To think normal activities may help her straighten elbow

[Luckymummy22]

Elbow break / dislocation - operation and 12 weeks in cast / bandage.

2 weeks post bandage remove all and 3 1/2 weeks post wire removal we still have a very very stiff elbow with limited movement.

No pain at all and can do many things, just can't move her elbow. And she is still a very very long way from being able to straigthen it (prob about 60 degrees from straight)

She is young so a dedicated exercise regime is hard. And school / work etc doesn't help.

And the Drs are being ever so cautious and I am wondering if they really need to be so.

I am thinking that returning to normal activities in a careful way may help her to regain movement in her elbow.

They have said no to swimming lessons. Although did mention hydrotherapy. We will take her to the pool when I get chance but husband at work and I can't deal with 2 young kids in pool on my own. They have said no to most other activities as well.

She's not done anything since May Half Term and is thoroughly fed up with it all.

I know arm needs to heal but I am really concerned about the movement and just don't know how wrapping her up in cotton wool is going to get these muscles working again. There is only so much you can through a ball back and forth across a room etc. And it feels too much like a chore for her and she is too young to fully understand the consequences.

Whereas dancing or maybe back to gymnastics (in a very limited capacity) would maybe get her working her arm, we aren't able to do that.

Don't know if I'm just frustrated and fed up with it all so my judgement is not great. Or if they really are just covering their arses because of the situation (slightly long story but the Drs don't come off looking good) but ultimately that's not helping my wee girl.

Sorry for the long winded ramble but had a few teary moments this week because of the lack of progress that's been made plus lack of support from NHS.

And the Drs are being ever so cautious and I am wondering if they really need to be so

I imagine the doctors with their many years of training and experience probably know a little more about it than you do.

Has she been referred to physiotherapy ?You tend to get more practical advice from them.

You would think so wouldn't you - let's just say we wouldn't be in this position if they knew their jobs!!

Is she getting physio? I broke me elbow when I was 14 (this is 27 years ago though!) It was a bad break and the tip of the elbow was broken off and they pinned it back on. I remember having to go to physio for a time and having some kind of heat lamps on it . I had exercises I had to do (which i wasn't great at doing I must confess). I've never regained full.range of movement, although it's not overly affected me. It was in my dominant arm.

It's still quite early days for your dd if wire on my removed 3.5 weeks ago. Are they giving you a reason for the caution in letting her do things?

She was to get intense physio according to Dr. So one waste of time session later and another in a week or so.........

We are going down the private route and any movement she has got back is thanks to our private physio.

I think she was off the opinion she could do more activities but wanted Drs to say elbow was stable. Will ask again this week.

no they haven't said why they are being cautious. It's a slightly more complex case as her initial treatment was not correct.
But they are not very good at communicating at all.
And it's a different Dr we see each time and they probably all know there could be some fallout if they cock it up any more

Not that we've done anything other than make contact with PALS.

I broke my elbow (pinned and in a cast for the best part of 6 months) as a child. It took over 2 years to eventually be discharged from the consultant because they took it very slowly so I didn't damage it further. I'd take your doctor's advice!

I don't want to be the prophet of doom but 30 odd years later and lots of physio, painful manipulation etc I still can't straighten my arm or rotate my lower arm properly (it was seized completely when I first came out of the cast but I've got about 90% movement now). To be honest it has never been a problem and nobody has ever noticed unless I point it out.

I think you need to try to come to terms with the fact that she may never be able to straighten her elbow again, rather than assuming the medical experts can't do their jobs properly. I had a similar injury last year, elbow fracture with dislocation, and it's a complicated injury. Yes, the bones heal, but all the soft tissue damage lasts a lot longer and you can't just resume normal activities without physio as you could end up damaging the soft tissue more.

Physios really know their stuff, and you have to start gently - remember those muscles, nerves and ligaments etc. have been idle for weeks, and muscles atrophy without use. You have to be patient and listen to the professionals. Even if you only have one appointment a week, you have to do the exercises at home in between.

They're being cautious because they can't forecast how the recovery will go as everyone is different. I was told it would take 18 months to 2 years to recovery fully, but that I'd never be able to straighten my arm again. After 6 months I'd regained more movement than they'd predicted, not straight by any means, but better than most who have this type of injury, they said. I've not improved much more since then, although I keep doing the exercises, and it's still not been 2 years yet so there is still time to improve further.

I was initially determined that I'd prove them all wrong and regain full movement, but I now accept this isn't going to happen and that there will always be things I can't do. It's far better to accept the limitiations then be pleasantly surprised if you exceed them, than to kid yourself that you just need better medical advisers and it will all be OK.

I fractured my elbow as an adult, had it rebuilt with the aid of many pins.

I remember my consultant saying that elbows had to be dealt with slowly and carefully, due to the possibility of calcification of the joint.

I have full movement and no pain now, but at the time I followed to the letter the physiotherapist's regime, doing the exercises twice daily, that is more important than how often you actually see the physiotherapist.

One thing I found very helpful was theraputic putty which I used to recover the fine control in my hand and wrist.

I'd be very wary indeed of ignoring professional advice at this stage, I think gymnastics might do more harm than good.

