Elbow stiffness after surgery

[Dannie_]

Hello

2 months ago I underwent surgery on my right elbow because in October 2014 I damaged it horse riding and was midsdiagnosed, this left my unable to move my elbow form a right angle.

During the surgery they:
released my vdry inflamed and irritated ulnar nerve
release my tendons
released capillaries
released my biceps
and removed some hetertopic ossification - excess bone that grew from a chip

i was in a straight cast for 3 weeks, I then moved into a brace and started physio however, my elbow did not bend easily at all. They then took me back in and snapped lots of abrasions to make the arm easier to move. It is now getting easier to bend it but even with ohysio to strategic it - it hurts so much.
After the second procedure I was in a 90' cast for a week and it seems my muscles have shrunk again? When I straighten my arm there is the most horrific tearing pain from my biceps - so bad my body shuts off and won't allow me to push it any further even when I'm trying to be relaxed.

i was hoping somebody could help me? Please? Any exercises any advised to get my movement in my arm would be so appreciated! Even the bit of movement I have is not free it's forced and I need my arm to be free as I am an athlete.

Thank youuu!!

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[sietzeh]

Hi Dannie,

what happened to your elbow in order to have it for surgery? Was it broken or something? The things they did is/was not a simple release, the elbow must have some scar tissue now. Are you happy with the way it looks now or do does it makes you angry?

First I would like to know whether there are any objective changes seen on imaging, eg X-ray/MRI/Ultra sound. Second, how much movement is there in the elbow? How much mobility has the joint left. Finally, did you do general exercises fot the elbow, to flexion and extension? Does it respond differently to those movement directions?

This is a dreadfull story for a youngster who likes to sport.

[Dannie_]

Hi Sietzah,

Thank you you for taking the time to reply.
Well I fell from a horse and got kicked, I went straight A&E where the did an x Ray and told me it was bruised keep moving it and hurried me out the. Door. It wasn't until I persisted in visiting them, they sent me to physio which didn't work, they then ran some more tests and realised I had Hetertopic OSsificatiom - now when they sent me to a specialist he believes I had chipped my elbow and the chip had grown, trying to repair itself and bridged over my joint - causing the restricted movement and various other damage.

After my first surgery it had lots of scar tissue, around my elbow it was solid. Therefore, they took me back into surgery hoping they wouldn't need to fully operate, they broke all of the scar tissue and put in me in a right angle cast (may I add left in me in terrible pain and terribly bruised when the cast came off).
This cast came off a week later but has caused issues with straightening my arm, before they broke the scar tissue my arm was stuck straight as they casted it straighten for 4/5weeks.
I, not overly happy with how it looks, my surgeon keeps telling me I need to put in more effort to move it and my physio says both elbows measure the same size. However, when I hold them up for my mum to see and compare them the right one is clearly very swollen and still very bruised from where the surgeon broke the scar tissue.

I havent seen and Xrays/MRI's if they are doing them, they are doing them when I'm still asleep from the aesthetic. The joint has more than before the surgery, prior to surgery it was stuck at a right angle. Now it goes just a bit more than a right angle, but because of the pain I get when trying. To straighten it - it only extends to ... Maybe -30/40 degrees.
The pain I get is unbearable, it's like a tearing between my bicep muscle meeting the muscle in me lower arm and my brain automatically blocks me from letting my arm drop completely, even to get it a bit straighter I have to put a 0.5kg weight in my hand a force it to drop.

but none of this movement is free.. I can't wake up and stretch my arm freely, I have to do exercises to loosen it and because in the day I'm not using it to its full movement due to not being able to do much I then have to exercise it to loosen it whenever I want to use it. I havent actually been given any exercises for extension yet, I will see my ohysio for the first time after the scar tissue being broken on Thursday. But the exrercises do loosen the flexion.
I guess the elbow reacts ok to the exercises I have because it does loosen the arm, just nothing is a free movement still.
Pit bends a bit better if I start with my pal, facing the sky and bend it that way, rather than y palm facing side ways as if I'm holding a hammer.

Yeh, I'm devastated and becoming increasingly worried and anxious.

[sietzeh]

Hi Dannie,

with your hetertopic ossification the natural healing of the elbow does not follow a "normal" recovery, while the elbows is already known to recover a far bit slower than for example the knee. Remaining restrictions to extension are quite common. I agree with the surgeon that you should try, with all your effort (combined with despair and tears), to move it. So, I think that some of your pain and immobility is normal and nothing (easily put and said) to be worried about. (although it is quite normal again that you are ;-) ) To my opinion one should never exceed a pain score 5 out of 10, especially when the exercise leaves you with extra pain for longer than 15 minutes.
BUT When the extra pain, caused by the physio/exercise or normal activities, settles down within 10-15 minutes the loaded tissue of the elbow is able to cope with the activities and should be able to reinforce/gain strength. That is some sort of a ideal training respons. So you may have (extra) pain with or after exercising, but it should subsides within 15 minutes after stopping the exercise. Then it is a normal response to loading and although not a nice experience or feeling, it gives the damaged tissue the right stimulus to recover.

My only concern is that negative thoughts about the misdiagnosis and future does not help recovery. You should nevertheless address this, but put or leave/share it with somebody who is knowledgeable about such issues to tackle this. Scientific data shows that negative thoughts about misdiagnosis/law suits/blaming/anxiety has a very bad impact on recovery and rehabilitation. It lengthens rehab and has a lesser outcome. From a holistic point of view or better said, the bio-psycho-social approach one could say that a human only has f.e. 5 cans of energy a day to repair it from daily stress and damage. When 2 or 3 of these cans are used up by concerns and worries, that energy can not be put anymore in healing of our soft tissue etc. So, it can be wise to see a psychologist or a physiotherapist who is trained or familiar with Graded Motor Imagery or Explain Pain theories. see NOI | Neuro Orthopaedic Institute


I will not give advise about the sort of exercises, but to my modest opinion and experience, the subsiding respons to loading/exercise is very wise and should be followed, although it lacks scientific support (Like most of the medical knowledge/thoughts/ideas about musculoskeletal disorders).

I wish you lots of luck and strength in your way to recovery. It will be a long haul. When walking such a long way it is very wise to keep your eye to the horizon (where do you wish to go, where do you wish to be one year from today, so that you will not get lost) and look back frequently in order to see what you already have gained or achieved. Rehab is like walking in the mountains, the top seems not to get closer, but when you look back one gets scared of the elevation....and there will be set backs and little falls. But as long as you keep your ropes attached and healthy (with family and friends, good physio and maybe other support) you will reach the top. When there is a set back (bad weather), pause your trip, take shelter and wait until it subsides/eases (it will!!!) and continue your trip

Sietze