An olecranon stress fracture is a tiny crack in the bony tip of the elbow (the olecranon), caused by repeated throwing or weight-bearing loads that outpace the bone’s natural repair process. Although uncommon, it is the fourth most frequent stress-fracture site in sport and the leading elbow stress injury in baseball pitchers, javelin throwers and gymnasts.
Why does it happen?
|
Key force |
Simple explanation |
Typical sports |
|
Posteromedial impingement |
Repetitive “knock” of the olecranon against the back of the humerus, especially when the elbow snaps straight under valgus (out-turning) load. |
Pitching, javelin, serving in tennis |
|
Triceps traction |
Powerful pull of the triceps brachii (main elbow-straightening muscle) on its bony insertion during the acceleration phase. |
Pitching, weight-lifting presses, handstand push-ups |
|
Valgus-extension overload |
Combination of the above forces producing a shear-and-twist effect. |
High-velocity throwing |
Contributing factors
- High pitch counts or short rest periods
- Incomplete growth-plate closure in adolescents
- Poor technique or sudden jump in training volume
- Loss of ulnar collateral ligament (UCL) strength after previous injury
Common warning signs
- Aching or sharp pain at the back-inner corner of the elbow that eases with rest
- Pain returns quickly when throwing, serving or pressing weights
- Localised tenderness over the olecranon tip
- Possible mild swelling; usually full elbow movement is still possible
- Pain on resisted elbow extension or forearm supination
- Feeling of looseness if a UCL injury co-exists
Red flag: Sudden increase in pain, swelling or loss of motion may signal a full fracture or loose fragment and needs urgent medical review.
How is it diagnosed?
- Clinical examination by an upper-limb specialist
- X-rays (front, side and oblique) – may show a crack or, in early stages, only subtle widening at the growth plate
- MRI scan – detects early bone-marrow oedema (first sign of stress injury) and checks the UCL (“T-sign”)
- CT scan – helps plan surgery if the fracture line is complex
Early MRI allows detection before a visible break develops, reducing time away from sport.
Treatment options
Non-operative (first choice in most)
|
Stage |
Typical time-frame |
Goals |
|
Rest & protection |
4–6 weeks away from throwing; hinged elbow brace if needed |
Pain control, prevent further micro-trauma |
|
Rehabilitation |
Weeks 2-6 start gentle mobility → strength of shoulder blade, core and forearm |
Maintain motion, restore muscle balance |
|
Gradual return-to-throw |
Month 3 onward, supervised interval throwing plan |
Re-load bone safely, refine technique |
90 % of adolescents heal fully with this programme and return to previous level of sport.
Operative (about 1 in 4 athletes)
Indications
- Fracture gap does not unite after three months’ rest
- Visible displacement / loose fragment
- Elite athlete needing quicker union for career demands
Common procedures
- Cannulated compression screw fixation (most used)
- Tension-band wiring if fragment is small
- Bone-graft or drill to wake-up slow-healing bone
Expected outcomes
- Radiographic union ≈ 14 weeks
- Return to sport ≈ 6 months
- Hardware irritation is the main risk; 1 in 6 need screw removal
Preventing recurrence
- Pitch-count rules and enforced rest days (see NHS Youth Baseball Guidelines)
- Pre-season screening of shoulder, core and hip strength
- Coaching feedback to correct late-arm or “drop-elbow” mechanics
- Adequate vitamin D and calcium intake
- Early reporting of any elbow pain lasting >7 days
Clinical Pearls / Key Points
- Persistent back-of-elbow pain in a young thrower is a stress fracture until proved otherwise.
- MRI picks up bone-stress reaction weeks before X-rays change.
- Treat the triceps and shoulder chain, not just the elbow.
- Nonunion risk rises sharply if throwing continues through pain.
- Surgical fixation reliably unites the bone but carries hardware-related complications.
Patient FAQs
Is this the same as “pitcher’s elbow”?
Pitcher’s elbow is a broader term. Olecranon stress fracture is one specific type that affects the elbow tip, often alongside UCL strain.
Will I need surgery?
Only if rest and a structured rehab plan fail to heal the crack or if the fragment shifts. Most teenagers recover without an operation.
How long before I can pitch again?
With prompt rest you may start a light throwing programme by three months and be match-ready at five to six months, depending on healing checks.
Can it happen again?
Yes, if training loads, technique or rest periods are not adjusted. Following the prevention tips keeps the risk low.
Does lifting weights make it worse?
Heavy presses and triceps isolation work can delay healing. Your physiotherapist will re-introduce strength work in a staged manner.
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated May 2025