Choosing the Right Rehabilitation Approach After a Complex Arm Fracture

Rehabilitation content in the field of physical medicine and rehabilitation..?

Hello Dr.
Lee, three months ago I underwent surgery for an open comminuted fracture of the distal humerus in my left arm.
Currently, the range of motion in my elbow joint is approximately 60 degrees of extension and 90 degrees of flexion upon waking up.
After performing self-rehabilitation exercises at home, I can extend to about 20 degrees and flex to a point where my fingers can barely touch my shoulder, which should be over 135 degrees.
Recently, I visited your hospital's rehabilitation department, and you suggested that I continue rehabilitation at a facility near my home, so I switched to Hospital B for rehabilitation.
The rehabilitation content at Hospital B (Monday, Wednesday, Friday) includes: 20 minutes of electrical therapy, followed by about 10 minutes of assistance from the therapist to manipulate my arm, then concluding the session.

I have personal concerns: the treatment time feels too short, and I don't feel any noticeable effects, which affects my willingness to continue rehabilitation at this hospital.
The therapist mentioned that rehabilitation for a comminuted fracture needs to be gradual, which is why each session is so brief.
However, the surgeon who performed my operation said otherwise, emphasizing that I should not be afraid of pain and that being proactive in rehabilitation is essential for recovery.

Later, during a follow-up visit at Hospital A, where the surgery was performed, I mentioned that my progress in joint range of motion was not significant.
The surgeon recommended that I try rehabilitation with their therapists.

The rehabilitation content at Hospital A (Tuesday, Thursday, Saturday) includes: 15 minutes of soaking in hot water, followed by 30 minutes of passive flexion and extension using a machine, then self-directed strength training with sandbags, and concluding the session.

I have personal concerns regarding this process: it requires complete patient self-motivation without assistance from a therapist, which leaves me feeling very confused and distrustful.
During last week's rehabilitation session, the therapist assisted me with my hand twice (similar to wringing a towel), for about 5 minutes, but most of the time, I was left unattended, relying solely on machines and self-directed efforts.

Due to my inability to fully extend my arm for an extended period, I am experiencing shoulder strain and pain while walking.
I truly hope to receive effective rehabilitation to enable my arm to straighten out soon.
I feel that my progress at home has reached its limit, but I am currently uneasy about the rehabilitation methods at both Hospital A and Hospital B.

I would like to hear your opinion, Dr.
Lee.
Should I continue rehabilitation at one of these facilities, or do you have other suggestions? Thank you for taking the time to read my concerns.

Miss Huang, 30~39 year old female. Ask Date: 2013/03/09

Dr. Li Weiqiang reply Rehabilitation

Dear Ms.
Huang,
Hello.
The treatment results seem to have plateaued.
Would you like to come to the outpatient clinic for further recommendations?
Wishing you safety and health.
Sincerely,
Dr.
Li Wei-Qiang
Director, Rehabilitation Department
Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2013/03/09

More Info

Choosing the right rehabilitation approach after a complex arm fracture, such as an open comminuted fracture of the distal humerus, is crucial for optimal recovery. Your situation, where you have undergone surgery three months ago and are experiencing limited range of motion in your elbow, highlights the importance of a tailored rehabilitation plan.
Firstly, it is essential to understand that rehabilitation after a complex fracture can be a slow process, especially when dealing with comminuted fractures. These types of fractures involve multiple fragments of bone, which can complicate healing and recovery. The goal of rehabilitation is to restore function, improve range of motion, and strengthen the muscles around the joint.

From your description, it seems you have been following two different rehabilitation programs at two hospitals, each with its own approach. At B Hospital, the rehabilitation sessions are relatively short, focusing on electrical stimulation and passive manipulation by the therapist. In contrast, A Hospital offers a more hands-on approach with a combination of heat therapy, passive range of motion exercises, and active muscle training.

Here are some considerations to help you decide which rehabilitation approach might be more effective for you:
1. Duration and Intensity of Therapy: Rehabilitation after a complex fracture often requires more intensive and longer sessions, especially in the early stages. If you feel that the sessions at B Hospital are too short and not yielding results, it might be worth discussing this with the rehabilitation team. Effective rehabilitation should include both passive and active exercises, allowing for gradual progression in range of motion and strength.