It's not just muscles, there are tendons & ligaments to manage, too. If you over extend one of those items (or a muscle) it may imbalance the whole joint (I imagine).

Dislocations are ligament injuries. Any you get before age 19 have a high risk of re-occurring for life (this is why you hear about people who frequently sprain their ankle -- that's a ligament problem). So I'm not surprised need to be handled carefully to reduce the future risks.

I hope that she continues well on a healing trajectory.

We asked the question many times whether she would get full use back and just got told that's what they were aiming for. Or often said she is young and healing well etc etc.

No one has ever taken the time to properly discuss things.

2 weeks ago we were told that gravity would straighten her elbow and not to use lotion / ointment or rub her skin in any way as it may cause extra bone growth!

Yesterday was the 1st time we were told by the Dr that he would be happy with 80 - 90 % movement back. One we hadn't seen before.

We had already begun to realise ourselves that full movement wasn't coming back.

I think that's where much of the frustration is coming from. They just are not talking to us so we really don't have a clue what to expect. And each time it's a different Dr who we have not seen before. Dr a couple of weeks ago even said there is no break when we asked a question (Ok technically that is true as it's probably healed now but there was a break initially at the same time as the dislocation just the dislocation was not treated until weeks later)
There's been other issues too with communication.

I think you need to be realistic and adjust your expectations. It's only a few weeks since the restrictions were removed, and she was in a cast for a very long time. Of course the elbow is going to be stiff for a while, and progress will be slow. You need to make sure that she does the recommended exercises and don't encourage her to do things that have been specifically banned for now.

It is very common to see different doctors at each visit, as there are many of them working in trauma / orthopaedics in each hospital. Generally speaking you might see the consultant once, who will make the initial treatment plan, and more junior doctors thereafter, who will only ask the consultant to see her again if things aren't going to plan. That doesn't mean the consultant isn't keeping an eye on things in the background, but they can't see everyone at every visit. The only way to see the same person every time is to go private, I'm afraid.

yes as pp said bones are funny things, growth plates, joints even funnier and the elbow is the funniest of all.
go with consultants advice. you don't want to cause permanent damage and limitations to movement by not letting it heal properly.
physio is great, nhs physio often too late and not enough sessions to make a difference imo, so if you can afford private physio that's great.

Agree I do need to alter my expectations - we have never been told what to expect and I think that hasn't helped.

Just really hoped the fact she is so young would make the difference.

We will listen to Drs within reason (no gymnastics for example or other sports)

we are lucky that we have private healthcare so physio covered at moment. Once it runs out we will pay.
We are fortunate that way and money's not important just now.

Hi OP I have broken both my elbows - at different times fortunately - I am also double jointed in both elbows so even more complicated- I only gained full movement and almost back to normality in the joints by Physio - it was very hard and painful - tears in the eyes painful - but I did the exercises every day for weeks and eventually I got there. There is no quick fix for elbows just time and doing the physio exercises every day two to three times a day for weeks. Good Luck!

My daughter had the exact injury st age 7.
She has pins in it though.
Movement will come, push for physio if you aren't happy. My dd is back to doing all sports, no pain and can straighten arm although there is a very visable bump almost like it looks out of place and a very big scar from the op. Her elbow doesn't give her jip though so pleased.
She broke her elbow on 14 February this year.
She was back at swimming lessons within three months and not a bother.
The arm will regain stregnth again.

I'm a physio. Yes, it sounds like the information you have been given is rubbish. That said, it is early days. Bear in mind that elbows should never be overly stretched, as they have a massive tendency to myositis ossificans, where bone forms in the muscles and other tissues around the joint if overstretching occurs. That said, I can see no reason why normal use should be avoided, otherwise, why have they taken off the cast and removed the wire? Actively moving the elbow (so the person doing the movement themselves) will never cause myositis ossificans.

I would usually say don't worry too much about the final outcome at this stage. If this is a child, she will be getting better for the whole of her life, as her body tries to remodel the bone to 'normal'. And a lack of full extension of the elbow is generally something most people can cope with without noticing. 60 degrees from straight is a huge amount though. That would not be an acceptable long-term outcome - but I doubt it is going to be. This is not an unusual state of play after such an injury at this stage, but the way you have been treated so far gives cause for concern, and naturally feeds into the worry that all is not as it should be.

Given how shit the treatment seems to have been so far, I think you would be justified in seeking referral to an orthopaedic specialist centre for a second opinion, on the assumption that it will take you ages to get the referral. You can always cancel if things turn around

If you are in striking distance, Royal Orthopaedic Hospital in Birmingham is excellent.

I broke my elbow when I was 7, it was a bad break and had to be reset. When I finally got the cast off I went to see a physio and got exercises to do, which eventually meant I could straighten my arm.

Doing the exercises at home was tedious and frustrating (I remember my mum shouting at me when I got bored and started reading a book instead!) but really important.

Christmas thank you so very much. I am not a million miles from Birmingham and actually that hospital was mentioned originally before we knew for certain that the surgeon was prepared to operate on her. I actually researched it and considered seeing if we could ask to get referred there but decided against it because our local hospital was easier.
But it is something that I have been thinking about recently.
You have reassured me as she's not even 6 yet so still has an awful lot of growing to do.