Radial head fractures are common elbow injuries that occur when the radial head (the top part of the radius bone) is cracked or broken. The radial head forms part of the elbow joint and plays a critical role in forearm rotation (turning the palm up and down) and overall elbow stability.
These fractures most commonly occur after a fall onto an outstretched hand, where force travels up the forearm and impacts the elbow. Radial head fractures account for around one third of all elbow fractures and are frequently seen in adults following low-energy falls, sporting injuries, or accidents.
Symptoms can range from mild pain and stiffness to severe pain, swelling, and loss of movement, depending on the severity and stability of the fracture. Some fractures are subtle and can be missed on initial assessment, particularly when swelling is minimal.
Physiotherapy for radial head fractures is essential for restoring elbow and forearm movement, preventing stiffness, and guiding a safe return to work, sport, and daily activities. Early and appropriate rehabilitation is a key factor in long-term outcomes.
Key Facts
- Radial head fractures account for approximately 30–35% of all elbow fractures in adults and commonly occur after a fall onto an outstretched hand. 🔗
- Many radial head fractures are minimally displaced and can be managed conservatively with early mobilisation and physiotherapy. 🔗
- Elbow stiffness is one of the most common complications following radial head fractures, highlighting the importance of early guided movement. 🔗
- Physiotherapy-led rehabilitation is recommended following both non-operative and operative management to restore elbow range of motion and function. 🔗
Risk Factors
- Falls, particularly onto an outstretched hand.
- Sporting activities with risk of falls or collisions.
- Reduced bone density (osteopenia or osteoporosis).
- Poor balance or previous falls.
- High-risk occupations involving heights or manual handling.
Symptoms
- Pain around the elbow, particularly on the outer (lateral) side.
- Swelling and tenderness at the elbow joint.
- Pain with forearm rotation (turning the palm up or down).
- Reduced ability to fully straighten or bend the elbow.
- Pain when pushing through the hand or lifting objects.
- A feeling of stiffness or locking in the elbow as swelling settles.
Aggravating Factors
- Attempting to push up from a chair using the affected arm.
- Lifting or carrying objects, even light loads.
- Rotating the forearm, such as turning keys or doorknobs.
- Weight-bearing through the arm, such as during sport or exercise.
- Sudden or forced elbow movements.
Causes
Radial head fractures typically occur when a person falls onto an outstretched hand with the elbow slightly bent. The force is transmitted up the radius, causing the radial head to impact against the capitellum of the humerus.
The severity of the fracture depends on the magnitude and direction of force, as well as elbow position at the time of injury. Some fractures involve small cracks with minimal displacement, while others involve multiple fragments or disruption of elbow stability.
Associated injuries can occur, including ligament injuries around the elbow or wrist, which is why a thorough assessment is important. From a physiotherapy perspective, understanding whether the fracture is stable or unstable guides how early movement can begin and how aggressively rehabilitation can progress.
How Is It Diagnosed?
Diagnosis of a radial head fracture is based on a combination of injury history, physical examination, and imaging. A physiotherapist or doctor will suspect a radial head fracture when there is elbow pain and loss of forearm rotation following a fall.
On examination, there is often tenderness over the radial head, swelling, and pain with rotation of the forearm. Importantly, some fractures present with relatively mild symptoms initially, which can delay diagnosis.
Physiotherapists are trained to recognise red flags and refer for imaging when a fracture is suspected. Early diagnosis ensures appropriate protection and timely rehabilitation.
Investigations & Imaging
- X-ray
- First-line imaging to confirm the presence of a fracture. Some non-displaced fractures may be subtle and require careful interpretation.
- CT scan
- Provides detailed assessment of fracture pattern and displacement, often used for surgical planning or complex fractures.
- MRI
- Used less commonly, but may identify occult fractures or associated ligament injuries if X-rays are inconclusive.
Grading / Classification
- Mason Type I
- Non-displaced or minimally displaced fractures with no mechanical block to movement. Usually managed conservatively.
- Mason Type II
- Displaced fractures involving a single fragment, which may cause mechanical block to movement. Management may be conservative or surgical depending on symptoms.
- Mason Type III
- Comminuted fractures with multiple fragments. These often require surgical management.
- Mason Type IV
- Radial head fracture associated with elbow dislocation, indicating significant joint instability.
Physiotherapy Management
Physiotherapy for radial head fractures focuses on restoring elbow and forearm movement, minimising stiffness, and progressively rebuilding strength and function. The approach depends on fracture stability, pain levels, and whether surgery was required.
For stable fractures, early guided movement is encouraged to prevent long-term stiffness. For surgically managed fractures, physiotherapy is carefully progressed according to surgical guidelines and healing timelines.
Exercise
Radial head fracture physiotherapy exercises usually begin with gentle range-of-motion exercises for elbow flexion, extension, and forearm rotation.
As healing progresses, strengthening exercises are introduced to restore grip strength, forearm control, and load tolerance through the arm. Exercises are progressed gradually to avoid overloading the healing bone.
Activity Modification
Activity modification is essential early on. This may include avoiding lifting, pushing, pulling, or weight-bearing through the affected arm until cleared.
Your physiotherapist will guide a gradual return to daily tasks, work duties, and sport-specific activities.
Manual Therapy
Manual therapy may be used to address joint stiffness and soft tissue tightness once the fracture is stable. Techniques are applied carefully to improve movement without stressing the healing bone.
Heat & Ice
Ice may be used to manage pain and swelling in the early stages. Heat may assist stiffness later in rehabilitation if appropriate.
Education
Education is a critical part of rehabilitation. Physiotherapists explain healing timelines, safe movement, and why early but controlled motion is important for elbow recovery.
Other
Other considerations may include workplace modifications, ergonomic advice, and coordination with employers or sporting organisations.
Other Treatments
Other treatments may include short-term immobilisation, pain relief prescribed by a doctor, and follow-up imaging to monitor healing.
Surgery
Surgery may be required for displaced, unstable, or comminuted radial head fractures, or when elbow stability is compromised. Surgical options include fixation, radial head excision, or radial head replacement.
Physiotherapy is essential following surgery to restore movement, strength, and function, while respecting surgical precautions.
Prognosis & Return to Activity
The prognosis for radial head fractures is generally good, particularly for stable fractures managed conservatively. Most people regain functional elbow use with appropriate rehabilitation.
Recovery time varies depending on fracture severity, but stiffness can persist if movement is delayed. Early physiotherapy-guided rehabilitation is associated with better outcomes.
Complications
- Elbow stiffness and loss of range of motion.
- Persistent pain with forearm rotation.
- Post-traumatic arthritis in severe cases.
Preventing Recurrence
- Follow rehabilitation guidelines and avoid prolonged immobilisation where possible.
- Maintain upper limb strength and balance to reduce fall risk.
- Address bone health and fall prevention strategies if relevant.
When to See a Physio
- You have elbow pain and limited movement after a fall.
- Pain persists despite rest and basic care.
- You want guidance on safe return to work, sport, or lifting.