Challenges in Elbow Rehabilitation After Humerus Surgery: A Patient's Guide

Rehabilitation Issues for Elbow Joint After Humerus Surgery

Hello Doctor: I had surgery on August 31 to implant a steel pin for a fracture above my right elbow.
I started rehabilitation six weeks later (on October 12) and have been doing it since.
Currently, my arm can only bend from about 30 to 95 degrees (assuming normal range is straight at 0 degrees and bending to 135 degrees).
During rehabilitation, I endure significant pain while trying to bend it, but it feels like there has been no progress in terms of range of motion.
Each day, I manage to gain about 5-10 degrees, but within half an hour, it returns to its original position.
I'm unsure how to maintain the angle I achieve each day and how long it typically takes to recover to normal range of motion.
I would like to know how many times a day I should perform stretching exercises and how long each session should last for the best results.
Is it too early to consider joint mobilization surgery? Thank you, Doctor.

A-Zhi, 30~39 year old female. Ask Date: 2018/10/30

Dr. Wang Zhaomin reply Rehabilitation

Currently, you have been undergoing rehabilitation therapy for less than three weeks.
Based on the described condition, this should be considered normal progress, and there is no need to be overly anxious.
Generally, rehabilitation after a fracture takes about three to six months.
Manual joint mobilization can be initiated once rehabilitation begins, but each individual's condition varies, so it cannot be generalized.
The rehabilitation plan and progress should be discussed directly with your rehabilitation physician and therapist.

Reply Date: 2018/10/30

More Info

Rehabilitation after elbow surgery, particularly following a humeral fracture, can indeed be challenging and requires a structured approach to ensure optimal recovery. Based on your description, it seems you are experiencing significant limitations in your elbow range of motion, which is not uncommon after such surgeries. Here’s a comprehensive guide to help you navigate the rehabilitation process.

Understanding Elbow Rehabilitation
1. Initial Recovery Phase: After surgery, the primary goal is to allow the bone to heal while preventing stiffness. This phase typically lasts for the first 6 weeks post-surgery. During this time, gentle range-of-motion exercises may be introduced, but the focus should be on protecting the surgical site.

2. Active Rehabilitation Phase: Once you have progressed past the initial healing phase, which seems to be the case for you since you are now 6 weeks post-surgery, the focus shifts to regaining range of motion and strength. This is where you are currently at, and it can be frustrating if progress feels slow.

Challenges You May Face
- Pain and Discomfort: It’s common to experience pain during rehabilitation, especially when pushing the limits of your range of motion. However, it’s crucial to differentiate between discomfort from stretching and pain that indicates potential injury.

- Scar Tissue Formation: After surgery, scar tissue can form around the joint, which may limit movement. This is why consistent stretching and rehabilitation exercises are essential.

- Muscle Weakness: Post-surgery, the muscles around the elbow may weaken due to disuse. Strengthening these muscles is vital for overall function.

Effective Rehabilitation Strategies
1. Range of Motion Exercises: Aim to perform your stretching exercises multiple times a day. Ideally, you should be doing them at least 3-4 times daily. Each session can last around 15-30 minutes, focusing on both flexion and extension.
2. Progressive Stretching: Start with gentle stretches and gradually increase the intensity as tolerated. If you are experiencing significant pain, it may be beneficial to back off slightly and allow your body to adjust.

3. Use of Heat and Cold Therapy: Applying heat before exercises can help relax the muscles and make stretching easier. Cold therapy afterward can help reduce inflammation and pain.

4. Strengthening Exercises: Once you have regained some range of motion, incorporate strengthening exercises. Resistance bands can be particularly effective for this purpose.

5. Consultation with a Physical Therapist: If you haven’t already, consider working with a physical therapist who specializes in post-surgical rehabilitation. They can provide tailored exercises and techniques to improve your range of motion and strength safely.

When to Consider Surgical Options
If you find that despite diligent rehabilitation, your range of motion is not improving, and you are still experiencing significant limitations, it may be worth discussing the possibility of a joint manipulation under anesthesia or arthroscopic surgery with your orthopedic surgeon. These procedures can help break up scar tissue and improve range of motion, but they are typically considered after conservative measures have been exhausted.

Conclusion
Recovery from elbow surgery is a gradual process, and it’s essential to remain patient and consistent with your rehabilitation efforts. Keep track of your progress, and don’t hesitate to communicate with your healthcare provider about any concerns or lack of progress. With dedication and the right approach, you can work towards regaining full function of your elbow. Remember, every patient’s recovery timeline is different, and it’s crucial to listen to your body throughout this journey.

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