Are you in two minds whether your toddler’s arm is just badly sprained or actually broken after that nasty fall from the swing… To make matters worse you struggle to gauge how much pain your toddler has seeing that she is only 2 years old!

To confuse you even further, she uses the arm and hand without complaining, there is also very little swelling and no bruising on her arm. But she frequently tells you that she has “Ouchy” on the arm and always starts crying when she pushes herself up on that arm.

What to do… give more pain syrup, make an appointment with your GP or rush to the emergency department? RELAX you are not a bad parent neglecting your child, help is at hand!

A sprained wrist or a cracked bone can present very similar and you would need a medically trained person to accurately diagnose between the two. Our physiotherapist are experts in understanding what force is needed to brake a bone and what symptoms to look out for.

• Bones:

Your arm consists of 3 major bones. The humerus that runs from your shoulder to your elbow. This is called the upper arm, or, simply, the arm.  At your elbow, your humerus connects with 2 bones: the radius and the ulna. These bones go from your elbow to your wrist and are regarded as the forearm.

• Ligaments:

There are 4 main ligaments that supports your elbow joint. Medial collateral ligament, Lateral collateral ligament, Annular ligament and Quadrate ligament. The palmar radiocarpal ligaments consist of 4 ligaments that attaches your forearm to your wrist.

• Nerves:

• Bones:

The 3 bones (humerus, ulna, radius) that form your arm have numerous important functions, for example… These bones form joints that provide a wide range of movement and flexibility needed to maneuver objects with your arm and hand. They also provide strength to resist the extreme forces and stresses acting upon your arms and hands during sports, exercise, and heavy labor. Lastly your bones also provide an attachment surface for your muscles allowing movement to take place.

• Ligaments:

Ligaments are rope like structures that joins bone to bone. The function of your ligaments in your arm is to provide strength and stability to your shoulder, elbow and wrist joints and preventing these joints from dislocating.

• Nerves:

The nerves in your arm act as messengers, bringing information from your arm to your brain and vice versa. These messages can act as a protective mechanism warning you when your arm is experiencing pain and is at risk of injury. Further more these messages provides your arm with feeling and movement.

When fracturing your arm a discontinuity in your bone results from mechanical forces that exceeds your bone’s ability to withstand them. Arm fractures can occur in a variety of methods.

Your bone was subjected to a sudden overwhelming force, usually in the setting of trauma. A disease process can weaken your bone, known as pathological fractures. Long term application of high loads (e.g. boxing),can result in a stress fracture.

There are many different systems to classify fractures. Classification of fractures can be based on the integrity and alignment of your broken bone. Whereas other classifications look at the manner in which your bone broke.

Integrity and alignment of your fracture:

• Complete: Extends all the way across your bone (most common)
• Incomplete: does not cross your bone completely (usually encountered in children)
• Non-Displaced / Stable: Broken ends of your bone line up.
• Displaced / Unstable: Broken portions of your bone are separated or misaligned.
• Closed / Simple: Bone has not pierced your skin.
• Open / Compound: Skin has been pierced or punctured by your bone or by a blow that breaks the skin at the time of the fracture.

Manner in which your bone broke:

• Transverse: Fracture is in a straight line running horizontally across your bone.
• Oblique: Fracture runs diagonally across your bone.
• Spiral: Fracture spirals around the length of your bone.
• Stress: Small crack or severe bruising within your bone, seen in overuse injuries.
• Comminuted: Your bone is broken in three or more pieces with fragments present, usually due to severe external trauma.
• Compression: Your bone is crushed, caused by a force compressing your bone.
• Buckle Fracture: The strong outer part of your bone is buckled, often due to a compressive force.
• Greenstick Fracture: Fracture in a young, soft bone in which the bone bends and the outer part of bone is broken, but only on one side.

The following activities are known to cause arm fractures:

• Boxing: Large compressive loads goes through your arm when you land a punch.
• Cycling: Falling off your bike and landing on your outstretched arm.
• Gymnastics: Quick rotational movements can lead to an oblique fracture of your arm.
• Arm wrestling: Poor technique leads to severe spiral fractures of your upper arm.
• Rugby: Falling oddly when tackled.
• Kick boxing: Getting a direct blow to your arm.
• Motor vehicle accident: High velocity impact can lead to open or segmental fractures of your arm

Your pain is one of the first signs of a broken arm. Swelling and bruising is obvious due to blood cells that escape from your broken bone, these cells leaks out into the area causing swelling under your skin.

