March 3, 2015

Why Won’t My Elbow Straighten?

elbow stretching for gradual straightening
On one occasion while playing basketball, I was knocked off of my feet, and I landed onto my left elbow. Thankfully, my elbow was not fractured, although it did bruise up substantially.

In addition to some swelling, I soon noticed an inability to straighten out my elbow. For many months my elbow remained unable to completely straighten. I ended up consulting an orthopedist and a physical therapist, and their advice was invaluable…

Elbows respond to slow and gentle stretching.

Elbow fractures, elbow surgeries, and general elbow trauma all can have the unfortunate consequence of “contractures,” or lags in range of motion. I have found that the soft tissue of the elbow does not respond favorably to aggressive stretching. Aggressive pushing of the ranges of motion will actually cause the elbow to become more inflamed, and in many cases, the contracture will worsen.

The soft tissue of the elbow tends to agree with a slower, gentler stretch imposed over a longer period of time. If you cannot fully straighten your elbow, try this simple exercise. (See photo above)

1. Lie on the floor “face upwards” and place a pillow under your forearm so that your arm may rest with a slight amount of stretch. Make sure that your shoulder does not lift off the floor as you lie in this position. Adjust the amount of support under the forearm if necessary.

2. Allow your elbow to rest into extension over ten to fifteen minutes. Gently press your forearm down into the pillow for ten seconds every minute by contracting your triceps muscles.

3. As your range of motion improves, use less of a support under your forearm.

4. The level of stretch imposed on your shoulder during this exercise should be a “one or two” out of a scale of ten. If you are encountering too much stretch, adjust the pillow under your forearm to allow a more comfortable amount of flexion.

About Dan Baumstark, MSPT, CHT

Dan is a physical therapist who specializes in sports medicine & upper extremity rehabilitation. He is certified by the American Society of Hand Therapists, and he has extensive continuing education in manual therapy from the Michigan State University School of Osteopathic Medicine. Google+

Comments

  1. Elbow surgery successful.But mobility of my elbow not improved fully.

  2. Hey! Ok so I play volleyball for my school and now that the seasons over, I play club volleyball until school starts again, so it’s year round. Anyway, I don’t remember doing anything that just pops out of my head and says “that’s what you did”, but now I can’t open my elbow fully. I try to slowly force it open and when I get to a certain spot it begins to shake while I try to open it. It doesn’t hurt at all when its bent but now it hurts a lot when I open. It’s affecting my passing and I am an attacker so I need my elbow. Do you think you know what’s going on or what I should do?

    • That type of thing sometimes happens from falling directly onto the elbow, which sounds like a possibility given what you do. It is also possible that you are simply overusing one of the muscles that crosses the elbow joint, maybe the biceps. In either case, I would see your doc and see what is up. I don’t think that it will get better easily if you are playing through it.

  3. I had a bad fall. I was operated on 9 weeks ago for fractured humeral bone and dislocated shoulder. 5 screws and a plate. xrays show that everything is healing. the problem is my elbow will only bend to 90 degrees. Surgeon is suggesting manipulating elbow under anesthesia. I would like to continue p t. instead but worried that progress is slow what is your opinion

    • Elbows are cranky, they don’t like to be aggressively forced into flexion or extension. A manipulation might help, but it will cause inflammation in the elbow in the short term.

      Realize that I am a physical therapist, so my opinion is at times going to differ from that of a surgeon. I would try getting a brace that places a gradual flexion force on the elbow, and give it some time. Unfortunately these things do not go away overnight. You need to be patient. There is a company called “JAS” that we use here at PhysioDC for patients with elbows that don’t move well. It might be worth your while to talk to a physical therapist about it.

  4. Hi
    I fractured my radius near to the elbow some years ago I have not been able to straighten it properly since the injury and at the moment I will get a lump pop out under my tricep right neat the elbow when this happens I cannot straighten my arm past 90 degrees until I push the hard lump back in any ideas what this I and how I can get my arm to fully extend

    • Jason I would definitely see an orthopedist and get a good x-ray to see what is obstructing things. It is probably scar tissue but you should be sure. The fact that it has been years since the injury will make it a bit more difficult to correct. Start with an orthopedist.

