Radial Head Replacement Rehabilitation
What is a radial head replacement?
The radial head is the rounded top of the radius bone at the elbow — the portion that articulates with the humerus (upper arm bone) and the ulna to allow the elbow to flex, extend, and forearm to rotate (pronate and supinate). It is a critical stabiliser of the elbow joint, contributing to both lateral stability and the load transfer that occurs through the forearm during pushing, pulling and weight-bearing activities.
A radial head replacement involves removing the damaged or fractured radial head and replacing it with a metal prosthesis. It is most commonly performed for Mason type III and type IV radial head fractures — complex fractures where the radial head is shattered into multiple fragments that cannot be reassembled and fixed internally, or where the fracture occurs as part of a more complex elbow injury involving ligament disruption or dislocation. Less commonly it is performed for failed internal fixation or post-traumatic arthritis of the radiocapitellar joint.
Why is physiotherapy essential after this surgery?
The elbow is one of the joints most prone to stiffness after surgery and immobilisation — it has a tight capsule and is surrounded by structures that scar and contract readily in response to trauma and disuse. Without early, guided rehabilitation the risk of permanent elbow stiffness is significant, and the functional consequences of a stiff elbow are substantial — activities as basic as eating, personal hygiene, typing and carrying become difficult when elbow flexion is limited.
Physiotherapy after radial head replacement begins early — typically within the first week of surgery — and continues for several months. The rehabilitation needs to balance the requirements of protecting the prosthesis and healing soft tissues against the imperative to prevent stiffness from becoming permanent. Getting this balance right requires experience and careful communication with your surgical team.
What does rehabilitation involve?
In the first two weeks, the priority is early controlled movement to prevent stiffness while protecting the healing tissues and the prosthesis. Active-assisted range-of-motion exercises for elbow flexion, extension, pronation and supination are typically introduced within the first few days. The forearm is generally kept in a position of neutral or slight supination initially, and strengthening exercises are not yet appropriate. Swelling management with elevation and gentle compression is important during this phase.
From two to six weeks, range of motion work continues and progresses toward the full available arc. Static progressive splinting — a specialised form of bracing that holds the elbow at the end of its comfortable range to encourage tissue lengthening — may be introduced if stiffness is developing. This is a critical window for range of motion recovery and should not be neglected. Gentle isometric exercises for the biceps, triceps and forearm muscles begin toward the end of this phase.
From six to twelve weeks, active strengthening of the elbow flexors, extensors and forearm rotators progresses systematically. Functional activities are reintroduced — initially light daily tasks, progressing toward activities requiring more force and endurance as the prosthesis integrates and soft tissues mature. Grip strength and wrist stability work is included given the forearm's role in load transfer through the reconstructed elbow.
From three to six months, return to more demanding activities including lifting, sport and manual work is guided by functional strength testing and the surgeon's clearance for progressive loading. Most patients achieve a functional range of motion adequate for daily activities by three months, though full recovery of strength and the ability to return to demanding physical work or sport may take six to twelve months.
What are realistic expectations?
Most patients achieve a functional arc of elbow motion — roughly 30 to 130 degrees of flexion and reasonable pronation-supination — that allows comfortable participation in daily life. Return to light manual work is typically possible at three to four months. Return to heavy manual work or contact sport depends on the complexity of the original injury and the degree of soft tissue damage, and may take longer or not be fully achievable in cases with significant associated ligament or cartilage injury.
A common concern is whether the metal prosthesis will limit activities long-term. Modern radial head implants are durable and well-tolerated, but very high loads — particularly sustained axial loading through the forearm — are best avoided where possible to protect prosthesis longevity. Your physiotherapist will guide you on load management as you return to demanding activities.
If your radial head fracture and replacement occurred in the context of a workplace injury or motor vehicle accident, we provide WorkCover and CTP funded rehabilitation and liaise with your insurer and surgical team to coordinate your return to work.
