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external fixation - humerus - therapy
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external fixation - humerus - therapy - January 26, 2004 7:20:00 AM
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cayotte
Posts: 2
Joined: January 25, 2004
From: Michigan
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I underwent and open reduction of my right humerus requiring external fixation during the first week of Sept 2003. I began Therapy 3x/week Dec 1, 2003. I'm hoping to get some feedback from others with similar experience. Therapy has been proving small improvement in my ability to bend my elbow (currently at 114 deg on my own, 120 deg by force) would like to get to 190 deg again and perform simple tasks like brusing teeth, washing hair, etc.... I have the option of going under again for help with breaking the adhesions in the elbow capsule, but would rather continue possible new techniques in therapy?? Would welcome any comments. Thank you.
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cayotte
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Re: external fixation - humerus - therapy - January 27, 2004 3:34:00 AM
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Shill
Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
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Cayotte,
Can you straighten your elbow all of the way?
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Re: external fixation - humerus - therapy - January 27, 2004 7:32:00 AM
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Shill
Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
Status: offline
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Cayotte,
Sorry for the short post previously, I hit the wrong key.
Anyway, rather than give treatment suggestions without having seen your elbow, as that would be inappropriate, I would encourage you to have a heart-to-heart discussion with your current therapist. Let him or her know of your concerns and goals, if you havent already.
If your fracture was near your elbow joint, you may not regain full motion. Hopefully you have been told that along the way. Nevertheless, you may still have more to gain. Our bodies are very adaptive, provided we stress them in the appropriate ways, at the appropriate times, given the healing status of your tissues. Truth is, we cant predict exactly just how much a given person can recover. If your elbow is to gain more range, it could simply need more (appropriately applied) stress into the direction that is restricted. It could need skilled joint mobilization. Your specific needs can not be determined in a forum, they must be determined after careful evaluation by your therapist.
Good Luck,
Steve
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Re: external fixation - humerus - therapy - January 27, 2004 11:44:00 PM
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cayotte
Posts: 2
Joined: January 25, 2004
From: Michigan
Status: offline
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Thank you Steve for your reply. My Therapist has been an excellent source of advise, support, and continued therapy techniques. It's my patience and concern for whether my improvements are progressing based on those of other examples. Unfortunately, there are few to none examples of a similar injury like mine. I sustained 9 fractures in my humerus (located below the shoulder and clear down to near the elbow). The open reduction w/ external fixation provided the stability for the humerus to heal w/ new bone growth. My humerus is extremely strong now, but I am still unable to bend the elbow beyond that of a normal hand shake (unable to touch shoulder while bending), but there is the bounciness in the elbow making us hopeful for continued improvements. We've experienced several adhesion breaks in the elbow with Therapy and have begun to move into more agressive. My surgeon is really pushing me to undergo the surgery to break all the adhesions quickly and continue therapy immediately after. I'm extremely hesitant to undergo this surgery, but unable to get any feedback from anyone who has and what the results proved. Unfortunately I do know my final results are unknown as goes with many injuries, but I'll continue to pursue knowledge and undergo continued therapy until I'm satisfied or come to except the result (whichever comes first after I'm positive therapy will no longer produce improvements). Thanks again, your comments are welcome anytime.
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Re: external fixation - humerus - therapy - January 28, 2004 3:45:00 AM
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Shill
Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
Status: offline
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Cayotte,
One more idea. See if your therapist and the surgeon can get together on this, perhaps, (if you decide to go forward with the manipulation), with the therapist either assisting in the operating room, with the manipulation under anesthesia, or, at minimum, observing. There have been many studies done on manipulation under anesthesia, though I have not come across any at the elbow. Most I have seen are shoulder and knee. Nevertheless, it may be something to consider, or at least research at your local medical library, so you can make a more informed decision. When manipulations are done, there is risk, as you hopefully know, of injury, but this risk is lessened if the manipulation invlovles use of shorter lever arms. Physical Therapists have done a nice job researching manipulation of the shoulder when patients have "frozen shoulder", specifically after whats known as an "interscalene nerve block" is applied, which basically shuts off your arm for a while, so you cant move it or feel it. This makes it much easier for your therapist to move the arm beyond where it wants to go, as the pain that normally limits the range is not present. This nerve block is not without risk either, as it involves injection into a nerve, which needs to be done by a skilled anesthesiologist.
This study can be found in a journal called
The Journal of Orthopaedic and Sports Physical Therapy (JOSPT - 1996; Volume 24, pp 66-77).
Good Luck again,
Steve
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