Broken arm or elbow
Your arm is made up of 3 long bones. These bones often break after a fall, while playing sport and in vehicle accidents, as we use our arms to stabilise and catch ourselves.
Your arm bones and elbow
Forearm
Your forearm (lower arm) comprises 2 long bones, between your hand and your elbow, called the radius and the ulna. It is common to break both of these together.
The radial head (radial head fracture) is the top of your radius. A broken radial head means you have broken this bone just below your elbow.
Upper arm
Your humerus is the bone in your upper arm. The neck of the humerus is near the top of this bone.
Elbow
Your elbow is the movable joint between your humerus and your forearm bones. It works like a hinge. The hard point or tip of your elbow is called the olecranon. This is the top part of your ulna.
Causes of a broken arm or elbow
Broken forearm or radial head
A broken forearm or radial head usually happens from falling onto an outstretched hand or from swinging arm injuries.
A serious break can be caused by a car or motorcycle accident or by falling from a ladder.
Your forearm and radial head can break in many different ways. Some breaks are worse than others.
Broken elbow
A break (fracture) of the tip of your elbow (olecranon) usually happens when you:
- fall onto a hard surface and directly hit the point of your elbow
- receive a direct blow to your elbow from something hard, like a cricket bat or a dashboard or a car door during a car crash
- fall on an outstretched arm while holding your elbow rigid to brace against the fall.
If you fall on an outstretched arm, your triceps muscle, which attaches to your olecranon, can pull a piece of the bone off your ulna. If this happens, it is quite common to damage the ligaments around your elbow as well.
Broken upper arm
A broken upper arm (humerus) usually happens from falling onto an outstretched hand or from swinging arm injuries.
A serious break can be caused by a car or motorcycle accident or by falling from a ladder.
A break in the neck of the humerus is quite common, especially among older women.
Symptoms of a broken arm or elbow
If you have broken a bone in your arm, you may notice:
- your arm or elbow is painful and swollen
- it is hard to bend your arm or get it fully straight
- it is hard to turn your hand palm up or palm down
- your arm looks deformed because it is swollen or a bone is out of place
- your fingers tingle, or your fingertips may be numb.
If your fingers tingle or your fingertips are numb, this means your elbow is also dislocated and is stretching the nerve. Make sure you remove any rings from your fingers before they start to swell.
If you think you may have broken a bone in your elbow, it is important to seek treatment straight away, especially if you have any tingling or numbness. Delays can lead to permanent nerve damage.
If you have broken the neck of your humerus, you may notice:
- your shoulder and upper arm are very painful
- you have difficulty moving your shoulder.
Diagnosing a broken arm or elbow
If you think you may have broken a bone in your arm or elbow, it is important to see a healthcare provider. They will:
- ask how your injury happened
- look at the affected area
- take x-rays to find out which bone is broken and what kind of break it is.
They may take x-rays of above and below where you are sore to check if you have any other nearby injuries. You might also need:
- a CT scan, which can show a complex break more clearly
- an MRI, to show any soft tissue injury.
Self care for a broken arm or elbow
There are several things you can do to help your forearm heal, whether or not you are having surgery.
- If you smoke, stop smoking. Continuing to smoke will slow down how quickly you heal.
- Do not do any heavy lifting or gripping with the affected hand, as this will increase your pain and slow your recovery. You will probably need some time off work to let your forearm recover.
- Take regular pain relief as recommended by your healthcare provider. Seek advice from them if you still have pain while taking the recommended pain relief. Do not take extra pain relief that has not been prescribed for you.
- The more swollen your forearm is, the more painful it will be. To reduce swelling, keep it raised above the level of your heart whenever possible. Also, apply ice (wrapped in a towel or plastic bag) to your hand or arm above the cast. Do not put ice directly on your skin as this can burn it.
- Look after your cast and take care not to get it wet.
Treating a broken arm or elbow
The way your broken arm or elbow will be treated depends on many different things, including:
- the type of break and whether the bones have moved or are unstable (meaning they could move around)
- whether a bone has broken through your skin (an open wound)
- how old you are
- your job, hobbies and activities
- whether the arm you use the most (your dominant arm) is injured
- whether you also have other injuries
- how good your overall health is.
You may need some time off work after your injury. For how long will depend on:
- your injury
- the treatment
- the type of work you do.
Treatment with a cast
If you have a stable (the bones do not move), less complex break, you probably will not need surgery. Instead, you will need a cast to hold the bones in the right place and stop them from moving while they heal.
The cast will probably start near your knuckles and go halfway up your upper arm with your arm bent at 90 degrees. This helps to keep your forearm bones in the right place.
Sometimes a break seems to be stable and is put in a cast, but as the swelling goes down, the broken bones move apart and need surgery to put them back in place. You will have regular x-rays while your arm is in a cast to make sure the bones stay in the right place while they are healing.
You will wear the cast for 6 weeks. You can probably start doing some gentle hand exercises after 3 weeks.
