July 8, 2008

Elbow Update

Posted in injury at 3:24 am by berzerkeleyan

Elbow Brace

Some of you have been wondering what’s up since my last post. To give you an update, I thought I’d list out answers to some of the questions I had for my orthopedist during my visit last Thursday. Because I was so busy processing a lot of information in real time, I don’t remember everything he said. But here’s what I have:

  1. What exactly was done during surgery?
    See answers to questions 2 and 3.
  2. Were pins or screws used on the radial head? Were fragments recovered/removed?
    Because I shattered the tip of the radius during my fall, a CT scan suggested that I might need a titanium prosthetic to replace the end. It turned out that the fragments were able to be salvaged without the need for an artificial part. Instead, screws were used to reattach the bone fragments. There is one piece that was not recovered. He didn’t remove it because it was small, and because it shouldn’t interfere with recovery. In fact, the fracture is not considered serious, so it’s the least of my concerns.
  3. My ligament tears — were they full tears, or just partials?
    There are three types of elbow separations — Type I, II, or III. They differ in the severity of ligament and bone damage. When I asked the doc what my degree of separation was, he said “you had a 736 degree separation.” In other words, he had never seen so much ligament damage. I completely tore three of the four ligaments that stabilize the joint. He reattached them by putting three individual screws in the bone, and wrapping each ligament around them. It’s recovering from these tears that will be challenging, and not the radial head fracture.
  4. As noted in my first visit, extension/flexion limitations are to be expected. What about rotational limitations?
    Extension and flexion of my arm should not be affected too badly. In fact, I should get back 90% of both. But rotation of the wrist — the ability to turn my wrist up or down — is uncertain at the moment. Because of the severity of the ligament tears, the amount of time I’ll need to be immobilized will affect how much flexibilty I recover. I can live without the ability to throw a ball or swing a golf club. But I can’t go without being able to write, or type with two hands. And right now I can’t do either. Out of all the news I received, this is what worries me the most.
  5. Is the joint now more susceptible to dislocation?
    According to my doctor, this shouldn’t be a problem. Everything is screwed in there pretty tight.
  6. Will I have permanent strength loss?
    No. Ligaments attach bone to bone. Tendons attach muscle to bone. Since I didn’t suffer any tendon tears, strength should not be affected.
  7. Can I be placed in a removable cast if I promise to keep my arm in it, except for showering?
    For fractures around joints, doctors try to minimize the amount of time in a cast. The longer the joint is immobilized, the less flexibility that’s recovered. Therefore, I was in a cast for only two weeks.
    Hallelujah! Praise the gods!
    In its place, I got a removable brace last Thursday (it’s a variant to the one pictured above). At the moment, my elbow is at a 90 degree angle, and I can only flex and extend a few degrees. But the brace is designed to allow me to extend/flex incrementally, without going too far in either direction and hurting myself. However, it completely prevents me from rotating the wrist. The doc wants the ligaments to take hold before I start turning my hand. Therefore, I can’t start rotational exercises for another two weeks.

There you have it. Probably more detail than what was necessary.

I’m still in quite a bit of pain. Surprisingly, most of it comes from all the soft tissue damage in my forearm, and not from my elbow. Unfortunately, my Percocet prescription ran out last Thursday. And ibuprofen and acetaminophen aren’t very effective. But each day it’s getting slightly more tolerable. And I’m remaining optimistic. Hey, at least I’m now able to take showers.

Hallelujah! Praise the gods!