You catch yourself with an outstretched hand after slipping on a wet sidewalk, missing a step, or falling during a sport. Your wrist may seem fine, but your elbow hurts. Turning your palm up to hold a bowl, opening a doorknob, or straightening your arm suddenly feels difficult.
Pain on the outside of the elbow after a fall, especially with swelling or painful forearm rotation, can signal a radial head fracture. The break may be subtle on the first X-ray. An examination can also identify injuries elsewhere in the arm that need attention.
This guide explains what adults should know about this injury, when to seek care, and why treatment differs from person to person. It cannot determine whether your elbow is fractured.
Where is the radial head, and how does it break?
The radius is one of the two forearm bones. Its rounded upper end, called the radial head, sits on the thumb-side of your elbow and helps the forearm rotate so your palm can face up or down. It also contributes to elbow stability.
A fall onto an outstretched hand can send force up the forearm to the elbow. The result may be a small crack in the radial head, a displaced fragment, or a more complicated injury involving ligaments or another bone. Direct blows can also cause injury.
The American Academy of Orthopaedic Surgeons (AAOS) describes outside-elbow pain, swelling, difficulty straightening the elbow, and trouble turning the forearm as common findings. These symptoms are not unique to a fracture, so an examination matters.
Signs that deserve an assessment
A radial head fracture can cause:
- Tenderness over the outer side of the elbow, near the bony area just below the outside of the joint.
- Swelling or an ache that increases after the injury.
- Pain when turning your palm up or down, such as when using keys or a screwdriver.
- Pain or restriction when bending or straightening the elbow.
- Difficulty putting weight through the hand or lifting with the injured arm.
Some people can still move their arm and have little visible bruising. That does not exclude a small fracture. Conversely, the same symptoms can accompany ligament sprains, other fractures, or an elbow dislocation. The Orthopaedic Trauma Association (OTA) patient guide explains how the radial head helps the elbow rotate and why an X-ray is often the first imaging test after a fall.
When is it urgent?
Seek emergency evaluation immediately if the arm looks deformed, there is an open wound near a suspected fracture, the hand is pale, cold, or blue, or you have new persistent numbness, marked weakness, or severe rapidly worsening pain. Those findings can reflect a dislocation, an open injury, or a circulation or nerve problem. Do not attempt to straighten a visibly deformed elbow yourself.
If the elbow is painful after a fall but there are no emergency warning signs, arrange prompt clinical assessment, especially if you cannot comfortably rotate the forearm or straighten the elbow. Significant wrist or forearm pain at the same time is important to mention. Some radial head injuries are accompanied by damage along the forearm or at the wrist, and overlooking an associated injury can affect treatment.
Until you are assessed, avoid heavy lifting, pushing yourself up from a chair with that arm, or repeatedly forcing painful rotation. A temporary sling may improve comfort, but prolonged immobilization without an individualized plan can increase stiffness.
What happens during a fracture evaluation?
Your clinician will ask exactly how you fell, when symptoms began, which movements hurt, and whether you previously injured that arm. A good evaluation is not confined to the most tender spot. It may include checking the elbow’s alignment and movement, tenderness over the radial head, circulation and sensation in the hand, and the forearm and wrist for associated injury.
Elbow X-rays are generally the starting point. Several views may be needed to evaluate alignment and look for a break. With a very small fracture, the first images may not clearly show a fracture line. Signs of joint fluid or swelling, the examination, and follow-up imaging can help guide the diagnosis. If the pattern is complex or a piece appears displaced, a CT scan may be useful for surgical planning; not everyone needs one.
AAOS notes that smaller, nondisplaced radial head fractures can initially be difficult to see on an X-ray. A Boston Medical Center patient explanation also describes why symptoms and imaging must be interpreted together.
Pacific Bone & Joint provides fracture-care evaluation in Hawaiʻi, including assessment of injuries that may need protection, repeat imaging, or surgical consultation. Tell the team if you have outside images so they can be reviewed.
Will a radial head fracture heal without surgery?
Many radial head fractures are treated without surgery. A key question is whether the pieces remain acceptably aligned and the elbow can move without a loose fragment mechanically blocking motion. Associated ligament injury or instability can change the plan.