Care of your arm and hand while in a wrist cast
You will still have to take special care of your forearm once the cast comes off. The same exercises that help with a broken hand or wrist will help with your broken forearm.
Care of your wrist and hand following a fracture
Surgery for a broken forearm
You may need surgery to put the broken bone back into the right place and hold it there until it heals if:
- the break is unstable (the bone can move out of the right position)
- the bone has shattered into many pieces
- the bone has broken where it forms a joint with another bone.
If you need surgery, a bone surgeon (orthopaedic specialist) will do it.
Exactly what surgery you have will depend on the type of break. Your surgeon will talk to you about:
- what it involves
- the risks
- the benefits
- how you are likely to recover.
Your surgery will involve some metal (usually a plate and screws and occasionally wires) to line up your bones properly and support them while they heal.
You will spend 1 to 2 nights in hospital. Your arm will be in a splint for up to 6 weeks.
For 2 to 3 months after surgery, you will not be able to lift or carry anything with the injured arm. You should also avoid sport or any other activity that may make your injury worse. Your surgeon will let you know when it is safe to start doing these things again.
Getting help for a broken forearm
If you have any worries about how you are healing or have a lot of pain, talk to your healthcare provider.
If your arm feels stiff after the pain has gone, see a physiotherapist who can help you with exercises and help strengthen your arm.
ACC may be able to provide help while you are not able to work, such as:
- home help
- taxis to appointments
- work compensation payments.
Most radial head fractures are treated by putting your arm in a sling to rest it while it heals.
You may need surgery if:
- the bone has shattered into many pieces
- the break is unstable
- the break includes the joint surface
- the break does not heal as expected.
Surgery for a broken radial head
If you need surgery for your broken radial head, a bone surgeon (orthopaedic specialist) will do it.
Exactly what surgery you have will depend on the type of break. Your surgeon will talk to you about:
- what it involves
- the risks
- the benefits
- how you are likely to recover.
Your surgery may involve some metal (a plate, screws or possibly wires) to line up your bones properly and support them while they heal.
Occasionally, the bone is so shattered that the entire radial head has to be removed. If this happens to you, you may need an artificial radial head inserted to ensure you can move your arm properly.
You will spend 1 to 2 nights in hospital. Your arm will be in a splint for up to 6 weeks.
Getting help for a broken radial head
If you have any worries about how you are healing or have a lot of pain, talk to your healthcare provider.
ACC may be able to provide help while you are not able to work, such as:
- home help
- taxis to appointments
- work compensation payments.
When your healthcare provider says you can start to exercise your arm, you may want to see a physiotherapist. This is usually a couple of weeks after your injury.
Exercises
These are some exercises they might suggest. Aim to do each exercise 10 times, 3 to 4 times a day.
To reduce the swelling, clench your hand and release your fist.
Turn your palm up, then down, keeping your elbow still.
Bend and straighten your elbow.
Raise your arm above your head.
Treatment with a cast
If you have a stable (the bones do not move), less complex break, you probably will not need surgery. Instead, you will need a cast to hold the bones in the right place while they heal. You will most likely wear the cast for 6 weeks before starting to gently move your arm again.
The cast will probably start near your wrist and go up your upper arm to near your armpit. Your arm will be bent to help keep your elbow bones in the right place while they heal.
You can start doing some gentle hand exercises after 3 weeks and some gentle elbow exercises once the cast comes off. Your cast may be changed to a removable splint after 3 weeks, so you can start gentle elbow exercises early.
After your cast is removed, you may need to see a physiotherapist to help gain the movement and strength back in your arm.
Sometimes a break seems to be stable and is put in a cast, but as the swelling goes down, the broken bones move apart and need surgery to put them back into place. For this reason, you will have regular x-rays while your elbow is in a cast to make sure the bones stay in the right place while they heal.
Surgery for a broken elbow
If the break is unstable (the bone can move out of the right position) or the bone has shattered into many pieces, you may need surgery to put the broken bone back into the right place and hold it there until it heals.
If you need surgery for your broken elbow, it will be done by a bone (orthopaedic) surgeon.
Exactly what surgery you have will depend on what type of break you have. Your surgeon will talk to you about what it involves, the risks, benefits and how you are likely to recover.
Your surgery will involve some metal (usually wires or a plate and screws) to line up your bones properly and support them while they heal. The screws may be held together with clamps and rods outside your skin to stabilise the break. This is called external fixation.
You will probably spend a night in hospital. Your arm will be in a cast or backslab (a half-cast that wraps around the back of your arm) for up to 4 weeks.
Wires and external fixation usually need to be removed once you have healed. Exactly when that will happen depends on how bad your break was and how quickly your bones heal.
Getting help for a broken elbow
If you have any worries about how you are healing or have a lot of pain, talk to your healthcare provider.
