Executive Editor: Peter Trafton

Authors: Kodi Kojima, Steve Velkes

Proximal forearm 21-A2.2 Functional treatment

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1 General considerations top


The elbow is a complex joint with three separate articulations, ie, the humeroradial, the humeroulnar and the radioulnar joint. Immobilization of the elbow may compromise patient’s range of motion.


Early movement is encouraged in:

  • Fractures involving less than 30% of the radial head, undisplaced or minimally displaced (<2 mm)
  • Radial neck fractures with less than 20 degrees of angulation and unrestricted elbow movement.

In the elderly, high surgical risk, and low demand patient with osteoporotic bone, there is a place for early motion in comminuted fractures of the proximal ulna or radius when the elbow joint is stable.

In A2.1 fractures in low demand patients, there is no indication for surgery.

2 Functional Treatment top

Pain control

Adequate pain management helps to achieve early range of motion. Early aspiration of the radioulnar joint and intraarticular injection of local anesthetics might be performed. This allows analgesia for clinical assessment of range of motion.


Aspiration technique

Enter the elbow through the anconeus triangle on the radial side. Flex and fully supinate the forearm to protect the radial nerve. The surface landmarks are the radial head, the lateral humeral epicondyle, and the tip of the olecranon (anconeus triangle). Insert an 18 gauge needle into the joint through the soft spot in the center of the triangle. With this approach, only anconeus and capsule are penetrated.


A cuff and collar sling may be used as an adjuvant for pain control.



Encourage the patient to move the elbow actively in flexion, extension, pronation and supination as soon as possible.


The sling may be removed for early range of motion exercises.
Monitor the patient at regular intervals to assess and encourage range of motion.

Shoulder, wrist and hand movement is also encouraged.

v1.0 2007-10-14