In a small, stable fracture, treatment may include a sling for comfort for a short period, temporary activity restrictions, and a clinician-directed progression of gentle elbow and forearm motion. Moving too soon against excessive force can be harmful, but leaving a stable elbow still for too long can make recovery harder. Follow the timing your treating clinician gives you rather than copying an exercise schedule found online.
The OTA explains that many patients begin gentle motion within days when the fracture is appropriate for nonsurgical care. That guidance does not apply automatically to an unstable fracture, a dislocation, or an injury requiring a different protection plan.
Pain relief may include ice through a cloth, elevation when comfortable, and an over-the-counter medication if it is safe for you. Ask about acetaminophen or an anti-inflammatory if you have kidney disease, stomach ulcers, bleeding risks, cardiovascular conditions, or take blood thinners. Medication can help symptoms but does not establish fracture stability.
When might an operation be needed?
Surgery may be discussed when a displaced fragment prevents rotation, the joint is unstable, or the radial head is broken into several pieces and cannot support normal elbow mechanics. Options can include fixing reconstructible fragments with screws or plates, or in selected severe injuries replacing the radial head. Ligament injury or an associated fracture may also require treatment.
The AAOS radial head fracture overview explains the broad fracture patterns used to guide care. A pattern label alone does not decide the operation: imaging, stability, the examination, activity needs, and other injuries matter.
Ask your surgeon what problem the operation is intended to solve, what nonsurgical treatment would involve, and what restrictions each approach requires. Surgery has risks such as infection, nerve irritation, stiffness, fixation problems, and further procedures. Nonsurgical care also has tradeoffs, including stiffness, persistent pain, and the possibility that healing or joint alignment will need reassessment.
Why elbow motion and recovery require a plan
Even a relatively small elbow fracture can leave the arm stiff. Your rehabilitation plan may focus first on safe elbow bending and straightening, then comfortable forearm rotation, followed later by strength and activities such as carrying groceries, paddling, gardening, or returning to work.
The schedule depends on fracture alignment, associated injuries, surgery if performed, the clinician’s restrictions, and symptoms. Do not treat a calendar date as clearance to lift, push, surf, or resume contact sports. If a therapist is involved, the therapist and treating clinician should share the same protection instructions.
Useful questions at follow-up include whether the fracture is stable enough to advance motion, what weight the arm may safely bear, what degree of pain is expected, and which change in symptoms should prompt a call. A return of significant swelling, increasing loss of motion, new clicking with blockage, or pain that is not improving warrants reassessment.
The OTA patient resource explains that stiffness and discomfort can persist and that rehabilitation is often part of restoring practical use of the arm.
Preparing for your orthopedic appointment
Bring your X-ray images or report if available and a list of current medications. Think about the exact movement that triggers pain: turning a key, carrying a bag, straightening the elbow, or leaning on your palm. Mention pain at the wrist, shoulder, or forearm and any numbness or tingling, even if the elbow is your main concern.
It is also helpful to describe your real goals and demands: desk work, lifting patients, manual labor, caring for children, cooking, or a particular sport. Those details help your clinician explain restrictions and set a practical recovery plan.
Your next step in Hawaiʻi
If you have new elbow pain following a fall without emergency warning signs, request an orthopedic fracture evaluation at Pacific Bone & Joint. Describe the injury date, whether you can rotate the forearm, any wrist pain, and the imaging you already have. A prompt assessment can clarify whether you need short-term protection, supervised motion, repeat imaging, or specialized treatment.
If your hand has circulation changes, persistent loss of sensation, a significant open injury, or the elbow is deformed, seek emergency care instead of waiting for a routine appointment.
Sources and Further Reading
- American Academy of Orthopaedic Surgeons (AAOS): Radial Head Fractures of the Elbow.
- Orthopaedic Trauma Association: Radial Head Fracture.
- Boston Medical Center: Radial Head Fracture.
- American Academy of Family Physicians: Common Forearm Fractures in Adults, background review; not a substitute for current individual assessment.
This article is for general patient education. It cannot diagnose a fracture or replace examination and imaging. Treatment depends on the specific injury and associated conditions.
