WHAT TO EXPECT AFTER BROKEN ELBOW SURGERY

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I thought about writing this post in chunks, separate entries for each part of my "journey", but in the end I've decided on a single post with distinct sections. You can scroll down to find a specific thing you'd like to know about, and you are certainly welcome to ask questions. I will post the videos separately so you don't have to try to navigate a half hour of me talking about all the different aspects of surgery/recovery/therapy/medication, etc. All right, let's dig in! (Read More)

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COMMINUTED DISTAL HUMERUS FRACTURE
​FANCY TERM FOR - I BROKE MY ARM WHILE SNOWBOARDING

A little backstory on how I broke my elbow. I was snowboarding, it was my very first lesson, I was at the bottom of the hill and caught my downhill lip. I was going fairly slowly, being very cautious, but when the lip caught and I got flung backward, I put both arms out behind me to catch my fall. Very bad idea. The bottom of my arm pushed up into the top of my arm, my Humerus cracked into several pieces right at the elbow, and that started a year of surgeries, physical therapy, and medication. Here's some of the images from my broken elbow.

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COMMINUTED DISTAL HUMERUS FRACTURE TREATMENT PROTOCOL
BROKEN ELBOW SURGERY - DIAGNOSIS

When I broke my elbow, I'd been on vacation with my family. We were there for a week, and it was our last day. The break happened around two in the afternoon, and since I was on the bottom of the slope I was able to get up and walk to the medical area. 

They removed my jacket so they could see my arm (I did have long sleeves on, so they couldn't see much) and then they wrapped a box around it and asked if I wanted to call an ambulance. I elected not to because the medical personnel at the mountain couldn't tell me if the paramedics would give me pain medication. I was in A LOT of pain. Since medication wasn't a sure thing, I saw no reason to mess with an ambulance. My husband drove me to the local hospital where I was admitted immediately. 

Funny side story - We originally drove to the local Urgent Care, not realizing they weren't the same thing. The people at the front desk gave me paperwork to fill out (mind you I am standing there with a severely broken arm) and then told me "Take a seat, someone will be with you soon." It was literally the most surreal experience and those people seemed extremely out of touch with reality. I asked if there was a hospital nearby, they told me that there was, and that they'd need to send me there anyway since they didn't have an x-ray machine. (I am internally rolling my eyes right now).

We left to go to the actual hospital, which was not very far away at all.

I walked into the emergency room and explained what happened. The staff was fantastic, no wasted time. The hospital personnel needed to get an x-ray, but before that they needed to get my arm free of my clothes. I begged them to just cut the clothes off instead of removing them like normal, but they wanted to make sure I had clothes to leave the hospital in, so I suffered through it. They did try their best to make it as easy as possible, but it hurt, it hurt a whole lot. 

Once my arm was bare and they could see the lumpy bumps (I tried not to look at it, so I can't describe it very well) they went ahead and gave me something to help me get through the x-ray that was coming. I'm not sure what the medication was, but they shot it up my nose and it didn't so much help the pain as it made me feel like I couldn't concentrate on the pain. 

I was wheeled to x-ray and the techs did a great job of not making me move a whole lot. They placed the x-ray plate beside my arm while I lay on the gurney asking if there was any way it could just be dislocated. (This makes me laugh now, but at the moment I was very hopeful it was just a dislocation).  They told me that they weren't trained to read he x-ray, but they didn't think it was just dislocated.

Here's that picture.

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COMMINUTED DISTAL HUMERUS FRACTURE TREATMENT PROTOCOL
BROKEN ELBOW SURGERY - THE ACTUAL SURGERY

The hospital in the small town where we ski said they weren't equipped to do surgery on my elbow since the break was so severe. I needed an Orthopedic surgeon. Thankfully, since the small town was close to some big ski towns (Vail, Breckenridge, etc.) they were easily able to transport me via ambulance to Summit Medical Center out in Frisco where a very good surgeon would be waiting.

I got to Summit around 6 p.m. and was moved to a room within a couple of hours. I was fine with the wait. By this time I was very medicated and not feeling much pain. At one point they did need to get me in an MRI machine. They told me I'd have to raise my arm above my head for them. Thankfully they pulled out the big guns for pain medication (Morphine) to get me through the MRI. I have never been so glad for a needle in all my life. That MRI was awful.