2. Active Participation: It is crucial that you are actively participating in your rehabilitation. While passive exercises (where the therapist moves your arm) are important, active exercises (where you move your arm) are essential for regaining strength and function. If you feel that the sessions at A Hospital allow for more active participation, this could be beneficial.

3. Therapist Interaction: The quality of interaction with your therapist can significantly impact your rehabilitation experience. A therapist who is engaged and provides feedback can help motivate you and ensure that you are performing exercises correctly. If you feel neglected at either facility, it may be worth addressing this concern directly with the staff or considering a change.

4. Pain Management: Pain is a common issue during rehabilitation, especially after a complex fracture. It is important to communicate with your rehabilitation team about your pain levels. They can adjust your therapy to ensure that you are not pushing through excessive pain, which can lead to further complications.

5. Progress Monitoring: Regular assessments of your range of motion and strength are vital. If you are not seeing progress, it may be necessary to reassess your rehabilitation plan. This could involve more frequent sessions, different types of exercises, or even a referral to a specialist in hand therapy or orthopedic rehabilitation.

6. Home Exercises: While attending therapy sessions is important, continuing exercises at home is equally crucial. Ensure that you are following a structured home exercise program that complements your therapy sessions. This can help maintain and improve your range of motion and strength.

7. Consulting with Your Surgeon: Since you have concerns about the effectiveness of the rehabilitation programs, it may be beneficial to discuss these with your orthopedic surgeon. They can provide insights into your recovery process and may recommend specific rehabilitation strategies or adjustments based on your healing progress.

In conclusion, the choice between the two rehabilitation programs should be based on which one aligns better with your recovery goals, provides adequate support, and allows for active participation in your healing process. If neither program feels satisfactory, consider seeking a third opinion or exploring other rehabilitation facilities that may offer a more comprehensive approach. Remember, recovery from a complex fracture takes time, and finding the right support system is key to regaining full function.

Similar Q&A

Effective Rehabilitation Strategies for Elbow Olecranon Fractures

Hello, Doctor. I fell in September this year and sustained an olecranon fracture. Currently, I am unable to bend my right arm normally, so I have just started rehabilitation. However, each time I go to therapy, it is very painful for me, and I feel scared every time. Are there al...

Dr. Shi Guozheng reply Orthopedics
If there is surgical fixation of the fracture, rehabilitation can proceed. However, if there is no surgical fixation, caution must be taken during rehabilitation to avoid bending, as this could cause the fracture site to reopen. During rehabilitation, applying heat can help relax...

Post-Accident Rehabilitation: Addressing Concerns and Treatment Options

Thank you very much, Dr. Lin, for carefully addressing my concerns. I understand that many medical issues require cooperation between the patient and the physician to achieve the best treatment outcomes. I later explained the situation to my elder family member, but considering t...

Dr. Lin Ruixiang reply Rehabilitation
Dear Mr. J: You have truly worked hard for the health of your family, putting in considerable effort and doing your homework. When it comes to trauma patients, the first step is to treat the injury; once the disease is treated, all problems are resolved. However, reality often p...

Rehabilitation After Humerus Fracture: Tips for Recovery and Nutrition

Hello doctor, I recently suffered a comminuted fracture of the humerus (broken into three pieces) due to exercise. The cast has been removed, but I have found that I cannot fully extend my arm, and it still hurts. Could this be due to muscle atrophy from having my arm bent for a ...

Dr. Hong Ximing reply Orthopedics
Hello! It is normal not to be able to fully extend the arm after a comminuted humeral fracture has been immobilized in a cast. Rehabilitation therapy is necessary to restore normal function after the fracture has healed. You can consult a specialist at a rehabilitation clinic to ...

Post-Dislocation Recovery: Key Tips for Diet and Exercise

Dr. Chen: Hello, I dislocated my right arm due to a fall on July 8, had my cast removed on July 22, and started rehabilitation on July 23. What should I pay attention to, such as dietary or exercise restrictions? Thank you!

Dr. Chen Yongxue reply Orthopedics
Hello: In response to your inquiry, you mentioned an arm dislocation that was treated with a cast. If I am correct, you are likely referring to an elbow joint dislocation. In cases of elbow dislocation without associated fractures, nerve, or ligament damage, rehabilitation therap...