Treatment of your fractured arm depends on the alignment of your broken bones, the stability of your joints and the integrity of your nerves and blood vessels. A broken bone closer to your wrist is more complex due to your many wrist bones, but there’s a higher risk of nerve injury closer to your shoulder. These are things to consider when determining how severe your arm fracture is.

When fragments close to your wrist, elbow or shoulder joints breaks it severely impacts the movement of your joint by disrupting the forces that are transferred through your joint. In the long run a fracture close to your joint can lead to increased wear and pain of that joint known as osteoarthritis.

A large area of blue bruising visible under your skin is of concern, because of rupture of important blood vessels in the area. When circulation is compromised less vital oxygen and nutrients can get to the injured site. Excessive swelling also puts pressure on the surrounding tissue that further limits good blood flow.

Sometimes the broken arm fragments pierce into surrounding muscle or through your skin, surgery is necessary. Even with closed arm fractures, bone pieces can sever nerves running to your hand. This is a medical emergency and has a limited time frame to re-connect the cut nerve ends. When a nerve is involved in a fracture, it takes the highest priority. Nerve damage is serious and usually causes pins and needles, numbness and weakness over your forearm and hand.

Our physiotherapists are specialists when it comes to the structure of your arm and experienced in the type of injuries that can lead to a fracture of your arm. We have years of experience to test, diagnose and treat a broken arm. When we suspect you have a broken arm, we will refer you to get a X-ray and confirm the type, stability and severity of the fracture.

If you don’t have a broken arm we can identify the root cause of your arm pain by testing other structures like joints, muscles, ligaments and nerves in the area and provide you with an accurate diagnosis. That’s why our physiotherapists are the best equipped to manage your arm injury.

X-rays are the best investigation to diagnose an arm fracture. X-rays shows the integrity and alignment of your bones.

With a X-ray we can determine the site, type and alignment of your broken arm. Even larger cracks can be picked up by a skilled radiologist.

If your specific arm fracture would require surgery, our team of physios are well connected with various specialists and can refer you to the most appropriate surgeon.

A Sonar is not the first choice of imaging when confirming a broken arm.

However, bone gapping, callus formation and severe bone swelling can be signs that we look for to assume there might be a fracture. Sometimes avulsion fractures are first picked up on sonar, that’s usually followed by an X-ray.

Furthermore ultrasound identifies bleeding, ruptured ligaments and muscles around your injured arm. If you need an ultrasound, your physio can refer you.

An MRI scan can image all of the structures in your arm including muscles, ligaments, nerves and bones.

However, for a simple broken arm an image like this is unnecessary and very expensive.

A MRI scan would also be requested if you sustained a very complex arm fracture where multiple bones are involved leaving you with many displaced bone fragments.

The scan assists the surgeon as to which technique to use to reduce or realign and fixate the many pieces of broken bone in your leg.

If your physiotherapist suspects that you sustained a very complex arm fracture, you will be referred to the right specialist whom is authorized to request an MRI scan.

When you break your arm, the initial pain that you feel in and around your arm is normal. This is your body’s way of warning you that you are loading your broken arm too early. This protective mechanism reminds you that your broken arm still needs to heal. There is a risk of more critical and possibly irreversible damage if you don’t take these warning signs seriously.

The opposite is also true, if you are too scared to start loading your healing arm when indicated, chronic pain and other complications will develop. If you consult your physio soon after your injury took place, we can accurately diagnose your fracture and also advise you when and how to load your arm and what level pain is acceptable.

When you complete the correct treatment protocol, your pain should gradually decrease. However, if you neglect to work through your rehabilitation process and don’t get the right treatment from the start, you’ll continue to feel pain. With time, it bothers you more and more, it will prevent you from using your arm properly and your wrist, elbow and shoulder pain gets worse. You become stuck in a cycle of pain, not knowing if it is better to respect pain or push through pain.