After seeing the MRI, the surgeon decided to delay the operation until the next day to let the swelling go down a bit, so I told my husband not to worry about coming up there since I'd just be sleeping. Like I said, this was our last day of vacation and they still had to pack up the VRBO and clear out early the next morning. 

My surgery took place at around 2 p.m. the following afternoon. The surgeon explained everything to me in detail, including the types of things I could expect going forward:

Arthritis
Limited mobility
Nerve pain
A long recovery
Physical therapy

None of it was shocking. I knew by then that it was a very bad break. The surgeon said it was normally the type of break he would see when a passenger in a car puts their hands out to brace against the dashboard before they rear end someone. 

He took me back to the OR, worked his magic, and when I woke up, my arm was in a half cast from my wrist to my armpit. That half cast was wrapped in miles of cotton batting and gauze. I couldn't move it at all and wouldn't be able to for a couple of weeks. 

​It made for a very fun seventeen hour ride home!

HERE'S HOW I GOT OVER MY GABAPENTIN ADDICTION AFTER SURGERY

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ELEVATING THE TRICEPS FOR BROKEN BONES

Since my humerus was shattered so severely, the surgeon wasn't able to go in and make the repairs without making some room first. What this means is that he cut off the bottom of my Ulna (where it would meet at the elbow) where my triceps attached, then pulled it up toward my shoulder. This gave him room to work on my Humerus, making the repairs as needed. Once he finished, he put the Ulna back in place, screwed it down tight, and closed up. 

That big screw was one of the most irritating parts of this surgery. I could feel it all the time. If I leaned my elbow against anything, that screw hurt. I couldn't even rest it on my mattress at night, it was too sensitive.  I did eventually have all of the hardware removed, but I'll get in to that further down. 

After two weeks in the cast, my local surgeon removed it so that I could start showering without wrapping my arm in a trash bag. I had to put it the cast and bandage back on whenever I wasn't in the shower to keep it protected, but he did let me take it off if I was someplace very safe (in bed before I went to sleep) so I could make tiny micro movements, but for the most part it had to stay on.

​I didn't realize what an impact this would have on my range of motion later on.

TY WRITES BOOKS FOR MIDDLE SCHOOL READERS

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LIMITED RANGE OF MOTION AFTER ELBOW FRACTURE

Broken elbow surgery recovery time isn't just about the bones mending. As you can see in the video, my range of motion after elbow surgery was very limited. I could basically hit 90 degrees and then move another 30 degrees toward an open arm. This was probably the biggest shock to my system. I had no idea just how limited that range of motion would be, nor did I have any realistic idea of how long it would be before I began regaining range of motion after elbow surgery.

How long does it take to regain range of motion after elbow surgery? It's been more than a year and my range is still limited, though not by more than 10 degrees on either open or close, so I'm okay with it. I do not expect it to get any better at this point.

There were some things I did at home to help myself gain more range of motion, so I'll go over those, but I want to be very clear that I'm not a medical professional and I am not handing out medical advise. Talk to your surgeon/physical therapist before you do anything.

​I went to physical therapy for a few weeks, and for me it was a complete waste of time and money. I needed help closing my arm (hand to shoulder flexion) and opening my arm (extension). They gave me some very basic pointers on opening my arm, but weren't able to offer any help closing my arm. I spent most of the time doing wrist rotations with very light dumbbells. It was all stuff I was able to do at home, so I stopped going after six weeks or so. 

I recommend going to PT at least so you can see if they can offer you some knowledge you don't already have. And I definitely recommend it if you aren't going to work on any of this yourself at home. For me, I'm a doer, no one wanted my range of motion back more than me, so I researched, watched videos, and tried various things to find out what would help me the most, with the least amount of discomfort.

UNIVERSAL YUMS IS OUR FAVORITE MONTHLY SNACK BOX SUBSCRIPTION

My scar after my third surgery once the hardware had been successfully removed - Broken Elbow Surgery Scar

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HAND SWELLING AFTER ELBOW SURGERY

About a week after I had surgery, my hand started to swell like crazy. I couldn't figure out what was going on, but a call to my surgeon assured me that it was just edema, fluid traveling from the surgery site down to my hand, likely because I wasn't keeping it elevated enough while I slept. It looked terrible, but it didn't hurt.

