I thought I’d get a moments peace! Before I’d even been discharged home, I had my first chat with the physiotherapist on the ward to talk to me about what I needed to do in order to help myself get back to health. That is the crucial thing about a fractured elbow – what YOU need to do after the operation. So let’s have a look what I was told to do!
Early Olecranon Fracture Rehabilitation
So prior to being discharged home, 18hrs after the operation, I got a shock visitor – the physiotherapist came by to beat me up!
I was relatively surprised by the REALLY early start, I understand that early mobilisation of the fracture is vital to getting full mobility back, but I did it think it would be starting within the first 24hrs!! What I didn’t appreciate about the physio was at this stage, it is directed at everywhere other than the elbow, trying to keep the hand, wrist and shoulder mobile to help prevent any stiffness occurring there whilst my elbow is immobilised.
Stiffness is one of the biggest, real, problems for a joint after it has been placed in plaster post op. I say real as there is a myriad of problems, some very significant, some can affect a fracture or a joint, but anything after two weeks or more will result in stiffening of that joint.
Stiffening results from the tendons, ligaments and muscles contracting, slightly, due lack of use, in turn preventing the joint moving as far, and as easily, as before. Physiotherapy is used to stretch out these tissues, to overcome the temporary contraction and prevent long-term stiffness of the joint.
This is why the stretches the physio gives are VERY important. However what isn’t made entirely clear is how hard work and how uncomfortable/painful those stretches are!!
The stretches I was instructed upon were:
- Internal rotation of the shoulder.
- External rotation of the shoulder
- Tricep stretches
- Wrist Extension & Flexion
For best effect, these should be done as often as possible, but as a guide, once an hour would be best, and also gives some idea of the intensity of the physio yet to come!
So what do these stretches look like: – where possible I’ve found videos from across the web
Internal rotation of the shoulder:
So arm hanging down, elbow held at 90 degrees (which was kind of forced on me due to the plaster) and turning the shoulder, so the hand moves in, across the chest
External rotation of the shoulder
The same movement, but in the opposite direction to the extreme of movement
These two movements crucially work the rotator cuff muscles of the shoulder. Maintaining activity of the rotator cuff is very important, as when you have an elbow injury and immobilisation,whilst it is possible to compensate for some of the loss of movement using the deltoid muscles, this can also mean that the movement of the should is “taken over” or dominated by the deltoid muscles group.
Loss of strength in the rotator cuffs can later lead to functional problems of the shoulder, such as shoulder impingement.
Wrist Extension and flexion
This can be performed both with the fingers straight and also in a fist.
Finally – and most painfully
The other exercises honestly were ok, but this is the one that caused me the most pain – for two reasons
1) My tricep muscle is inserting into the broken piece of bone which is now at the centre of the operation site, therefore stretching this muscle, is rather uncomfortable
2) I was rather bruised from the operation, and the way the first plaster cast was put on was rather digging in my arm. I was certainly looking forward to the two-week review so that I could have it removed!