Challenges in Rehabilitation After Humeral Nail Removal: A Patient's Journey

Removal of distal humeral locking screws?

It has been 10 months since my rehabilitation began.
There has been some improvement in my ability to straighten and bend my arm, but I still cannot touch my shoulder or straighten my arm independently.
I have tried at home to extend my arm with my palm facing down and my elbow pointing inward, as if lifting something to the sides.
I noticed that my forearm tends to droop slightly, and when I exert force to straighten it, I feel discomfort on the outer side of my elbow, along with a sensation of nerve movement, followed by a brief tingling sensation.
I see others who have completed rehabilitation in just a few months, while I feel like I have spent so much time on this.
After my surgery, one month post-cast removal, I returned for a follow-up appointment.
The doctor noted that my ability to straighten and bend my arm was poor and suggested using anesthesia to help improve my range of motion.
However, the postoperative X-ray revealed that one of the metal screws had bent, indicating that my previous rehabilitation efforts were not vigorous enough, and it must have taken significant force to bend that screw.
During the months of rehabilitation, the physical therapist suggested removing the screw, and the rehabilitation staff mentioned that it was quite noticeable upon examination.
Additionally, I have experienced atrophy in my palm, and my little finger cannot extend on its own, which are symptoms consistent with ulnar nerve injury.
In a recent follow-up, my attending physician mentioned that there are many nerves and blood vessels in the area.
After reviewing the X-ray, he hesitantly told me to return in two months for scheduling surgery.
I truly don't know what to do...

A-Qin, 20~29 year old female. Ask Date: 2014/05/21

Dr. Shi Guozheng reply Orthopedics

Humeral fractures typically require a full year to heal completely before the removal of bone screws.
Some physicians may advise patients not to remove the screws depending on the situation.
If there are no other discomforts or complications, it is still important to discuss with your physician whether or not to remove the screws.

Reply Date: 2014/05/21

More Info

Rehabilitation after the removal of a humeral nail can be a challenging journey, especially when complications arise, such as nerve damage or improper healing. Your experience highlights several key aspects of post-operative recovery and rehabilitation that are crucial for understanding the process and setting realistic expectations.

Firstly, it is important to recognize that recovery from surgery, particularly involving the humerus and associated nerves, can vary significantly from patient to patient. Factors such as the extent of the injury, the type of surgical intervention, and individual healing responses all play a role in the rehabilitation timeline. In your case, it seems that the presence of a bent nail and potential nerve involvement has complicated your recovery, leading to prolonged rehabilitation efforts.

The symptoms you describe, such as the inability to fully extend your arm, discomfort when attempting to move, and the sensation of nerve movement, suggest that there may be underlying issues that need to be addressed. The fact that you are experiencing a feeling of "bad sensation" and "numbness" could indicate that the ulnar nerve, which runs along the inner side of the elbow and controls movement and sensation in the forearm and hand, may be affected. This is not uncommon in cases of humeral fractures or surgeries involving the upper arm, as the nerve can be stretched or compressed during the healing process.

In terms of rehabilitation, it is essential to work closely with your physical therapist to develop a tailored program that addresses your specific limitations. This may include gentle range-of-motion exercises to gradually improve your flexibility and strength without exacerbating any pain or discomfort. It is also crucial to communicate openly with your therapist about any sensations you experience during exercises, as this feedback can help them adjust your rehabilitation plan accordingly.

Regarding the potential need for further surgery to address the bent nail and any associated nerve issues, it is understandable to feel apprehensive. However, it is essential to weigh the risks and benefits of additional surgical intervention. If the current rehabilitation efforts are not yielding the desired improvements, and if imaging studies suggest that the bent nail is contributing to your symptoms, surgery may be a necessary step to facilitate better healing and function.

In the meantime, consider incorporating supportive measures into your daily routine. This may include using a brace or splint to stabilize your arm during activities, engaging in gentle stretching exercises, and ensuring that you are following a balanced diet to support healing. Additionally, exploring modalities such as occupational therapy may provide you with strategies to adapt to your current limitations and improve your overall quality of life.

Lastly, it is crucial to maintain a positive mindset throughout this journey. Rehabilitation can be a slow process, and it is not uncommon to feel frustrated when progress seems minimal. Setting small, achievable goals can help you stay motivated and focused on your recovery. Celebrate the improvements you make, no matter how small, and remember that every step forward is a step toward regaining your strength and functionality.

In conclusion, your journey through rehabilitation after humeral nail removal is undoubtedly complex, but with the right support, communication with your healthcare team, and a commitment to your recovery plan, there is hope for improvement. Stay proactive in your rehabilitation efforts, and do not hesitate to seek further evaluations or interventions if you feel they are necessary for your recovery.

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