tucked into your side and bent to a right angle (so the shoulder can’t cheat), turn the palm up, hold 5 seconds, then palm down, hold 5 seconds. 10 reps, every 1 to 2 hours. This is THE exercise for this injury.
- Gravity-assisted straightening: lie on your back, arm by your side on a pillow, and let the elbow sink straight. Hold 30 to 60 seconds, 3 to 5 times a day.
- Fingers, wrist and shoulder: full fists, wrist bends and arm lifts, 10 reps, 3 to 4 times a day. Don’t let a sling stiffen the shoulder.
- Weeks 3 to 6, a little leverage: hold a light hammer by the handle during palm up/palm down, and let its weight tip the forearm gently further at the end. 10 reps, 3 to 4 times a day.
- From week 6: light curls and rotation work with 0.5 to 1 kg (1 to 2 lb), 2 to 3 sets of 10 to 15, plus grip putty. Build up week by week if the elbow isn’t sore the next morning.
Expect some ache with these. Sharp pain, or pain that’s worse the next morning, means you went too hard. Ease off one notch, don’t stop.
When can I drive, work and lift after a radial head fracture?
- Desk work: often within days to 1 to 2 weeks. See returning to work after an injury.
- Driving: once you’re out of the sling and can turn the wheel and control the car in an emergency, often around 2 to 4 weeks for an undisplaced fracture, longer after surgery. See driving after an injury.
- Light manual work: around 4 to 6 weeks.
- Heavy manual work: about 8 to 12 weeks for an undisplaced fracture, 3 to 6 months after surgery.
- Gym and sport: light training from about 6 weeks. Push-ups, heavy pulling and contact sport around 3 months, later after surgery.
Will my elbow go back to normal?
Honest expectation-setting: losing the last 10 to 20 degrees of full straightening is common after any significant elbow injury, and it’s frequently permanent. Most people never notice functionally, because the arm works fine through that range. Worth knowing in advance so it doesn’t feel like failure at week eight.
This injury runs on a clock. The first 6 weeks are the OPEN window, when range comes back with exercise alone. Between 6 weeks and about 3 months the window is closing, and stalled range needs more help: a hand therapist, and sometimes a static progressive splint. Past about 6 months, what you have is mostly what you keep, unless a stiff elbow release enters the conversation.
Go to the ER if
- The elbow looks deformed or out of place, or you can’t move it at all.
- The hand is cold, pale or numb after the fall.
- Severe, escalating forearm pain with tight swelling that isn’t settling with elevation, especially pain when the fingers are stretched.
Get it checked if
- Rotation that isn’t improving at all between weeks 2 and 6, or that stops abruptly at a hard endpoint rather than a painful one.
- New locking, catching or grinding, which can mean a loose fragment in the joint.
- Numbness or tingling in the hand that appeared after the injury.
- An elbow that gets more swollen and more painful rather than less over the first two weeks.
- Your X-ray was “normal” but the elbow is still swollen and painful at 7 to 10 days.
The crack heals on its own. The stiffness only goes if you move it.
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. Follow your own surgeon’s protocol where it differs from anything here.
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.