Our physiotherapists Bethany Kippen and Emma Cameron both have post-surgical upper limb rehabilitation experience and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
The radial head is the rounded top of the radius bone at the elbow — the portion that articulates with the humerus (upper arm bone) and the ulna to allow the elbow to flex, extend, and forearm to rotate (pronate and supinate). It is a critical stabiliser of the elbow joint, contributing to both lateral stability and the load transfer that occurs through the forearm during pushing, pulling and weight-bearing activities.
A radial head replacement involves removing the damaged or fractured radial head and replacing it with a metal prosthesis. It is most commonly performed for Mason type III and type IV radial head fractures — complex fractures where the radial head is shattered into multiple fragments that cannot be reassembled and fixed internally, or where the fracture occurs as part of a more complex elbow injury involving ligament disruption or dislocation. Less commonly it is performed for failed internal fixation or post-traumatic arthritis of the radiocapitellar joint.
Why is physiotherapy essential after this surgery?
The elbow is one of the joints most prone to stiffness after surgery and immobilisation — it has a tight capsule and is surrounded by structures that scar and contract readily in response to trauma and disuse. Without early, guided rehabilitation the risk of permanent elbow stiffness is significant, and the functional consequences of a stiff elbow are substantial — activities as basic as eating, personal hygiene, typing and carrying become difficult when elbow flexion is limited.
Physiotherapy after radial head replacement begins early — typically within the first week of surgery — and continues for several months. The rehabilitation needs to balance the requirements of protecting the prosthesis and healing soft tissues against the imperative to prevent stiffness from becoming permanent. Getting this balance right requires experience and careful communication with your surgical team.
What does rehabilitation involve?
In the first two weeks, the priority is early controlled movement to prevent stiffness while protecting the healing tissues and the prosthesis. Active-assisted range-of-motion exercises for elbow flexion, extension, pronation and supination are typically introduced within the first few days. The forearm is generally kept in a position of neutral or slight supination initially, and strengthening exercises are not yet appropriate. Swelling management with elevation and gentle compression is important during this phase.
From two to six weeks, range of motion work continues and progresses toward the full available arc. Static progressive splinting — a specialised form of bracing that holds the elbow at the end of its comfortable range to encourage tissue lengthening — may be introduced if stiffness is developing. This is a critical window for range of motion recovery and should not be neglected. Gentle isometric exercises for the biceps, triceps and forearm muscles begin toward the end of this phase.
From six to twelve weeks, active strengthening of the elbow flexors, extensors and forearm rotators progresses systematically. Functional activities are reintroduced — initially light daily tasks, progressing toward activities requiring more force and endurance as the prosthesis integrates and soft tissues mature. Grip strength and wrist stability work is included given the forearm's role in load transfer through the reconstructed elbow.
From three to six months, return to more demanding activities including lifting, sport and manual work is guided by functional strength testing and the surgeon's clearance for progressive loading. Most patients achieve a functional range of motion adequate for daily activities by three months, though full recovery of strength and the ability to return to demanding physical work or sport may take six to twelve months.
What are realistic expectations?
Most patients achieve a functional arc of elbow motion — roughly 30 to 130 degrees of flexion and reasonable pronation-supination — that allows comfortable participation in daily life. Return to light manual work is typically possible at three to four months. Return to heavy manual work or contact sport depends on the complexity of the original injury and the degree of soft tissue damage, and may take longer or not be fully achievable in cases with significant associated ligament or cartilage injury.
A common concern is whether the metal prosthesis will limit activities long-term. Modern radial head implants are durable and well-tolerated, but very high loads — particularly sustained axial loading through the forearm — are best avoided where possible to protect prosthesis longevity. Your physiotherapist will guide you on load management as you return to demanding activities.
If your radial head fracture and replacement occurred in the context of a workplace injury or motor vehicle accident, we provide WorkCover and CTP funded rehabilitation and liaise with your insurer and surgical team to coordinate your return to work.
Our physiotherapists Bethany Kippen and Emma Cameron both have post-surgical upper limb rehabilitation experience and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
