Elbow Stress Fracture: How to treat

While relatively uncommon, elbow stress fractures can significantly impact athletes and individuals involved in repetitive arm movements. The most common type is olecranon stress fracture. This blog discusses diagnosing and managing elbow stress fractures, emphasising olecranon stress fractures.

What is a Stress Fracture?

A stress fracture is a small crack in a bone caused by repetitive stress or overuse. Unlike acute fractures, which occur due to a single traumatic event, stress fractures develop gradually over time. They appear in non-weight-bearing regions like the elbow, especially under repetitive strain.

Types of Elbow Stress Fractures

Olecaranon stress fracture

The olecranon is the bony prominence of the ulna at the back of the elbow. Over 50% of all upper limb stress fractures occur in the olecranon, 

Olecranon stress fractures are most commonly observed in athletes who perform repetitive overhead or pushing motions, such as baseball pitchers, weightlifters, gymnasts, and javelin throwers. These fractures arise from the repetitive tensile forces applied to the olecranon by the triceps muscle during elbow extension.

Distal Humeral Stress Fractures

The distal humerus sits just above the elbow joint. Athletes subjected to high rotational forces on the elbow tend to develop bone stress in the lower humerus. 

Symptoms of Elbow Stress Fracture

• Gradual onset of pain at the back of the elbow or lower part of the humerus, exacerbated by activity.

• Swelling or tenderness around the elbow or lower arm

• Reduced range of elbow motion due to discomfort.

• Weakness or difficulty performing activities involving elbow extension or throwing 

Diagnosis

Generally, a good clinical assessment is needed to consider an elbow stress fracture and exclude other causes of elbow pain. Other causes of elbow pain include arthritis, tendonitis, and nerve entrapment. 

An X-ray may show a stress fracture, but a normal X-ray does not exclude it. An MRI scan showing bone swelling + /—fracture line is the gold standard for diagnosing an elbow stress fracture. 

Management of Elbow Stress Fracture

Non-Surgical Treatment

Most olecranon stress fractures can be managed conservatively, especially in the early stages. Key approaches include:

• Rest: Stopping activities that exacerbate the pain allows the bone to heal. Sometimes, a sling is needed for a few weeks to encourage healing. 

• Physical Therapy:
  • Gradual strengthening of the triceps and surrounding muscles.
  • Improving range of motion and correcting biomechanical issues, such as reduced shoulder range of motion. 

• Bone healing treatments such as LIPUS and optimising Vitamin D and calcium 

In a recent study, the average return to sports with conservative management of an elbow stress fracture is 4 months. 

Surgical Treatment

Surgery may be necessary in cases of:

• Fractures that fail to heal with conservative treatment.
• Displaced or unstable fractures.
• High-performance athletes requiring quicker recovery.

However, the complication is relatively high (17%) and related to metal hardware. So, you should always start with non-surgical management first. 

Final Word from Sportdoctorlondon about Elbow Stress Fracture

While challenging, olecranon stress fractures are preventable and manageable with timely intervention. Early recognition and a tailored treatment plan can ensure a full recovery and a return to activities without long-term complications.