Sprained Arm or Broken Forearm? Elbow & Forearm Injury Signs

A slip on a wet marble staircase, a stray ball on the basketball court, a tumble off a bike: arm injuries are very common, and most happen the same way, by landing on an outstretched hand or straight onto the elbow. The next question is always the same: is this just a sprain that will settle with rest, or a fracture that needs an X-ray and a cast? This guide focuses on the elbow and forearm: what a "sprained arm" really means, what forearm and elbow fractures look like, why a radial head fracture can be deceptive, and how long recovery takes.

For the general rules on telling a fracture from a sprain anywhere in the body, including the ankle and hand, start with our main guide, broken bone or sprain? How to tell and where to go. If the pain is in the wrist or at the base of the thumb, our guide to a broken wrist or sprained wrist is the better fit.

What is a sprained arm, and what are the signs?

There is no single joint called "the arm", so a "sprained arm" usually means a sprained elbow or wrist. A sprain is an injury to a ligament, the tough tissue that holds bones together at a joint. An injury to a muscle or tendon in the forearm or upper arm is called a strain. The usual signs of a sprained elbow are:

• Pain around the joint that's worse when you move it or carry something.
• Swelling and bruising that build over hours rather than necessarily straight away.
• Stiffness, but you can still bend and straighten the elbow, even if it hurts.
• The hand works, the fingers move and feeling is normal.
• The arm keeps its normal shape.

The NHS says a sprain and a break can be hard to tell apart and that you'll probably need an X-ray if there's any doubt. A practical rule: pain around a joint fits a sprain, while sharp pain directly over the bone when you press on it deserves an X-ray.

How to tell if your forearm is broken

The forearm has two bones: the radius on the thumb side and the ulna on the little-finger side. They rotate around each other when you turn your palm up and down, which is why losing that movement is one of the clearest signs of a fracture. Signs that point towards a broken forearm:

• A bend, bump or step you can see along the forearm.
• Sharp pain at one spot when you press on the bone.
• A crack or snap heard at the moment of injury.
• Being unable to turn your palm up and down, or severe pain when you try.
• Quick swelling and bruising, sometimes with numbness or tingling in the hand.

Not every break is obvious, though. A fracture where the bone hasn't moved out of place, or a child's "greenstick" fracture where the bone bends and cracks without breaking through, may cause only pain and swelling. That's why the X-ray, not the look of the arm, settles it.

Fell on your elbow and it's swollen? Signs of an elbow fracture

The single most useful sign after a fall onto the elbow or an outstretched hand is whether you can fully straighten the elbow. If it stays slightly bent and won't go as straight as your other arm, that's a classic sign that needs an X-ray, even if everything else seems minor.

Radial head fracture: the break that looks like a sprain

The radial head is the top end of the radius at the elbow, and it's one of the most common places for an adult to break the elbow. It typically causes pain on the outer side of the elbow that's worse when you turn the forearm, with swelling that may be only moderate, so many people assume it's a sprain and delay getting it checked. As general guidance, many small fractures that haven't moved are treated with a sling and early movement, while bigger ones may need an orthopaedic surgeon's opinion. The doctor decides after the X-ray.

Children and the elbow

A child with a swollen elbow after a fall from climbing frames, swings or a bike should have an X-ray the same day, even if they can wiggle their fingers. If their hand is pale or cold, they can't move their fingers, or the elbow looks out of shape, go to the ER straight away.

Elbow sprain, fracture or dislocation?

Never try to push a dislocated elbow back or straighten a bent arm yourself; it can damage the nerves and blood vessels around the joint.

When should you go to the ER for an arm injury?

Call 911 for

• Bone showing through the skin, or a deep wound over a possible break.
• A hand or fingers that are numb, pale, blue or cold.
• An arm injury as part of a major accident, such as a high-speed car crash or a fall from height.
• Heavy bleeding that won't stop with pressure.

Go to the ER now

• An arm or elbow that's clearly deformed or bent.
• Severe pain that keeps getting worse rather than easing, with a lot of swelling and tight, shiny skin — especially if it's out of proportion to the injury or worse when you move your fingers.
• Pins and needles or weakness in the hand after the injury.
• A cast or bandage that feels much too tight, with swollen or discoloured fingers.

Pain that keeps rising with severe swelling can be a sign of compartment syndrome, a build-up of pressure inside the muscles. It's an emergency that needs hospital treatment quickly. Don't wait until morning.

Urgent care or a doctor the same day

• You can't fully straighten the elbow after a fall.
• Sharp pain when you press on the forearm or elbow bone.
• Pain when you turn your palm up and down.
• A child's swollen elbow after a fall.
• A "sprain" that hasn't clearly improved after two or three days.

Usually fine at home

• Pain and swelling around the joint, with full movement even if it hurts.
• No sharp pain over the bone, and the arm looks normal.
• Pain that's gradually easing day by day.

What should you do while you wait to be seen?

• Support the arm in a sling or a folded scarf and try not to move it. Don't try to straighten it.
• Take off rings, watches and bracelets straight away, because the hand and fingers may swell.
• Use ice wrapped in a towel, never directly on the skin, for up to 20 minutes every 2 to 3 hours.
• Painkillers: ask a pharmacist what's suitable for you, such as paracetamol; ibuprofen isn't suitable for everyone.
• If there's a wound, press on it with a clean pad to stop bleeding.
• Don't drive with an injured arm; ask someone to take you.

How long does a sprained arm take to heal?

According to the NHS, most sprains and strains feel better after about 2 weeks, but you may need to avoid strenuous exercise for up to 8 weeks to avoid injuring it again, and a severe sprain can take months. A broken arm or wrist usually takes around 6 to 12 weeks to heal, longer if the injury was severe. After a cast or sling comes off, a stiff elbow is common; it's a joint that stiffens quickly when it isn't moved.

Don't rush back to lifting or arm-heavy sports such as tennis or basketball. Our guide to returning to sport after an injury explains how to build back up safely.

When does physiotherapy help after an elbow or forearm injury?

Once a doctor has confirmed the injury is stable, physiotherapy helps you get back full elbow straightening, forearm rotation and grip strength. At the physiotherapy clinic at Emergency Plus, open 9:00–20:00 daily with no referral needed, the physiotherapist assesses how your elbow and wrist move and how strong they are, then builds a graded exercise plan for you to continue at home. If you've had surgery to fix a fracture, our guide to physiotherapy after surgery in Amman explains what to expect. Weeks in a sling can stiffen the shoulder too; see our guide to shoulder pain and frozen shoulder.

Sources

• NHS — Broken arm or wrist
• NHS — Sprains and strains
• NHS — Compartment syndrome
• MedlinePlus — Broken bone
• MedlinePlus — Elbow injuries and disorders