Post-Surgery Rehabilitation for Distal Humerus Fractures: Key Insights

Rehabilitation after surgery for distal humeral fracture?

I have visited multiple times before and asked questions, and I'm here again to seek your advice.
It has been 3 months and 10 days since my surgery, and I am still undergoing rehabilitation.
There has been some improvement in the flexion of my elbow.
During a follow-up appointment the day before yesterday, my attending physician mentioned whether I should go back to the operating room for anesthesia to assist with the flexion and extension of my arm.
He feels that my rehabilitation is still lacking a bit.
I consulted with the rehabilitation hospital I frequently visit, and they suggested that surgery may not be necessary given my current condition.
I am unable to assess this myself; normally, there is about a 10-degree difference in both extension and flexion.
Additionally, initially, my attending physician stated that this type of surgery would not damage the ulnar nerve.
However, I have researched the location of the ulnar nerve online, and it seems to correspond with areas where I have numbness and slight tingling upon touch.
I am concerned whether this could lead to "cubital tunnel syndrome." (Near the location of the steel plate and screws at my elbow, I can feel a thin line, and pressing on it makes the numbness and pain more pronounced.) Now, all the doctors are telling me that this is a common occurrence after such surgery.
During the last anesthesia procedure for flexion and extension, the surgeon mentioned that I could check the nerve, but he mainly asked if I could close my hand, so he did not explain the duration or method of the examination.

A-Qin, 20~29 year old female. Ask Date: 2013/11/01

Dr. Shi Guozheng reply Orthopedics

If cubital tunnel syndrome occurs, there may be numbness in the ulnar side of the skin and potential atrophy of the muscles in the palm, although this may not be evident in the early stages.
Electromyography (EMG) and nerve conduction studies can be performed to confirm the diagnosis.

Reply Date: 2013/11/01

More Info

Post-surgery rehabilitation for distal humerus fractures is a critical aspect of recovery, especially considering the complexity of the injury and the surgical intervention involved. Your situation, having undergone surgery over three months ago, indicates that you are in a crucial phase of your rehabilitation journey. Here are some key insights and considerations based on your description and general medical knowledge.

Rehabilitation Progress
1. Range of Motion (ROM): It is encouraging to hear that you have seen improvements in elbow flexion. Achieving full range of motion is essential for functional recovery. Typically, after a distal humerus fracture, patients aim for at least 130 degrees of flexion and full extension. The fact that you are only 10 degrees off from full extension and flexion suggests that you are on the right track, but there is still work to be done.

2. Physical Therapy: Continuing with physical therapy is crucial. Your therapists can provide tailored exercises that focus on strengthening the muscles around the elbow, improving flexibility, and enhancing overall function. Modalities such as ultrasound therapy, electrical stimulation, and manual therapy may also be beneficial in reducing pain and improving mobility.

3. Surgical Considerations: Your doctor’s suggestion of a potential second surgery to assist with the bending and straightening of your arm indicates that they are closely monitoring your progress. While some patients may require additional surgical intervention to release scar tissue or address limitations in motion, it is essential to weigh the risks and benefits. If your physical therapists believe that you can achieve your goals without further surgery, it may be worth discussing this with your orthopedic surgeon.

Neurological Concerns
1. Ulnar Nerve Function: The ulnar nerve runs close to the elbow, and it is not uncommon for patients to experience some degree of nerve irritation or compression post-surgery. Symptoms such as tingling, numbness, or pain in the ring and little fingers can indicate ulnar nerve involvement. If you are experiencing these symptoms, it is crucial to bring them to your doctor's attention.
2. Cubital Tunnel Syndrome: Your concerns about developing cubital tunnel syndrome (often referred to as "elbow tunnel syndrome") are valid. This condition occurs when the ulnar nerve is compressed at the elbow, leading to symptoms similar to what you described. If you notice persistent numbness or tingling, or if the symptoms worsen, it may warrant further evaluation, possibly including nerve conduction studies to assess the function of the ulnar nerve.

Recovery Timeline
1. Expected Healing Time: Generally, the healing process for distal humerus fractures can take several months, and full recovery may take up to a year or more, depending on the severity of the fracture and the surgical intervention. Regular follow-ups with your orthopedic surgeon are essential to monitor healing and adjust your rehabilitation plan as needed.

2. Activity Modification: As you progress, it is important to gradually increase your activity level while avoiding movements that may exacerbate pain or discomfort. Your therapists can guide you on how to safely incorporate daily activities and exercises into your routine.

Conclusion
In summary, your rehabilitation after a distal humerus fracture is a multifaceted process that requires careful monitoring and adjustment. Continue to communicate openly with your healthcare team about your progress and any concerns, particularly regarding nerve symptoms. It is essential to balance the need for further surgical intervention with the potential benefits of continued conservative rehabilitation. With dedication to your therapy and regular follow-ups, you can work towards achieving optimal recovery and regaining full function of your elbow.

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