I underwent a surgery in mid May which involved an ulna shortening and subsequent 'clean up' in the wrist. The end of the ulna was smoothed and a hole in the ligament was repaired. The break where the 3mm section of bone was removed is roughly half way between wrist an elbow. I have a titanium plate containing seven screws holding the break. My scar runs from my hand (across the end of the ulna) down the length of my arm in sort of an odd 'S' shape to about 4 or 5 inches from my elbow.
So far my PT has been great. I am regaining motion by 5 and 10 degrees each week. My problem, however, lies with my scar. I have been instructed by my therapist to manually break up the scar tissue through deep massage and movement of the scar. It hurts, but I do it anyway, several times every day, with and without lotion. I don't seem to be making any progress.
Joined: March 12, 2004
Gaining ROM via scar management is only half the battle, but it sure does aid in preventing tissue adhesions and thus decreased range of motion. It sounds to me like the scar was purposely created in a 'S' or 'Z' fashion so as to allow better range of motion post surgery. They do this often with burn patients and it's called a z-plasty.
Your therapist is correct in telling you to massage the scar as often as you can. You should be able to 'pick up' your skin with your fingertips because this is evidence that your skin is healthy and not pathological. One thing that I recommend to my patients is to flex and extend their wrist/elbow while massaging the scar. This is essentially movement with mobilization and it can pertain to scar tissue as well as a 'stuck' bone/joint. If lotion helps, continue using it, but make sure you don't cake it on heavily. You don't want too much slip 'n' slide when you're massaging scar tissue becuase it may not allow enough friction to penetrate the tissue.
Thanks, Chris. I have been conscious of trying to lift the scar. I alternate the deep massage with sort of pinching the skin. The trouble I encounter, however, is that my left wrist aches after the massage of the right arm's scar. I had the surgery because of a condition called Madelung's Deformity. I have it in both arms but have only, until recently, experienced pain in the right arm. All the overuse of the left arm due to the imobility of the right post surgery is terribly aggrivating to the left!! If it's not one thing....
Nonetheless, I'm trying to deal with the scar for short intervals often. Thanks for the information, particularly regarding the shape of the incision.
Can you explain how the use of ultra sound facilitates recovery? Others in conversation have suggested that I pursue ultra sound to break up the tissue. Any thoughts?
Joined: March 12, 2004
Madelung's Deformity is a very tough thing to deal with. How long have you had it if you don't mind my asking? If you have the time to email me (firstname.lastname@example.org) I'd be interested to hear how you've dealt with it thus far as well as the routes you've taken to deal with it medically and therapeutically.
Ultrasound (US) is basically a sound wave that selectively raises the temperature of the target tissue (i.e. your scar for instance) and provides a therapeutic effect. Humans can typically hear sound waves up to 15,000-20,000Hz, but US goes beyond this. There are two main types of US...thermal and non-thermal. The prior is usually used to elongate tissues and the latter is used to aide in the healing process.
By increasing the temperature of the targeted tissues, many things begin to take place at the cellular level. Basically, it helps by somewhat creating an inflammatory response and this triggers all kinds of mechanisms that promote tissue healing.
Please understand that this description is simply the tip of the iceberg! I love the effects of US and I use it on quite a few of my patients. Anyways, hope this helps!