You can see just how swollen my entire hand and arm is. I felt like the Stay Puffed Marshmallow wo(Man).

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PHYSICAL THERAPY EXERCISES FOR A BROKEN ELBOW
​WORKING ON EXTENSION

How do you rehab a broken elbow? Very carefully. 

In order to help get my arm straight again, I employed some basic techniques. The first of which was holding something very light (a soup can) while resting my elbow on a folded towel on the edge of my couch. I'd watch TV, hold the can, and let gravity slowly pull my fist toward the floor. I feel like this helped a lot, though it was slow going. Bending my elbow after doing this for awhile was uncomfortable and I did end up tearing a muscle or something, but the surgeon wasn't worried about it and said that it sometimes happens when your elbow has been contracted for so long.

Another variation of this, which I really liked, was using a Urias Air Splint. It sounds weird, but it really worked for me. 

You put your arm in the splint, blow it up to your comfort level, then leave it. I have heard people say that they would sleep in it, but I didn't do that. Instead I would use the splint at night while watching TV, letting it straighten my arm while I did something else. I liked it because I didn't have to hold a weight or soup can, and I could even fit a small heating pad inside the air splint to use heat to help my mobility. 

I made that part up, so if you do it, do it at your own risk, and please be careful of the heat. The heating pad I used was something like this, and I made sure to put something between my arm and the pad. I'd wear a sweater, wrap a towel around my arm, etc. Basically my arm wasn't coming into direct contact with the heating pad while I had it inside of the air splint. 

This, for me, was the most effective means of getting my arm straighter.

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PHYSICAL THERAPY BROKEN ELBOW AFTER SURGERY
WORKING ON FLEXION

Range of motion exercises after elbow surgery - for flexion.

Working on flexion after elbow surgery was a little more difficult for me. I needed it to bend, but I wasn't getting anywhere by just flexing my muscles over and over again. It would reach a certain point and stop, and no amount of me gritting my teeth was making a difference.

I had heard that some people would lay down on their backs while holding a weight. They would let that weight drift toward the floor with their elbow in a bent position, allowing gravity to bend their elbow more. 

This didn't work for me. I found it almost impossible to firmly grip the weight while still letting my elbow relax, it felt wrong and I didn't like it. 

What did work for me, and what I highly recommend you talk to your doctor about before doing, was bending my arms beneath me while I lay on them on my stomach. I'd put my hands just below my collar bone, palms on my shirt, open and flat, then lay down on my stomach, forcing the elbow to bend.

Doing this made a lot of progress, but certainly you could do some damage if your bones aren't healed enough to take the weight, so talk to your doctor first.
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How long does it take to get range of motion back after elbow surgery/how long does it take to regain range of motion after elbow surgery/how long does it take to get full range of motion after elbow surgery? Everyone is different, but it's been a year, and I think it's as good as it's going to get for me.

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HOW LONG DOES IT TAKE TO RECOVER FROM BROKEN ELBOW SURGERY
FOR ME - ABOUT A YEAR

I had my six weeks of physical therapy under my belt when my doctor and I agreed that it would be okay to move ahead with having the hardware removed. The large screw in my Ulna was really bothersome, and I could also feel the plates on either side, both being very prone to getting sore and tender when my arm rested on one side or the other, especially during sleep. 

My bones had mended for almost 9 months at that point, so they were well healed and he wasn't worried about anything being broken again if the hardware was removed prematurely. The idea was to go in and remove all of the hardware in one fell swoop, but as things panned out, it got a little more complicated and he decided only to remove the large screw in my Ulna and a few of the smaller screws holding the plates on.

I remember waking up in recovery and him telling me that he just wasn't comfortable removing the hardware without once again elevating my triceps, which would have meant cutting into the Ulna again, raising it toward my shoulder, removing the plates, putting my Ulna tip back, and putting the big screw in all over again.

I wanted to cry.

