Elbow Rehabilitation: Bruising, Pain, and Joint Stiffness

Elbow rehabilitation with bruising, swelling, and unusual sounds?

Due to a car accident, I sustained a fracture of the ulnar and radial bones near my left wrist.
My elbow joint has become stiff from lack of movement, and I can only bend it to 90 degrees.
After two months of rehabilitation at the hospital, I still can only achieve 90 degrees actively, although with the therapist's assistance, I was able to reach a greater angle previously.
However, this maximum angle was achieved under significant pressure, which later led to bruising and swelling around the elbow.
After a few days without pressure, the swelling gradually subsided, so I decided to ignore it for the time being, as I still needed to apply pressure.

Each time pressure is applied, my elbow remains very stiff (possibly due to the bruising), and I do not feel it becoming looser with bending.
Sometimes the therapist still pushes it to the limit, which feels like my muscles are tight and being pulled, causing significant pain.
During a session today, while applying strong pressure, I suddenly heard a popping sound, similar to a bone breaking or something loosening or snapping.
At that moment, I feared that my joint might become loose (which, as it turns out, did not happen).
Both the therapist and I were startled, but after checking, it seems the bones are fine; we are unsure why this occurred, as it had never happened before, and it was quite painful.
However, after returning home, the pain subsided after a while, but moving or pressing around the elbow still causes pain, which is slightly worse than the previous bruising and swelling.
Bending it even a little is very painful.
I am uncertain if there is damage to the soft tissue, tendons, or ligaments.
I also wonder if I should continue with rehabilitation, fearing it might worsen.
Yet, I know that avoiding rehabilitation due to pain will only lead to further stiffness.
I feel like I am stuck in a cycle: stiffness - strong pressure - bruising and swelling - resting for a few days - then stiffness again...

Kaidens, 20~29 year old female. Ask Date: 2017/06/15

Dr. Shi Guozheng reply Orthopedics

You can take a week off to rest before continuing rehabilitation.

Reply Date: 2017/06/15

More Info

It sounds like you are experiencing a challenging recovery process following your car accident and subsequent elbow injury. The symptoms you describe—persistent pain, stiffness, and bruising—are common in cases of joint injuries, especially after a fracture. Let's break down your situation and explore some important aspects of elbow rehabilitation.

Understanding Your Condition
1. Joint Stiffness: After an injury, especially one involving a fracture, it is common for the surrounding muscles and soft tissues to become stiff due to disuse. This stiffness can limit your range of motion, making it difficult to fully extend or flex your elbow. The fact that you can only bend your elbow to 90 degrees indicates significant stiffness, which may be exacerbated by the lack of movement during your recovery.

2. Bruising and Swelling: Bruising and swelling around the elbow can occur due to trauma and the manipulation of the joint during rehabilitation. When the therapist applies pressure to increase your range of motion, it can lead to microtrauma in the soft tissues, resulting in bruising. While some swelling is normal, excessive swelling can indicate that the joint is not tolerating the stress being applied.

3. Pain During Rehabilitation: Pain during physical therapy is not uncommon, especially when pushing the limits of your range of motion. However, it is crucial to differentiate between discomfort that is part of the healing process and pain that signals potential injury. The "popping" sound you heard during therapy could have been a normal release of gas from the joint or a sign of soft tissue movement, but it is essential to communicate this with your therapist to ensure that no further damage has occurred.

Recommendations for Rehabilitation
1. Communication with Your Therapist: It is vital to maintain open communication with your physical therapist. Inform them about the pain levels, the popping sound, and any changes in your symptoms. They may need to adjust your rehabilitation plan based on your feedback to avoid exacerbating your condition.

2. Gradual Progression: Rehabilitation should be a gradual process. If you are experiencing significant pain during certain exercises, it may be beneficial to modify those exercises or reduce the intensity. Your therapist can help you find a balance between challenging your joint and avoiding excessive strain.

3. Incorporating Rest: While it is important to keep moving to prevent stiffness, allowing time for recovery is equally crucial. If you notice increased pain or swelling after a session, consider taking a break or reducing the frequency of intense sessions until your symptoms improve.

4. Focus on Range of Motion: Gentle stretching and range-of-motion exercises should be prioritized. These can help maintain flexibility without putting too much strain on the joint. Your therapist can guide you through specific exercises that target the elbow without causing excessive discomfort.

5. Strengthening Exercises: Once you regain some range of motion, your therapist will likely introduce strengthening exercises to support the muscles around the elbow. This will help stabilize the joint and prevent future injuries.

6. Pain Management: Discuss pain management strategies with your healthcare provider. This may include over-the-counter pain relievers, ice therapy, or other modalities that can help reduce inflammation and pain.

Conclusion
Your recovery journey may feel frustrating, especially with the cyclical nature of stiffness and pain. However, with consistent communication with your healthcare team and a tailored rehabilitation plan, you can work towards regaining full function of your elbow. Remember, recovery takes time, and it is essential to listen to your body throughout the process. If you have concerns about your progress or experience new symptoms, do not hesitate to reach out to your healthcare provider for further evaluation.

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