Patient Information: Elbow and Upper Arm Pain After Fall with Negative Rib X-Ray
What You Need to Know About Your Injury
Even though your rib X-ray was negative, you may still have an elbow or upper arm injury that requires proper treatment and possibly additional imaging to prevent long-term problems.
Your initial X-rays ruled out rib fractures, but elbow injuries can be subtle and sometimes don't show up on standard X-rays, especially soft tissue injuries like tendon, ligament, or muscle damage 1.
Immediate Treatment Plan
Pain and Swelling Management
- Apply ice for 10-minute periods through a wet towel to reduce swelling and provide pain relief 2, 3
- Take NSAIDs (like ibuprofen or naproxen) for pain control unless you have medical reasons to avoid them 2, 3, 4
- Rest and modify activities - avoid movements that cause pain, but don't completely immobilize your elbow as this can lead to stiffness 2, 3, 4
What to Watch For
You need to return for additional evaluation if you experience:
- Inability to fully extend your elbow - this is a red flag that suggests a possible hidden fracture 5
- Mechanical symptoms like clicking, locking, or catching - these indicate possible intra-articular problems 4
- Numbness or tingling in your hand or fingers - this suggests nerve involvement 4
- Persistent pain despite following treatment recommendations 2, 3
When Additional Imaging Is Needed
If Pain Persists After Initial Treatment
Your doctor should order additional imaging if your symptoms don't improve within 10-14 days 1:
- Repeat X-rays in 10-14 days can detect fractures that weren't visible initially, as bone healing makes them more apparent 1
- CT scan without contrast is equally appropriate for detecting occult fractures if repeat X-rays are still unclear 1
- MRI without contrast is the best test if soft tissue injury (tendon, ligament, or muscle tear) is suspected rather than a fracture 1
- Ultrasound can also detect tendon and ligament injuries and is particularly good at finding dynamic problems that only occur with movement 1, 2
Critical Warning
If you cannot fully straighten your elbow and your X-ray appears normal, you need a CT scan - studies show that 12.8% of patients with this finding have hidden fractures 5.
Recovery Timeline and Physical Therapy
First 2 Weeks
- Focus on pain control with ice and NSAIDs 2, 3
- Gentle range-of-motion exercises to prevent stiffness, but avoid painful movements 2, 4
- Avoid lifting, pushing, or pulling with the injured arm 2, 3
Weeks 2-6
- Start physical therapy if symptoms persist beyond 2 weeks 2, 3, 4
- Eccentric strengthening exercises are particularly effective for tendon healing 3, 6
- Stretching exercises for wrist and elbow muscles 3
Expected Recovery
- 80% of soft tissue elbow injuries resolve within 3-6 months with proper conservative treatment 2, 3
- Full extension should be restored gradually through active exercise, never through forceful stretching 7
When to Consider Advanced Treatment
If Conservative Treatment Fails
- Corticosteroid injections may provide short-term relief if pain persists after 4-6 weeks, though they don't change long-term outcomes 3, 6
- Surgical evaluation is only warranted if pain continues despite 6-12 months of well-managed conservative treatment 3
Important Pitfalls to Avoid
- Don't ignore persistent inability to extend your elbow - this strongly suggests a fracture even with normal X-rays 5
- Don't completely immobilize your elbow - this leads to permanent stiffness 3, 8
- Don't delay follow-up imaging if symptoms persist - hidden fractures can lead to arthritis and permanent disability if untreated 1, 5
- Don't assume normal X-rays mean no injury - soft tissue injuries and some fractures require MRI or ultrasound to detect 1, 2