Accident-Related Shoulder Ligament Injury After Fracture Surgery: What to Know

A car accident resulted in a fracture surgery that caused an accidental rupture of the shoulder ligaments?

Hello Doctor, I would like to ask you the following questions:
1.
I suffered a car accident on a mountain road, resulting in a fracture of the right humerus and an intra-articular fracture of the medial condyle.
After surgery at a private hospital in Miaoli, I received treatment at an orthopedic and rehabilitation clinic.
Recently, during the rehabilitation process, the doctor at the clinic used ultrasound to diagnose that the surgeon inadvertently cut the shoulder ligament during the operation.
This has caused difficulties in my elbow rehabilitation; whenever I bend my elbow, I experience shoulder pain.
Is there a direct relationship between these two issues?
2.
Following up on the previous question, to treat the torn shoulder ligament, I was advised by the clinic's doctor to undergo shockwave therapy and glucocorticoid injection treatment.
Given the high cost, I am skeptical about its efficacy, especially since there are differing opinions among orthopedic doctors online.
Could you please provide your insights on the feasibility of this treatment? Or would it be sufficient to manage my condition with medication and physical rehabilitation?
3.
I would like to ask about the steel pins placed in my elbow.
Could they affect the range of motion during rehabilitation? Currently, my rehabilitation seems to be stalled, as I often reach a certain degree of flexion and cannot bend further, and my elbow also cannot fully extend.
Is this related to the pins?
4.
Lastly, if I experience pain during rehabilitation exercises, should I continue or take a break? I often hear some doctors say that one should push through the pain.
Is this perspective correct? Additionally, if the pain becomes unbearable, is it advisable to take anti-inflammatory pain medications? I am concerned about potential side effects from taking too many medications.
I sincerely appreciate your time and assistance.
Thank you!

Xiao Bi, 40~49 year old female. Ask Date: 2018/03/07

Dr. Li Yongheng reply Orthopedics

Hello, in response to your earlier questions, here are the answers: 1.
There is no absolute relationship between the two; the likelihood of cutting the shoulder ligaments is low.
2.
Shockwave therapy and glucose injection treatments are beneficial for soft tissue repair, but they are not very helpful for shoulder ligament tears.
If an MRI confirms a shoulder ligament tear, surgical intervention should be considered.
3.
Rehabilitation seems to be at a standstill; often, bending is limited to a certain degree and cannot be further achieved, and the elbow cannot be fully extended.
This may be related to the presence of metal screws, but it is more likely associated with the level of active rehabilitation.
4.
It is important to continue rehabilitation exercises within the limits of pain tolerance; if the pain becomes unbearable, analgesics and anti-inflammatory medications can be taken.
Wishing you a speedy recovery.

Reply Date: 2018/03/07

More Info

In response to your questions regarding the shoulder ligament injury following your fracture surgery, it's essential to address each concern systematically.

1. Relationship Between Shoulder Ligament Injury and Elbow Rehabilitation: It is plausible that the injury to your shoulder ligaments could be affecting your elbow rehabilitation. The shoulder and elbow are interconnected through a complex network of muscles, tendons, and ligaments. If the shoulder's rotator cuff or other ligaments are compromised, it can lead to altered mechanics and compensatory movements that may cause pain or limit the range of motion in the elbow. However, it's important to note that while there may be a correlation, it does not imply a direct causation. A thorough evaluation by an orthopedic specialist, possibly including imaging studies like an MRI, would be beneficial to ascertain the extent of the shoulder injury and its impact on your elbow.

2. Effectiveness of Shockwave and Glucose Injection Treatments: Shockwave therapy and glucose injection (often referred to as prolotherapy) are treatments aimed at promoting healing in soft tissue injuries. While some studies suggest that these treatments can be beneficial for certain conditions, the evidence is mixed, and their effectiveness can vary from person to person. If you are skeptical about these treatments, it may be worthwhile to seek a second opinion from another orthopedic specialist. Often, a combination of physical therapy, medication for pain management, and possibly corticosteroid injections can be effective in managing pain and promoting recovery without the need for more invasive treatments.

3. Impact of Elbow Hardware on Rehabilitation: The presence of hardware, such as screws or plates, in the elbow can indeed affect your rehabilitation process. If the hardware is causing discomfort or restricting movement, it may be necessary to evaluate whether it is positioned correctly or if it is contributing to your limited range of motion. In some cases, if the hardware is causing significant issues, surgical removal may be considered after sufficient healing has occurred. However, this decision should be made in consultation with your orthopedic surgeon.

4. Managing Pain During Rehabilitation: It is common to experience pain during rehabilitation, especially after an injury or surgery. The general guideline is to work through mild to moderate pain, as some discomfort can be a normal part of the healing process. However, if the pain is severe or prevents you from performing exercises, it is crucial to listen to your body. Taking breaks and allowing for rest is essential. Over-the-counter pain relievers, such as NSAIDs (non-steroidal anti-inflammatory drugs), can be used to manage pain, but it is important to use them judiciously to avoid potential side effects, especially if taken over a prolonged period. Always consult with your healthcare provider before starting any medication regimen.

In conclusion, your situation requires careful monitoring and possibly a multidisciplinary approach involving orthopedic specialists, physical therapists, and pain management experts. Regular follow-ups and open communication with your healthcare team will be vital in ensuring a successful recovery. Remember, healing takes time, and it's essential to be patient with your body as it recovers from these injuries.

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