Jock Doc

Elbow fracture can be hard to see on X-ray

Q. I was working out and tripped over a bench and fell on my left elbow. I am not sure if I heard a crack but it was immediately painful and it swelled. I went to the emergency room and had X-rays and was told it was just a bruise.

The injury was two weeks ago but my elbow is still painful and I cannot move it all the way. Why is it not yet back to normal and do I need to see a doctor?

Falls on the elbow can result in a bruise, as you were told, but can also result in a fracture or ligamentous injury. Sometimes the initial X-rays do not show the fracture and if you are still having pain and limitation of motion I recommend you see an orthopedic surgeon or upper extremity specialist for repeat evaluation and likely X-rays and possibly even a magnetic resonance imaging scan.

The most common fracture that sometimes can be missed on initial X-rays is a radial head fracture. An untreated fracture may result in limitation of motion, particularly limited extension and rotation of the elbow and forearm. Most radial head fractures that are significantly not out of place can be treated with physical therapy and gentle motion exercises.

Other possible diagnoses include a ligamentous tear, bone contusion, or bursitis. These injuries respond best to treatment when initiated soon post injury and I recommend you see the doctor as quickly as possible.

Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Email your questions to

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