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.

What is the structure of your arm?

  • 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:
There are 3 major nerves that originates from your neck and runs along your arm, towards your fingers. These 3 nerves are the Median, Ulnar and Radial nerves.

What is the function of your arm?

  • 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.

I think I broke my arm… How did it happen?

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.

Causes of my broken arm

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

Symptoms if your arm is broken

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.

Tests that you can do to see if you might have a broken arm

  • Kneel down on your hands and knees
  • Slowly shift most of your body weight onto your arms
  • Then lower your chest down to the floor by slowly bending your elbows far as possible
  • Pain or weakness felt in your injured arm at any point during these movements may indicate that you have a broken arm
  • Standing comfortably with your feet slightly apart, pick up a soccer ball
  • Using only your painful arm, attempt to throw the ball as far as possible
  • Pain or power loss experienced at any point during this movement may indicate that you have a fractured arm
  • Hold a 2 liter bottle filled with water in the palm of your injured hand
  • Slowly straighten your elbow fully while holding the filled bottle
  • Pain or weakness of your injured arm may indicate that you have indeed broken your arm

How serious is my broken arm?

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.


Physiotherapy diagnosis of your broken arm

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.

Diagnostic ultrasound

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.

Why is the pain not going away?

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.

What NOT to do

  • Leave your broken arm untreated

  • Managing your pain by only taking pain medication or muscle relaxants for more than 2 weeks.

  • Not respecting your pain and pushing through pain.

  • Use of anti-inflammatory medication for more than a week.

  • Not keeping to your treatment guidelines.

  • Loading your injured arm too soon.

What you SHOULD do

  • Rest and elevate your arm as instructed.

  • Still use your arm for light pain free tasks like eating with a spoon.

  • Make an appointment to confirm the diagnosis and determine how severe the tissue damage is.

  • Finish your treatment and rehabilitation programme for better long-term results

Making it worse

  • Not using your injured arm at all, in fear that you will worsen your injury.

  • Not taking your pain medication as prescribed

  • Picking up your child.

  • Avoiding certain movements anticipating it will be painful.

  • Participating in contact sports while your fracture is still healing.

Problems we see when patients come to us with a broken arm…

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.

Physiotherapy treatment

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.

Phases of rehabilitation

Right after you break your arm, your body sends out signals to start bone healing. These signals cause cellular and chemical reactions. You can imagine the process like a production line in a workshop full of specialists, where each one has a specific role. Bone healing is a four-step process consisting of inflammation, repair, new bone formation, and bone remodeling.

You need physiotherapy treatment twice a week for the first 2 weeks after your fracture. After these initial 2 weeks, your treatment sessions are spaced out to 1 session a week for the next 12 weeks. We’ll reassess as you progress through the phases.

1st Phase: Bone Healing (0-1 week)

Aim of this phase:

Hematoma formation (days 1 to 5 after fracture). This stage begins immediately following your fracture and starts the healing process of your broken arm. Fibrocartilaginous callus formation (days 5 to 11 after fracture). This stage involves the forming of new bone cells to mend your fracture site. It is crucial to ensure good immobilization of your arm by means of a cast, brace or splint to limit excessive movement of your broken arm. Limiting the amount of force going through your broken arm, is important to ensure no shifting of your broken bones. Another aim of this phase is to keep you safe, while staying active.

Physiotherapy treatment techniques:

Laser and ultrasound are applied to your injured area to increase your rate of healing. Ice, elevation and circulatory exercises helps to decrease your pain and swelling. Strapping and Taping is used to support and protect your injured arm from further injury.

At this stage you should be able to…

At the end of this phase you must be able to eat with a spoon with minimal pain while your arm is supported in your cast or brace.

2nd Phase: Pain free range of motion (2-6 weeks)

Aim of this phase:

Promote good bone healing and union. Move your elbow and shoulder through full range. Strengthen your affected arm in preparation for carrying your groceries.

Physiotherapy treatment techniques:

Dry Needling of your surrounding muscles, is used to ensure smooth pain free movement of your arm. We massage and use Soft tissue mobilization techniques of all your affected muscles to decrease muscle spasm.

We will use TENS, laser therapy and joint mobilization techniques to decrease your swelling and pain. Neural interface release, strengthening exercises for your surrounding muscles and Isometric exercises are used to build the necessary support for your fractured arm.

At this stage you should be able to…

At the end of this phase you must be able to lift and drink from a cup of coffee, without spilling any coffee or experiencing any pain in your arm.

3rd Phase: Fusion Phase (6-8 weeks)

Aim of this phase:

Bone remodeling (day 18 after fracture onwards, lasting months to years). 6 Weeks after your arm fracture, no fracture line should be seen on a x-ray. A white bump like formation can be seen at your fracture site uniting your 2 broken bones. This “bump of bone” will gradually remodel and become smaller, after a few months no bump will be seen and your bone would look the same as before your fracture took place.

