Elbow Injury – Anterior Fat Pad Sign

The “anterior fat pad sign,” also known as the “sail sign,” is a radiographic finding in elbow X-rays that indicates the presence of an elbow joint effusion.

The elbow joint has small pockets of fat, called fat pads. On a X-ray, the front (anterior) fat pad is flat and close to the bone and cannot be seen. After a fall or knock, the elbow joint can become swollen with fluid or blood. This pushes the fat pad up, making it look like a little sail on the X-ray. Doctors call this the “sail sign” or anterior fat pad sign.

Does it mean there is a serious injury?

This sign is just a small shadow on the X-ray and most often there is no break in the bone nor a serious injury to your child’s joint.

If there is an injury, it is usually very minor.

These minor injuries do not need any special treatment beyond supporting the arm for 1-2 weeks.

What Happens Next?

Your child’s arm may be put in a collar and cuff or sling or in a backslab if they are really sore for about two weeks to keep it still and comfortable while it heals.

These help reduce pain and stops the arm from moving too much.

Your child will have some pain, tenderness, swelling and bruising, which will gradually settle over a few weeks. Rest, elevation and an ice pack can help with pain and swelling the first few days. Your child may need simple painkillers such as Paracetamol (Calpol) or Ibuprofen (follow the dosage instructions) for the first few days after the injury, which can be bought from your local pharmacy or supermarket.

Recovery time is usually 2-3 weeks.

Your child can go back to nursery / school as soon as they feel comfortable and happy to do so. Sporting activities, physical education and trampolining should be avoided for 4 – 6 weeks.

Your child does not need a follow-up appointment or a further x-ray and they will be discharged back to the care of your family doctor.

Can the sling be taken off sometimes?

If your child is in a sling or collar and cuff, you can take it off for washing, dressing and doing the exercises showed below.

The following simple exercises can help your child to improve their function and use of their arm. They could help prevent their elbow from becoming stiff and decrease the recovery time.

It is important that for the first 1-2 weeks the sling is worn throughout the day but can be taken off when performing the exercises.

The exercises can be performed as pain allows.

Elbow bend & straighten

Your child should gently bend and straighten the elbow of their injured arm, feeling a mild to moderate stretch.

If needed, they can use their other arm to assist.

Do not push if it causes pain.

Repeat 10 times.

Forearm rotations

Your child should rest the elbow of their injured arm by their side, bending it to a 90-degree angle. They should then slowly rotate their palm to face upward and then downward until they feel a mild to moderate stretch. If necessary, they can use their other arm for assistance.

Do not push if it causes pain.

Repeat 10 times.

When to Get Help?

If your child develops severe pain that doesn’t get better with regular painkillers, if their fingers look pale, blue or swollen, if they develop, numbness or pins and needles, and inability to move their hand or fingers, it may be that the sling is too tight. If any of these signs occur, check the sling and loosen it, rest and elevate the limb for 30 minutes. If symptoms persist even after elevating the limb for 30 minutes, take your child immediately back to the hospital Emergency department.

You should contact us (see below) if your child is struggling to mobilise out of the sling four weeks after the injury or is struggling to go back to their sports eight weeks after the injury.

Useful contact numbers

If you have any questions or concerns, please contact:

Children’s Orthopaedics Nurse Specialist Team

(Monday – Friday, 8.00 am – 5.00 pm)

Tel. 0113 392 8570

Plaster Room, Leeds General Infirmary

Monday – Friday, 8.30 am – 5.00 pm)

Tel. 0113 392 5717