Elbow Fracture, Epicondyle

with Rehab

ExitCare ImageAn epicondyle elbow fracture is a break in the end of the arm bone (humerus) that is part of the elbow joint. Epicondyle fractures are more common in children than adults, because the growth plates have not closed and are vulnerable to injury. Epicondyle fractures may be incomplete or complete fractures. The inner epicondyle is the attachment site for muscles that bend down (flex) the wrist, and the outer epicondyle is the attachment site for the muscles that bend up (extend) the wrist. For this reason, these injuries often show signs of wrist weakness.

SYMPTOMS

  • Severe elbow and arm pain at the time of injury.

  • Tenderness, inflammation, and later bruising (contusion) of the elbow (within 48 hours).

  • Visible deformity, if the fracture is complete, and the bone fragments are not aligned properly (displaced).

  • Numbness, coldness, or paralysis in the elbow, forearm, or hand, from pressure on the blood vessels or nerves (uncommon).

CAUSES

An elbow fracture occurs when a force is placed on the bone that is greater than it can handle. Typical causes of injury include:

  • Direct hit (trauma) to the elbow.

  • Twisting injury to the elbow.

  • Indirect stress, due to falling on an outstretched hand with the elbow locked.

RISK INCREASES WITH:

  • Contact sports (football, rugby).

  • Children under 14 years of age.

  • History of bone or joint disease (osteoporosis, bone tumor).

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • When appropriate, wear properly fitted and padded elbow protection.

PROGNOSIS

If treated properly, elbow fractures often heal within 4 to 6 weeks in children.

RELATED COMPLICATIONS

  • Fracture does not heal (nonunion).

  • Fracture heals in improper alignment (malunion).

  • Chronic pain, stiffness, loss of motion, or swelling of the elbow.

  • Excessive bleeding in the elbow or at the fracture site, causing pressure and injury to nerves and blood vessels (uncommon).

  • Calcification of the soft tissues around the elbow (heterotopic ossification).

  • Risk of bone death, due to interrupted blood supply caused by the fracture.

  • Unstable or arthritic joint, following repeated injury.

  • Stopping of normal bone growth in children.

  • Wasting away (atrophy), weakness, stiffness, numbness, and poor control of the hand, due to injury to blood vessels, nerves, cartilage, muscle, ligaments, and connective tissue sheets (fascia).

TREATMENT

If the fracture is displaced, it must be put back in proper alignment (reduced) by an individual trained in the procedure. Often, displaced fractures cannot be realigned by hand, and surgery is needed. Once the bones are properly aligned (with or without surgery), ice and medicine can be used to reduce pain and inflammation. The elbow should be restrained for at least 4 weeks. After restraint, it is important to complete strengthening and stretching exercises, to regain strength and a full range of motion. Theses exercises may be completed at home or with a therapist.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Elbow Fracture (Epicondyle)

These exercises may help you restore your elbow mobility once your physician has discontinued your restraint period. Beginning these before your caregiver's approval may result in delayed healing. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds. A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched area.

ExitCare Image RANGE OF MOTION – Supination, Active-Assisted

  • Sit with your right / left elbow bent at 90 degrees, resting your forearm on a table.

  • Keeping your upper body and shoulder in place, roll your forearm so your palm faces upward. When you can go no farther, use your opposite hand to help until you feel a gentle to moderate stretch. Hold for __________ seconds.

  • Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Pronation, Active-Assisted

  • Sit with your right / left elbow bent at 90 degrees, resting your forearm on a table.

  • Keeping your upper body and shoulder in place, roll your forearm so your palm faces the tabletop. When you can go no farther, use your opposite hand to help until you feel a gentle to moderate stretch. Hold for __________ seconds.

  • Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Extension

  • Hold your right / left arm at your side and straighten your elbow as far as you can, using your right / left arm muscles.

  • Straighten the right / left elbow farther by gently pushing down on your forearm, until you feel a gentle stretch on the inside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Flexion

  • Hold your right / left arm at your side and bend your elbow as far as you can, using your right / left arm muscles.

  • Bend the right / left elbow farther by gently pushing up on your forearm, until you feel a gentle stretch on the outside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Supination, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm upward until you feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION – Pronation, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm downward until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION – Elbow Flexion, Supine

  • Lie on your back. Extend your right / left arm into the air, bracing it with your opposite hand. Allow your right / left arm to relax.

  • Let your elbow bend, allowing your hand to fall slowly toward your chest.

  • You should feel a gentle stretch along the back of your upper arm and elbow. Your physician, physical therapist or athletic trainer may ask you to hold a __________ hand weight, to increase the intensity of this stretch.

  • Hold for __________ seconds. Slowly return your right / left arm to the upright position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Elbow Flexors

  • Lie on a firm bed or countertop, on your back. Be sure that you are in a comfortable position which will allow you to relax your arm muscles.

  • Place a folded towel under your right / left upper arm, so that your elbow and shoulder are at the same height. Extend your arm; your elbow should not rest on the bed or towel

  • Allow the weight of your hand to straighten your elbow. Keep your arm and chest muscles relaxed. Your caregiver may ask you to increase the intensity of your stretch by adding a small wrist or hand weight.

  • Hold for __________ seconds. You should feel a stretch on the inside of your elbow. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Elbow Fracture (Epicondyle)

These exercises may help you regain your strength after your physician has discontinued your restraint in a cast or brace. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

ExitCare Image STRENGTH - Elbow Flexors, Isometric

  • Stand or sit upright, on a firm surface. Place your right / left arm so that your hand is palm-up and at the height of your waist.

  • Place your opposite hand on top of your forearm. Gently push down as your right / left arm resists. Push as hard as you can with both arms, without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

  • Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Elbow Extensors, Isometric

  • Stand or sit upright, on a firm surface. Place your right / left arm so that your palm faces your stomach, and it is at the height of your waist.

  • Place your opposite hand on the underside of your forearm. Gently push up as your right / left arm resists. Push as hard as you can with both arms, without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

  • Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Elbow Flexors, Supinated

  • With good posture, stand, or sit on a firm chair without armrests. Allow your right / left arm to rest at your side, with your palm facing forward.

  • Holding a __________ weight, or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance, as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Elbow Extensors, Dynamic

  • With good posture, stand, or sit on a firm chair without armrests. Keeping your upper arms at your side, bring both hands up toward your right / left shoulder, while gripping a rubber exercise band or tubing. Your right / left hand should be just below the other hand.

  • Straighten your right / left elbow. Hold for __________ seconds.

  • Allow your muscles to control the rubber exercise band, as your hand returns to your shoulder.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.