Elbow Dislocation Recovery: Key Questions and Tips

Regarding elbow dislocation within one week?

Hello, I dislocated my elbow on April 1st.
After reduction at the hospital, I currently have a cast fixed at 90 degrees in front of my chest.
During my follow-up visit, I saw the X-ray of the dislocation, which looked similar to the first image on this website (https://www.mobile01.com/topicdetail.php?f=293&t=3694122).
The doctor mentioned that I need to keep it immobilized for 8 weeks.
I have one more week until my next appointment, so I would like to ask:
1.
Based on the degree of dislocation seen in the X-ray, is there a possibility that the ligaments are torn? How long after the injury does the doctor typically check for nerve or ligament damage? If the doctor doesn't mention anything during the follow-up, does that mean everything is fine?
2.
I am very concerned about the doctor saying that the joint may become stiff after three weeks of immobilization.
Can I start rehabilitation now? I experience pain near the elbow and arm when moving my fingers (lightly clenching my fist causes pain, but it's bearable), and I cannot lift my arm on my own without pain (lifting it just 1-2 centimeters makes the joint and muscles feel unable to continue).
Should I still try to move it even if it hurts a lot, move it slightly when there's mild pain, or is it better to avoid any pain at all? Do you have any recommended exercises?
3.
I currently have a half L-shaped cast from my upper arm to my wrist, fixed at 90 degrees in front of my chest.
It seems to have become tight, so can I rewrap it with a bandage? Is it okay to remove the bandage to clean my hand and allow it to breathe? When my hand is not in pain, I sometimes rest it on my leg or table, but when it's not supported, my elbow feels slightly sore.
Is that a bad sign?
4.
I found that passive stretching during rehabilitation can lead to heterotopic ossification.
Is that true? Is it acceptable to use external force to help move the injured arm? Does passive stretching refer to situations where there is pain, or does it also include situations where there is no pain?
5.
When sleeping, should I keep my hand fixed against my body or on my stomach/chest, or is it okay to place my hand above my head or extend my arm to the side (for example, extending my left hand to the left)?
6.
Initially, I was using ice packs, but during my follow-up visit, I was told I could switch to heat therapy.
However, I feel that the bandage has become tight and there may be some swelling.
Is it still okay to use heat therapy?
Thank you!

Kuai kuai hao, 20~29 year old female. Ask Date: 2019/04/05

Dr. Shi Guozheng reply Orthopedics

1.
An elbow dislocation typically involves ligament damage, which should be assessed for any associated fractures.
Most ligaments are merely sprained rather than torn.
To determine if there is nerve damage, check if the fingers can move and if the wrist can extend.
2.
Movement of the shoulder, wrist, and fingers is essential.
3.
It is advisable not to remove the gauze temporarily.
4.
After the cast is removed, you can begin rehabilitation exercises on your own.
5.
Position yourself in a way that feels comfortable.
6.
Ice therapy should be applied during the first two days post-injury; after that, if there is no swelling, heat therapy can be used.

Reply Date: 2019/04/05

More Info

Hello! It sounds like you’ve been through quite a lot with your elbow dislocation, and it’s great that you’re seeking information to aid your recovery. Let’s address your questions one by one, providing insights based on medical knowledge and best practices for rehabilitation after an elbow dislocation.

1. Ligament Injury Assessment: The degree of dislocation seen on X-ray can sometimes indicate whether ligaments are torn, but it’s not definitive. Typically, if there’s significant displacement, there’s a higher chance that ligaments, particularly the collateral ligaments, may be injured. Doctors usually assess for nerve and ligament injuries during follow-up visits, often around 1-2 weeks post-injury, or sooner if symptoms suggest a problem. If your doctor didn’t mention any issues during your last visit, it’s likely that they did not find any significant injuries, but it’s always good to ask for clarification.

2. Starting Rehabilitation: It’s common for doctors to express concern about stiffness after immobilization. While you should not push through severe pain, gentle movements within your pain tolerance can be beneficial. Start with finger movements and wrist flexion/extension, as these can help maintain mobility without stressing the elbow joint. If you experience pain, it’s important to listen to your body and not force movements. Consult your healthcare provider or a physical therapist for specific exercises tailored to your condition.

3. Adjusting the Cast: If your cast feels too tight, it’s essential to address this with your healthcare provider. A tight cast can impede circulation and cause further complications. You can gently rewrap the bandage for comfort, but be cautious not to compromise the immobilization. It’s generally okay to remove the outer layer for hygiene, but ensure the cast remains intact and supportive. Resting your arm on a table or your lap is fine, but if you experience increased pain, it may indicate that you need to adjust your position or seek medical advice.

4. Concerns About Heterotopic Ossification: It’s true that aggressive passive stretching can lead to complications like heterotopic ossification, where bone forms in soft tissue. Gentle, active movements are encouraged, but avoid any forceful passive stretching that causes pain. If you’re unsure, consult with your physical therapist about safe movement strategies.

5. Sleeping Position: Keeping your arm in a fixed position during sleep is generally recommended to prevent further injury. It’s best to keep your arm close to your body or in a comfortable position that doesn’t strain the joint. Avoid positions that may put undue stress on the elbow, such as raising it above your head or extending it outwards.

6. Ice vs. Heat Therapy: Initially, ice is recommended to reduce swelling and pain. If your doctor has advised switching to heat, ensure that there’s no significant swelling or tightness in the cast. Heat can help with stiffness, but if you notice increased swelling, it’s best to revert to ice until the swelling subsides.

In summary, your recovery will involve careful management of pain, gradual reintroduction of movement, and close communication with your healthcare providers. Always prioritize safety and comfort, and don’t hesitate to reach out to your doctor or physical therapist with any concerns. Wishing you a smooth recovery!

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