  5. Norman Jaravata says:

    Hi! Fractured my distal radius and olecranon due to a bike accident 11 weeks ago. Had surgery/ORIF on both and was on a sling and cast for 6 weeks. I have been doing rehab since pins came off. Hand and wrist range of motion has improved but I still could not straigthen my elbow. Have been given aggressive stretching for flexion and extension but not much gain. I want to go back to work asap but it has been a little frustrating despite all the PT sessions. Read about the light stretching over time. Any other ideas?
    Many thanks!

  6. Hello Five days ago I fell on concrete and landed and my right arm. I have used Advil, hot and cold. Some mild stretching but my elbow is still swollen and throbs up and down my arm. If I try to straighten it the pain streaks through my arm. I cannot lay on that side and it is even pulling on my neck to back muscles on that side. Should I see someone about this or just slowly work it out. They X rayed my wrist but not my arm.

  7. Mika Guzman says:

    Hello,
    I’m a 14 year old freshmen I broke my forearm about 2 months ago. My doctor said that its not fully healed yet and my doctor told me to straighten my arm but I can’t. Its hard and kind of scary for me. I have physical therapy in 2 weeks, but how do I do it by myself at home? I been researching about it and I heard that if you try to straighten your elbow then you might hurt the bone more. I need to know how I straighten it and I want to know if this happens to a lot of people?

    • Mika it does happen to lots of people who have trauma to the elbow. If the doctor gave you the “ok” to work on straightening the elbow I would just start with gently working on trying to move the arm through the range that is obtainable. Try to gently work on the end-range where it feels stiff. Don’t press it down with the other arm, just do what you can using the strength that the fractured side can do.

      The physical therapist will also work on the elbow and give you some exercises to start doing.

  8. Good day! I am a 53 year old woman and I broke my rt radial head and rt ankle 10/11/14 neither required surgery splinting only. Both have healed and am nearly finished with pt on my ankle the elbow however has been less responsive. I started pt on my elbow 11/10/14 and have been faithful 3 times a week. On 12/3/14 we started with a Empi Advance Dynamic ROM brace and have been advancing the tension weekly. As of today I still can not touch my shoulder nor straighten my arm. It’s locked at a 45* degree angle! My PT can get my arm 90* straight by TEARFUL stretching only to watch it slowly curl back up! My fingers won’t work and are extremely swollen/puffy. The brachio-radial muscle (which ever is on right top when flexing)seems to protrude the worse.
    Any suggestions and help will be greatly appreciated.

    • Amy I would normally suggest a stretching brace but it looks like you already are using one of those. The swelling in the hand is a bit strange for a radial head fracture.

      Elbows can be very cranky if they are stretched too aggressively. I would go more towards light stretching over a longer period of time. Try scaling the brace tension back a bit and see if you can tolerate it for a longer session. You may be re-inflaming the joint with all of the work that you are doing on it.

  9. last year i fall from a bicycle and fractured from elbow and doctor fixed some nails in my elbow after 55 days they taken out the nails.but my elbow is not straighten.please refer me some exercises to straighten my elbow.i don’t want any more operation or surgery.please give me some tips.

    • Lie on the floor and get the elbow to straighten out as much as possible. Place a pillow under the wrist and adjust it so that you feel a little bit of a stretch. Try to relax into the stretch for a few minutes and see if you can build up the time doing that.

      You might want to ask the doc about getting a stretching brace. You would need a prescription from the doc in order to get the brace.

  10. Good day!

    a week ago i suffered a minor dislocation of my elbow with a minor type one coronoid fracture. The orthopedics have already taken of the backslab that i had been wearing since my admission and I’ve been only using a arm sling for support now. However I realised that i am unable to flex or straighten my arm to a great extend. Would this affect my flexibility of my elbow in a long run, and do you recommend doing elbow exercises this early on?

    • Ian it takes up to six weeks for the fracture to heal. The coronoid is very close in to the elbow joint, so I am guessing that it might not be a great idea to push your end-ranges. Ask the doc about it, and I would want to have a “clear” x-ray prior to aggressive stretching.