Evaluate to see if your bone and upper limb muscles are able to handle tensile, elastic and compression forces. Gradually increase the load required on your arm to condition your joints and surrounding muscles. Ensure that you regain confidence in your arm’s functional ability.

Physiotherapy treatment techniques:

Gradually we will increase the load on your affected arm and ensure independent use of your arm with no pain. Soft tissue release of your surrounding muscles and ligaments, as well as joint mobilization techniques are used to help your arm deal with the increased load of this phase. Corrective taping and bracing of your joints and muscles as support. Finally, there will be concentric strengthening exercises and proprioceptive retraining.

At this stage you should be able to…

You should be able to hold a filled 2 liter bottle at your side, and then lift the bottle with an extended arm overhead. No pain should be felt when doing this action.

4th Phase: Stress Phase (8-10 weeks)

Aim of this phase:

To maximally strengthen your arm to your specific daily functional demands. Ensure that your arm can handle an increased load for an extended time period, without failing.

Physiotherapy treatment techniques:

After gradually increasing the load on your injured arm we will start to increase the amount/repetitions of the prescribed exercises. We will continue with soft tissue release of your surrounding muscles and ligaments, joint mobilization techniques and might use Electrotherapy (laser, EMG, Russian stimulations) to support the hands-on treatments. Corrective taping and bracing of your joints and muscles can be used to support your arm. Dry needling manages the muscle pain you are feeling. Concentric and eccentric strengthening exercises go along with and co-ordination retraining.

What you should be able to do by this stage is…

By now you should be able to lift a filled 5 liter bucket from the floor and place it on a shelf at a level above your head. You are allowed to use both hands and should be able to repeat this action 10 times within 1 minute.

5th Phase: Throwing Phase (10-12 weeks)

Aim of this phase:

Optimize your arm’s explosive power and co-ordination to avoid future injuries. Restore your arm’s strength when coming throwing activities.

Physiotherapy treatment techniques:

We will prescribe a specific exercise program to improve your arm’s power output and co-ordination. The use of Kinesio tape will facilitate your arm’s coordination and rigid strapping can be used to brace or offload your arm. Muscle activation techniques will help improve your arm’s immediate strength and firing pattern. Laser therapy is used to increase the rate of healing. Soft tissue release of your surrounding muscles and ligaments encourages free movement and gets paired with joint mobilization techniques.

What you should be able to do by this stage is…

At the end of this phase, you should be able to stand an arm’s length away from a wall while holding a 5kg medicine ball with both hands. You should then be able to squat down and as you come back to your standing starting position, attempt to throw the medicine ball upwards aiming for a specifically marked area on the wall, roughly a meter above your head. To successfully pass this phase you should be able to complete a minimum of 6 repetitions within 1 minute.

6th Phase return to sporting activities (3 -5 months)

Aim of this phase:

Gradually condition your arm to meet all the requirements of your specific sporting discipline. Ensure that you are ready to return to sport training and matches. Minimize the chances of you reinjuring your arm.

Physiotherapy treatment techniques:

We will provide endurance and fitness drills as well as sport-specific exercises depending on the sport you partake in. We make use of corrective and assisted taping techniques to support your arm and use muscle activation techniques to improve your muscle movement. Laser therapy is used to support hands-on therapy and psychotherapy ensures your confidence, in your newly healed arm. Yes, with a little bit of hard work you will be able return to your sport.

What you should be able to do by this stage is…

At the end of the final phase, you should be able to hold a 5kg medicine ball with only your injured arm. Then you should be able to bounce the medicine ball against a wall and catch the ball also just with your injured arm. To successfully pass this final stage you should be able to do 10 throws within 1 minute, without dropping the ball or any pain.

Healing time

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.


Other forms of treatment

Your physio or GP confirms your fibula fracture via X-rays. GPs prescribe pain meds or injections to control your pain and inflammation.

At the casualties department, X-rays of your arm will be done to confirm a fracture. Your arm will then either be put in a cast or splint and you will be sent home with some pain medication.

An Orthotist will be able to assist you with a custom made splint or brace for your arm.

Orthopedic surgeons attends to more complex, displaced arm fractures that will require surgery to realign your bone fragments.

A Neurosurgeon’s expertise will be called in when your nerves were also injured when braking your arm.

A Biokineticist helps in the final stages and with the fine tuning of your rehabilitation. They will ensure that you meet all the specific requirements to safely return to your specific sport.

Ozone therapy and calcium supplements only assist your healing process, but there are better things to speed up your recovery.

Is surgery an option?

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.

What else could it be?

  • 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

Also known as…

  • 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