Our rehabilitation program ensures that you can return to lifting, throwing and even competitive sport.

Common mistakes patients make when it comes to the healing proses after breaking their arms are…

Patients wait too long to consult a physiotherapist, because they think their injury is not that bad and is probably just a bad sprain… The problem with leaving your broken arm without treatment for too long is that many secondary complications develop; like a painful shoulder joint and neck.

Self diagnosing and not consulting a medical professional to accurately diagnose your injury. This can delay your healing time and cause more damage to your already injured arm. Especially with a broken arm, you will need guidance from a physiotherapist as to what type of fracture you sustained and what management is needed.

Not completing your treatment plan is a very common problem that we see in our practice. You might think that your arm is healed when the cast is taken off and can that you can return to your normal daily activities without pain. Unfortunately, this is not the case. You can reinjure your arm very easily when doing an odd and new activity. For example taking your colleague up on that long awaited squash match. The reason for this reinjury is that even though your arm is now pain free, it is not yet optimally strong and is specifically lacking co-ordination and stability. Co-ordination and stability needs to be retrained and is usually done at the end stage of your treatment process.

Our team of skilled physiotherapists follow specific treatment guidelines to help you heal from your broken arm. Physiotherapy treatment will heal your arm in the shortest time possible, while being safe and limiting complications that tends to develop after an arm fracture. We are confident that we can provide you with the best possible treatment for your broken arm.

Patients are often not well informed regarding their specific injury and are scared that they are doing too much or too little during their rehabilitation period. That is why we are here to provide guidance and answers throughout your healing journey to address your fears. We understand the various treatment protocols for each type of arm fracture. We’ll give you relevant and clear advice that is most useful for you. A personalized treatment program for your specific fracture and get you back to playing with your kids again.

6 Weeks after fracturing your arm, your bone is joined, but not ready for loading. At week 8-12 your arm is fused. Our treatment program is customized to your unique fracture.

A follow up x-ray is taken at week 8 to ensure adequate bone healing did take place. Even if your bone is fused, there are lots of hurdles to overcome like, muscle strengthening, endurance and retraining co-ordination before you can safely and without hesitation pick up your toddler.

Your arm fracture can take longer than expected to heal, you must be on the lookout for the following risk factors that will delay your bone healing:

• Smoking – Nicotine and increased levels of carbon-monoxide lowers the body’s immune response to repair bone tissue.
• Diabetes – Bone healing is slow due to uncontrolled blood glucose levels.
• Previous falls or fractures – Poor stability from the supporting structures puts you at high risk of re-injuring your arm.
• Very low levels of physical activity – Poor circulation and under developed muscles can alter bone structure and strength, that makes it easier to break.
• Low bone mineral density – underlying conditions can absorb more calcium from your bones making them brittle.
• Older than 50 years of age – Bone density peaks in your 30s, and gradually declines throughout your life, in some patients this process is accelerated triggered by hormonal changes, especially in females. Even a greater risk after menopause without hormone replacement therapy.
• Repetitive high levels of activity – can lead to a load to high for your arm to tolerate resulting in a stress fracture or a hairline fracture.

Surgery for your fractured arm is necessary when…

You sustained a complex fracture, where your arm bone fragments shifts and are compromising your surrounding nerves, vessels or muscles, this will need to be surgically repaired. If you severely fractured your arm, which resulted in broken pieces of bone piercing through your skin (open fracture), then surgery is the obvious choice.

Surgery is only halfway mark for a successful recovery, the rest is the reintegration, strengthening and adapting your body to the new change.

• Median, Ulnar or Radial nerve injury:

Drastic power loss of your hand, with numbness or pins and needles sensation of your fingers.

• Inflammation of the muscles in your arm:

Known as tendinitis, your pain gets better with movement, but with a fracture pain gets worse.

• Severely sprained wrist with torn ligaments:

Severe instability of your wrist, while the X-rays show no fracture

• Fracture of the distal radius/ulna
• Colles fracture
• Torus/Buckle fracture
• Greenstick fracture
• Fracture dislocation of the elbow joint
• Galeazzi fracture
• Monteggia fracture
• Humeral head fracture