You will need some weeks off work after surgery. For how long will depend on the injury and the type of work you do. ACC may be able to help you while you are not working.
You may need some physiotherapy to strengthen your arm and get it moving again. Your physiotherapist can also advise you on what kind of activities you can do and how much you should do.
Surgery for a broken upper arm (humerus)
A broken humerus often needs surgery.
If you need surgery, a bone (orthopaedic) surgeon will do it.
Exactly what surgery you have will depend on the type of break. Your surgeon will talk to you about:
- what it involves
- the risks
- the benefits
- how you are likely to recover.
For 2 to 3 months after surgery, you will not be able to lift or carry anything with the injured arm. You should also avoid sport or any other activity that may make your injury worse. Your surgeon will let you know when it is safe to start doing these things again.
Getting help for a broken upper arm
If you have any worries about how you are healing or have a lot of pain, talk to your healthcare provider.
If your arm feels stiff after the pain has gone and you are no longer wearing a sling, see a physiotherapist who can help you with exercises and help strengthen your arm.
ACC may be able to provide help while you are not able to work, such as:
- home help
- taxis to appointments
work compensation payments.
A broken humerus is usually treated by putting your arm in a sling or shoulder immobiliser, which keeps it at a right angle. This keeps the bone still.
If you have a very bad break (fracture), you might need surgery. If you do need surgery, it will be done by a bone (orthopaedic) surgeon.
You should wear the sling under your clothes for 1 to 2 weeks. This acts like a splint and helps to keep your arm still. As your shoulder becomes less painful, wear the sling on the outside of your clothes.
At first, it might be more comfortable to sleep sitting up. This helps to keep the broken bone lined up correctly and stops you from rolling on it.
It is important to exercise your wrist and elbow out of the sling at least twice a day. This stops them from getting stiff. Some exercises are described below.
You will probably have quite a lot of bruising, all the way down to your hand. This is caused by bleeding from the broken bone and is normal. Make sure you remove any rings from your fingers before they start to swell.
Getting help for a broken neck of the humerus
If you have any worries about how you are healing or have a lot of pain, talk to your healthcare provider.
You may need some physiotherapy to strengthen your arm and get it moving again. Your physiotherapist can also advise you on what kind of activities you can do and how much you should do.
ACC may be able to provide help while you are not able to work, such as:
- home help
- taxis to appointments
- work compensation payments.
Exercises
These exercises are a guide for the first phase of your rehabilitation. They might be a bit uncomfortable, but should not be painful. Your physiotherapist might give you other exercises to do as well.
Hand
Clench and release your fist 10 times an hour to reduce the swelling.
Elbow flexion and extension
- Take your arm out of the sling.
- Slowly bend and straighten your elbow as much as possible.
- Do this 10 times, 4 to 5 times a day.
Pendular exercise 1
- Standing up, hold on to a table with your good arm.
- Lean forward and let your affected arm dangle down straight.
- Swing your arm backwards and forwards 10 times, then side to side 10 times.
- Repeat 10 times, 3 times a day.
Pendular exercise 2
- Standing up, hold on to a table with your good arm.
- Lean forward and let your affected arm dangle down straight.
- Move your arm in a clockwise circle 10 times, then anti-clockwise 10 times.
- Repeat 10 times, 3 times a day.
Driving with a cast
Your ability to drive safely may be affected by:
- a broken bone
- surgery
- an injury that requires you to wear a cast or moonboot, such as an Achilles tendon rupture.
You may be advised to stop driving until your injury has healed. A healthcare provider can tell you if you are safe to drive.
Getting around
If you are advised not to drive, you will need to use another form of transport, such as:
- public transport
- taxis
- whānau and friends.
Sometimes, adapted controls in a car or hiring a modified vehicle might allow you to continue driving while you are rehabilitating.
Modifications to vehicles may include:
- hand controls for braking and accelerating
- left foot accelerators
- steering and secondary control aids
If your injury is the result of an accident, talk to ACC about whether they can fund the hire of a modified vehicle or temporary vehicle adaptations.
Travel and transport — ACCexternal link
Your insurance company may also fund the hiring of a modified vehicle. You can also hire a modified vehicle.
If your healthcare provider thinks your driving is impaired, and you continue to drive, the Land Transport Act says they have to tell the New Zealand Transport Agency.
Talk to your insurance company before you start driving again. They might not cover you while you are wearing a cast or splint.
The Accident Compensation Corporation (ACC) is a government agency that helps pay for treatment if you are injured in an accident.
The ACC provides comprehensive, no-fault personal injury cover for all residents and visitors to Aotearoa New Zealand. This means if you are hurt in an accident, ACC can help no matter who caused the accident.
If you have an accident and need emergency care in a hospital, it will be covered by ACC.
ACC usually pays some of the other medical costs if you have an accident, like surgery, physiotherapy and medicines. ACC may also be able to cover some loss of earnings resulting from an accident.
I'm injured — The Accident Compensation Corporation