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Olecranon Fracture Posts

Elbow Fracture Physiotherapy – Day 1

The previous day I had freed from the plaster which had protected my olecranon fracture. Today was the first trip to the physiotherapist. The start of my elbow fracture physiotherapy/rehabilitation and hopefully the road to regaining full use of my own arm

2 weeks and 4 days ago I fell from my bike fracturing my elbow, a potentially debilitating olecranon fracture. I was very lucky to be put back together by a great team, and an immediate followup through from taking off the plaster to beginning elbow fracture physiotherapy the next day.

Shocking change to the arm

Getting home after having the plaster removed, my arm didn’t feel right. It certainly didn’t exactly look great either!

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Muscle mass loss – 20% overall bulk reduction compared to left arm

On the outside of the above picture you can see the moderate loss of triceps muscle bulk. I’m not exactly built for strength, more speed, so any reduction is muscle is quite noticeable on my frame.

In addition to some loss at triceps, there was also quite a deterioration of the RIGHT pectoral muscle too. Thankfully, again with the PowerBall, and also the Grip exerciser, the forearm muscles remained in good condition.

As for the Physiotherapy proper. That was a bit of a surprise, as was coming back into a hospital I had worked for a couple of years at, but this time “on the other side of the fence.” Its one thing to be in your own department, but quite something else to see how other departments, you’ve no concept of, run. Plus crucially how that department runs for the patients.

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Off to physiotherapy at a patient!

Meet the physiotherapist

After having a seat in the waiting room, my physiotherapist came out to meet me. He insisted I shake hands with him – which one day out of plaster, was a relatively daunting task. He quickly explained though its use as a progress report marker.

Of the many issues I had with my right arm, was the almost complete and utter lack of speed. I could move it in a manner, but it was a very deliberate action. I had no reflex reaction ability. To shaking hands apparently told him about my ability to spontaneously extend my arm, my grip strength, and my overall confidence with the arm.

Personal details

After the brief introduction, we both sat down to find out about my fitness and flexibility before the accident its no use trying to straighten someones arm completely after an operation if that’s never been possible before.

Initially I said I was fit as a fiddle, but after a few more questions, it became apparent that even before the operation, I’d had a slightly increased carrying angle  on the right side.

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What is a carrying angle?

As you can see from the picture above, your arm will have a slightly carrying angle ANYWAY. But for some reason, my RIGHT arm, had previously had a larger carrying angle than is normal. Crucially this is just a variation of normal and isn’t really a problem.

During a lecture today, one of my students, was found to have moderately increased carrying angles on both arms. Not that it mattered, but gave me someone to compare with the other students.

Currently I just look a little lob-sided – You’ll have to excuse the poor photos here, my photographer was absent!

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Normal carrying angle

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Increased carrying angle

As part of the initial workup, and getting to know me in order to personalise the therapy for elbow fracture physiotherapy I had my remaining muscle bulk assessed. Comparing the RIGHT arm to the LEFT I’d lost an estimated 20% muscle bulk from both triceps and biceps. I really didnt like the sound of that, but was told it will return in time. That is one of the acknowledged problems with an olecranon fracture, you can remain at a 10% loss of muscle power in the affected arm even if physio is followed fully. I have every intention for hitting every piece of advise for my elbow fracture physiotherapy

Does it blend Bend? Elbow Fracture Physiotherapy – Day 1

After getting to know me, we moved on to the getting to know my arm. Specifically how far I could move it. The process was very simple

“Ok try and touch your shoulder”

“Ha” – flexes elbow and moves hand slightly towards shoulder

“Ok, lets try a little further” – He pushes my hand towards my shoulder

“OWWWW!”

At school you do an exercise to see how many times you can fold a piece of A4 paper. Everyone gets to the same point, after 8ish folds, the A4 can’t be folded any more, but there is always one person who tries to push that little bit harder – that person, I’m certain will always be destined to became a physiotherapist!!

We repeated the same, looking at extending the arm.

Now in all fairness, it was great seeing the arm beginning to move again, but rather uncomfortable, if not actually painful. In terms of trying to describe what t felt like, that’s hard. For want of a better phrase, it feels like the elbow has been packed with wool, and like the folded paper, you can only push it so far.

What was very interesting was to see how the arm could be manipulated and the movement increased in one session!

Homework

Short version

  • Flex arm as far as I can, and then push a little more – hold for 30secs
  • Extend my arm and hold with other arm – hold for 30secs
  • Place elbow at 90degress and turn in against pressure and hold

Longer version

  • As this is within the 3rd week post op, I have been told to attempt to flex the arm, using the muscles of that arm and not helping with my other hand – something I’d been doing a lot of the previous night. When it feels I’ve been able to move the arm as far as I can go, I then need to push gently with my other arm, forcing the arm to flex more, and than hand to move closer to the shoulder.
    • The crucial part of pushing the arm with the other hand, is to get the inflamed tissues, and the tight tricep muscles to go from mild to moderate stretch. BUT NOT SO THAT PAIN IS CAUSED! In this flexed position, I’d have to hold the arm, pressed by the other for a count of 30 secs.
  • Then I have to straighten the arm as far as I can using the other arm. This is crucial, with flexing the arm, it had to be unsupported, with extension, at this stage, I had to give the arm help. Both from a pain perspective, and to try not to interfere with the healing. Then carefully hold the arm in extension, with pressure for 30secs.
  • Finally carrying on working the rotator cuff muscles, place the arm at 90degrees, and turn the arm outwards, against pressure from the other arm. But hold for 10 secs. Repeat turning the arm inwards against pressure.

Little, and Often

Rinse and repeat 5 times EVERY HOUR

Living in the bath

The most surprising thing I was suggested was to try and perform the same actions in the bath. But rather than hold for 30secs, hold for THREE TO FOUR MINUTES, repeating FIVE TIMES! if possible have THREE TO FOUR BATHS A DAY!

Now I don’t know if you’ve ever tried that, but i) thats a LOT of time in the bath ii) thats a LOT of sweating iii) you WILL need electrolyte drinks!

Still I said I’d give it a go, as it would have a significant impact on the speed of rehabilitation, as would keeping to the suggested times and frequencies.

Overall

The start to physiotherapy was very good in actuality. The excellent explanations I was given about what to do, how to speed to healing, and how to prevent other problems really helped. As did explaining the biomechanics of my arm, about needing to using my other arm to move the bad arm etc really helped me get an idea as to what I needed to do.

Followup in 2 days time!

 

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James Gill

Author of TitaniumGeek, which started after smashing off my RIGHT elbow. Feel free to drop me a line about sports tech, medicine, or frankly anything that you want to chat about!!