  11. I’m a woman in my late 50’s. A month ago, I fell and fractured my left elbow – radial head fracture, Type II. Supposedly (according to the description in the medical report of the x-rays taken the same day), the humerus and ulna are intact.

    I consulted an orthopedic surgeon 4 days later (at one of the top hospitals in the U.S., where I have all my medical care), who said I would not need surgery. He thought I would probably regain most, though not necessarily all, of my range of motion, and sent me to physical therapy. My first session was gentle, and I was sent home with instructions for exercises (blended Elbow Flexion and Elbow Extension, and Forearm Supination). My next P/T session was scheduled 2 weeks (13 days) later, with a different therapist (the first therapist suggested I might like to go to one who was a few miles closer to me, at another highly ranked hospita). When the latter began to work with me, she told me that I had done the exercises improperly. I have seen her 4 times since; each time she manipulated my left arm in a way that caused me such intense pain that I could not endure it for very long. I have continued to do the exercises at home, and done them properly; usually 4 times per day, though a few times only 3. Manual dexterity in my left hand and fingers have increased, but my elbow extension and bending are, I believe, unchanged (there was measured improvement on 1/7, but it worsened on 1/9). My physical therapist told me on 1/13 that she could no longer work with me, after more of the torturous manipulation (not without result, I was able, with her forcing down the left forearm, to touch my left hand to my shoulder), that it was too difficult; perhaps she was tired of my needing to stop after a certain amount of time. I tried to endure the pain, but could not. She has also told me that she does not understand why I am in so much pain during the P/T sessions, and said there was no reason for it.

    I see my orthopedic surgeon again later today (1/14). I am afraid that he will tell me that he cannot authorize any future P/T, or even surgery. I am wondering if I’ve wasted 4 weeks out of the 6 week window, and am annoyed that I didn’t find out about the 6 week window (before the elbow stiffens) until 2 weeks had passed (when my questions prodded my P/T to tell me about it).

    Is it normal for P/T for a type II radial head fracture to the elbow to involve such intense pain? I was prepared for some pain and discomfort, but not for pain too extreme to endure for more than 10 or 20 seconds (and it was often longer than that). Am I just being too sensitive?

    I am very worried that I will not be able ever to bend or extend my arm to a greater degree, or be cleared to drive. I want to try P/T again with a different therapist who might cooperate more with me (I had asked my P/T to at least tell me how long the painful manipulation would last, if I’d known, I might have been able to withstand the pain; but she refused to tell me). Is a stronger painkiller (I’ve been taking Tylenol extra strength 500 mg) that might help?

    I’d appreciate any tips, insights or opinions you might have.

    • Pat let me preface this response by saying that I cannot actually feel what your elbow’s range feels like over the internet. Having said that, it sounds like the therapist that you are using is a bit too aggressive. Ditch her.

      I would go with gentle and slow stretching to tolerance. Maybe try another PT, or you could ask the doctor to prescribe you a “JAS” brace for the elbow. The JAS brace will apply a light stretch that you can control by turning a dial. The brace goes home with you as well so you can fit it in to your day.

  12. Hello,
    Ever since my drama teacher noticed it, I have always noticed that I cannot fully extend either of my arms. There is no pain in them, and I don’t recall having an injury to them at any point. Interestingly, my Dad’s arms also do not fully straighten. Is this sometimes just an anotomy thing. It isn’t inconvenient except when I do dog pose in yoga and structurally am not as strong die to the bent arms.
    Thanks.

    • Ella this definitely sounds like the contours of the elbows bones that you inherited from your parents are responsible for this. It is not a big deal at all, although you are correct in remarking that a “down dog” position is going to be a lot more work for you because you cannot “rest on your ligaments”. (It isn’t that you are not strong enough, you just have to use your triceps and other stabilizers waaaay more than people who can lock their elbows out).

