Is Your Dislocated Elbow Healing Properly? Rehabilitation Challenges

Improperly treated dislocation?

Hello, I dislocated my right elbow on March 16.
After two weeks in a cast, I had my cast removed, but my joint movement is less than 90 degrees (normal range is about 135 degrees).
After a month of traditional Chinese medicine rehabilitation, I have hit a plateau, so I am now seeking treatment at a Western medicine rehabilitation clinic (135 degrees per week).
I am undergoing water therapy, electrical stimulation, and manual therapy, but I am currently not using heat therapy.
I cannot fully extend my elbow (about 20 degrees short) and my internal flexion and upper arm movement are slightly less than 90 degrees.
The therapist says that my inability to externally extend is due to improper bone healing, so they are only focusing on internal flexion rehabilitation.
However, I have seen an orthopedic doctor, a rehabilitation specialist, and a traditional Chinese medicine doctor, all of whom said that the X-rays indicate proper healing.
What should I do? It has been three months; am I recovering too slowly? Thank you.

A-Hsing, 20~29 year old female. Ask Date: 2004/06/28

Dr. Zhang Yuzhang reply Rehabilitation

Dr.
Tseng Hui-Yu from the Rehabilitation Department of Tainan Hospital, Ministry of Health and Welfare, responds to Ah-Hsing:
Hello, in response to your question, whether a dislocation has been reduced can generally be determined through X-ray evaluation.
If the orthopedic surgeon concludes that the dislocation has been reduced, the current issue of joint contracture is primarily due to soft tissue adhesions.
This requires active and ongoing rehabilitation, including thermal therapy or hydrotherapy, combined with manual physical therapy, to gradually increase the range of motion of the joint.
The extent and speed of progress will depend on the severity of the condition and the intensity of the rehabilitation efforts.

Wishing you good health and all the best!
Dr.
Tseng Hui-Yu
Rehabilitation Department
Tainan Hospital, Ministry of Health and Welfare

Reply Date: 2004/06/28

More Info

When it comes to the rehabilitation process following a dislocated elbow, it is essential to understand the complexities involved in healing and regaining full function. Dislocating an elbow can lead to various challenges, including stiffness, pain, and limited range of motion, all of which can significantly impact daily activities and overall quality of life.

From your description, it appears that you are experiencing a common issue known as "joint stiffness" following your elbow dislocation. After an injury like this, it is not unusual for patients to struggle with regaining full range of motion, especially if the joint was immobilized for an extended period. The fact that you are currently unable to extend your elbow fully and are experiencing limitations in both flexion and extension is not uncommon.

Understanding the Healing Process
1. Initial Healing Phase: After a dislocation, the primary goal is to allow the joint to heal properly. This often involves immobilization through the use of a cast or splint. While immobilization is necessary to prevent further injury, it can also lead to stiffness due to the lack of movement.

2. Rehabilitation Phase: Once the initial healing has occurred, rehabilitation becomes crucial. This phase typically includes physical therapy, which focuses on restoring range of motion, strength, and function. It is important to follow a structured rehabilitation program tailored to your specific needs.

Challenges in Rehabilitation
1. Stiffness and Range of Motion: As you noted, achieving full extension (135 degrees) is a common goal, but many patients find themselves plateauing at certain points in their recovery. This can be due to various factors, including scar tissue formation, muscle tightness, or even psychological barriers related to pain and movement.

2. Therapist's Assessment: It is concerning that you have received conflicting opinions regarding the healing of your elbow. While X-rays may show that the bones are aligned and healing properly, the soft tissue surrounding the joint (ligaments, tendons, and muscles) may still be contributing to your limited range of motion. It is essential to communicate openly with your physical therapist about your concerns and progress.

3. Therapeutic Techniques: Different therapeutic modalities can be beneficial. You mentioned undergoing water therapy, electrical stimulation, and manual therapy. These methods can help alleviate pain and improve mobility. However, if you feel that your progress has stalled, it may be worth discussing alternative approaches with your therapist, such as more aggressive stretching techniques or even considering a referral to a specialist in hand and upper extremity rehabilitation.

When to Seek Further Evaluation
If you continue to experience significant limitations in your elbow's range of motion after three months of rehabilitation, it may be prudent to seek further evaluation. This could involve:
- Advanced Imaging: Sometimes, an MRI may be necessary to assess soft tissue structures that X-rays cannot visualize. This can help identify any underlying issues that may be contributing to your symptoms.

- Consultation with an Orthopedic Specialist: If your current rehabilitation efforts are not yielding results, a second opinion from an orthopedic surgeon specializing in elbow injuries may provide additional insights or treatment options.

Conclusion
In summary, the rehabilitation process following a dislocated elbow can be challenging, and it is not uncommon for patients to experience plateaus in their recovery. It is crucial to maintain open communication with your healthcare providers, adhere to your rehabilitation program, and advocate for your needs. If progress remains stagnant, do not hesitate to seek further evaluation to ensure that you are on the right path to recovery. Remember, every patient's healing journey is unique, and patience is key as you work towards regaining full function of your elbow.

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