OLECRANON STRESS FRACTURES

OVERVIEW

An olecranon stress fracture occurs when the elbow experiences extreme abuse and overuse. While anyone can suffer this injury, athletes (especially ones who throw frequently) are the most common group of people to get olecranon stress fractures. Most cases can be healed solely through nonsurgical treatments, but if all nonsurgical options have been exhausted and little to no pain relief has occurred, surgery may be necessary.

ANATOMY

The elbow joint is where the upper arm bone (humerus) meets the two forearm bones (radius and ulna). The bony point of the elbow is called the olecranon and is located at the upper end of the ulna. It consists of several muscles, ligaments, nerves, and tendons, and is both a pivot and hinge joint, meaning it allows you to bend and straighten, as well as twist and rotate your arm. It is also positioned directly under the elbow skin with very little protection from muscles or other soft tissues.

Thick ligaments (collateral ligaments) are located on the inner and outer sides of the elbow and hold the joint together and prevents dislocation. The ulnar collateral ligament (UCL) can be found on the inside of the elbow. It runs from the inner side of the humerus to the inner side of the ulna. The ulnar nerve crosses behind the elbow and controls the muscles of the hand while providing sensation to the small and ring fingers.

DESCRIPTION

An olecranon stress fracture is when the bony tip of the elbow is fractured due to stress. This type of fracture is typically caused by the overuse and abuse of the elbow, and is commonly found in athletes who apply extreme pressure on the elbow, such as baseball players. Although most common in athletes, an olecranon stress fracture can happen to anyone. When the elbow is not given enough time to recover after experiencing large amounts of stress, it begins to deteriorate and become weak. Over time, this weakening can result in an olecranon stress fracture.

SYMPTOMS

The symptoms commonly seen in olecranon fractures include:

• Pain with movement of the elbow or with the rotation of the forearm.
•  Swelling over the “tip” or back of the elbow.
• Bruising around the elbow that may also travel up the arm towards the shoulder or down the forearm towards the wrist.
• Tenderness to the touch.
• Numbness in one or more fingers.
• Pain with movement of the elbow or with the rotation of the forearm.
• A feeling of instability in the joint, as if your elbow is going to “pop out.”

DIAGNOSIS

Your Florida Orthopaedic Institute physician will perform a physical examination to determine if you have fractured your olecranon. During the exam, your physician will check for the following:

• Areas of Tenderness. These areas could indicate other broken bones or injuries, such as a dislocated elbow.
• Good Blood Flow. Blood flow will determine if any damage was done to the veins.
• Finger and Wrist movement. These movements will determine if any damage was done to the nerves.

X-rays will also be ordered to help diagnose the fracture. X-rays provide images of dense structures, such as bones, which will show if the break is in the bone. Depending on your symptoms, your physician may also order x-rays of your upper arm, forearm, shoulder, wrist, and/or hand to determine if you have any other injuries.

TREATMENT (OVERVIEW)

Both surgical and nonsurgical options are available to treat olecranon fractures. Surgical treatment is only chosen if all nonsurgical options have been exhausted.

NON-SURGICAL TREATMENTS

Rest is the most common and useful treatment option. Preventing the elbow from experiencing stress will allow for the fracture to heal in approximately six to nine weeks. If the pain is still present after nine weeks, surgical treatment may be needed.

SURGICAL PROCEDURES/TREATMENTS

Surgical treatment for olecranon stress fractures is usually recommended when nonsurgical treatments have been exhausted, and pain is still present. The most frequently used procedure to treat an olecranon stress fracture is open reduction and internal fixation. During this procedure, the bones are repositioned into their normal alignment. They are held in place with screws, wires, pins, or metal plates attached to the outside of the bone.

NEXT STEPS

Once the fracture itself has been healed, arm strength will need to be regained which often takes longer than expected. Most patients will make a complete return to their normal activities within four months. Some patients may take more than a year to recover fully. Recovery time depends on the patient and the severity of their injury. Occasionally, some patients may experience limitations in movement, even if the x-rays show that the fracture has healed completely. These patients will usually continue to improve over time.