  13. Hello,
    I’m 16 years old and I dislocated my elbow while tumbling at cheerleading practice. I was taken to the emergency room and it was put back in place. Since then I’ve been seeing an orthopaedic doctor and I got my splint off two weeks after the injury, and now at four weeks after the injury the doctor advised me to take off my sling and use my arm for daily activities. I am now able to bend my arm upwards towards my chest but I am unable to unbend to straighten it out. I try to stretch it out but it is extremely stiff and can only get it to unbend up to an obtuse angle. When I try to unbend it further there is pain but that is not the problem it feels physically impossible to get it past a certain point. My doctor tells me to just try to let my arm hang to let gravity pull on it and to try slowly unbending it but I feel like it’s taking me longer than necessary to recover from my injury I’m just very afraid that I will not be able to fully straighten my arm out or get full range of motion back in my elbow.

    • That injury is not fun at all. Elbow dislocations take a long time for recovery. You are going to have to be gradual with the stretching as I have found that elbows get even more irritated if you stretch them too aggressively.

      I would definitely hook up with a PT. Talk to the doctor about it and see if he will write you a prescription. Guided stretching might be a good idea.

  14. Hello

    I am 24 years old and broke my distal humerus 5 months ago and it healed into a malunion. I’ve just recently 3 weeks ago had an operation to re-align the bone and have a plate put in it. When it healed as a malunion I could never fully straighten my elbow and was hoping the opperation would sort this out. It’s been 3 weeks since the opp and the surgeon and PT told me some excercises to do to loosen it up… I have no pain now and I have got it to as straight as it was just before the opp, but it feels like it will not go any further than that.
    What is it thats making it not extend more and can I or will I ever get it to fully extend again?
    It’s just slightly bent at the elbow, could it be tendons, ligaments or the tricep muscles that still need more time to strengthen and repair??

    My hobbie used to be weight lifting and it’s quite important to be able to fully extend my arm to get a proper muscle contraction for triceps and chest, so I’m willing to try anything and your advice would be much appreciated.

    • It could be scar tissue causing a physical block. It could be inflammation of the elbow joint from the trauma (inflammation restricts ranges of motion). The muscles and tendons do accommodate to the position of a joint if it is kept in that position for a long time (such as from a fracture). It could be some combination of the above.

      You might benefit from what is called a “static progressive” brace for the elbow. It applies a gentle stretch over a longer period of time that a PT can stretch you for. You would need a prescription from your doctor, so you would need to see him and ask him about it. I have had some patients here at physical therapy who have improved quite a bit suing one of those devices.

  15. Hello. Almost 3 weeks ago I was at a soccer game and an altercation broke out. I believe the only movement my arm did was a punch motion. Immediately after there was no pain but by the 3rd day my arm couldn’t extend. When I accidentally extend my arm over what I am capable of doing intentionally a sharp pain is felt in my elbow. That same day a friend noticed a large bruise about 3.5 inches in diameter between my elbow and my tricep. I still cannot extend my elbow all the way. And about once a day I will over extend my arm causing the same pain doing simple things (putting on my shirt, taking it off, catching things). It doesn’t seem to get better. What should I do ?

  16. Hi,
    My situation may be a little different, about 12 years ago I was doing a 2nd story roof job by myself. I had to take up 400 plus bundles of shingles weighing about 60 lbs each. I tied a rope around them and pulled them up. After I was done with the job I was not able to straighten out my arms. I thought it would straighten out after the soreness went away. To this day I have not been able to straighten them out. I tried over and over to work them to straighten out and nothing has worked and it is becoming a major issue. I am in very good physical fitness condition. I don’t know what I can do or is this a permanent situation now. I did do what you mention not to do, tried to force it straight in several different ways and that made matters worse. My arms before this where able to hyper extend them not they are severely bent. When I try to extend them they hurt in the biceps and triceps by the elbow and all around the elbow. They were hurting around the forearm too especially If I really pressure them in an attempt to extend them or in weight bearing. Thanks, Kocho

  17. Hi..my elbow is operated for lateral condyl fracture, now 3 k wire are removed by doctor in last six month, screw is remaining,currently around 15-20 degree motion is remaining for both Stria-ting and bending of right hand,
    can my full motion possible without removing screw?
    please advise for full motion of hand

    • Yogesh you would have to get an x-ray to see if the screw is in a place that is keeping the hand from moving. I am sorry but I cannot answer your question because I don’t know exactly where the screw is in relation to the bones of your elbow and hand.

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