Instead of crying, I gave it a few weeks and reevaluated the situation. I had been having serious nerve pain in my hand and fingers (I'll talk more about that later on) and that pain seemed to double after the second surgery. I wanted the hardware out, I was convinced it was part of the reason I was still in so much pain from my nerves, so I decided to seek a second opinion from a well known Orthopedic group in Houston. 

What I actually did was go on their website and look for a doctor who had a specialty that seemed to fit my injury. Then I emailed them, explained what I'd done, and asked if the doctor I was thinking of seeing would be the right fit. They actually called me back almost right away and said they'd spoken to their doctors and thought that another doctor in the practice would be a better fit. I made an appointment to go in and see him at the end of November. 

He had me do another MRI and a nerve study to make sure there was no nerve damage, but felt confident that he could remove the hardware completely without having to elevate my triceps again, and he could get it done before my insurance deductible wiped out in January. I scheduled the surgery for the end of December and made it very clear that if he could not remove the hardware without elevating my triceps then I wanted him to go ahead and elevate them. I wanted the hardware out.

I figured it would mean I'd have to come back for another surgery in 2021 to back out the big Ulna screw again, but that would be nothing compared to what I'd already had done, so no big deal. 

Turns out, he was as good as his word and removed all of the hardware (except one screw that had broken off during the second surgery). 

I followed up at one week (during which time my arm was again in a half cast), lost a lot of mobility all over again and had to work to regain it, but having all of the hardware removed was definitely worth it. 

He did say I had a lot of scar tissue compressing my Ulnar nerve, so he was able to clear that out and clean out scar tissue (which was also causing me pain and making a horrid grinding/clicking sound). 

I was set up for a good recovery, but I was still having bad hand and finger pain, so I stayed on the Gabapentin for a couple more months. I'll talk about that next, but I'm still going to cover the clicking/grinding/snapping I had in my elbow prior to this final surgery.

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ULNAR NERVE PAIN AFTER ELBOW SURGERY

I've already written an entire blog post about dealing with an addiction to Gabapentin after I started taking it for nerve pain, so you can read that post if you want a whole lot more information. 

Right now I'm just going to give you the broad strokes. 

After the first surgery, I had limited feeling in my pinky. If you touched it, it almost felt (to me) like I was rubbing my hand across rubber. It had an intermittent, muted, sticky sensation, like parts had feelings, but other parts didn't. That got better over time, but was replaced by pain.

It wasn't the kind of pain you could relieve with a pain pill, it was this shooting, burning, aching pain that never went away.  I couldn't sleep through it, it was that bad. It didn't stop at my pinky, but spread to my entire hand, focusing on my pinky, thumb, and the back of my hand. 

My doctor prescribed Gabapentin. It worked very well, but after a year of taking it I tried to stop taking it, and...I couldn't. I had become physically addicted to it. I did wean myself off and I'm all done with it now, but it was an eye opening experience, and definitely not one I'd like to repeat. 

If you've broken your elbow, you're likely going to be prescribed an abundance of medication. Be careful with it.

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GRINDING IN OUTER ELBOW AFTER SURGERY

Once I'd gotten my cast off and had started physical therapy, I began to notice a clicking/grinding/snapping noise in my outer elbow. I'd flex, it would go "snap snap snap", I'd extend, same thing. If I put my fingers on my outer elbow and then flexed or extended, I could actually feel the grinding beneath my fingertips. 

I had done enough research to know that any sort of grinding could be a problem (especially since my doctor asked me specifically about grinding every time I saw him for a followup appointment) so I was extremely worried something had gone wrong.

Turns out, it was just scar tissue that had broken loose as I regained my range of motion. 

That's not to say it wasn't an issue, because it was. The scar tissue bits weren't going to dissolve or go away on their own, and they were large enough (small enough?) that they were getting jammed in my joint when I'd move, causing a lot of pain. 

The good news was that my bone wasn't grinding, so if you're hearing a grinding in your elbow after surgery, it could be scar tissue. You'll definitely want to get it checked out, but if I can give you a little peace of mind, it might not be anything really bad.

Thankfully, if you're not really having any troubles aside from the clicking in your elbow after surgery, it's something that can typically be taken care of in an outpatient procedure where they just make a little hole, flush the joint, then close it back up. 

I had my surgery almost three months ago and the grinding is gone for the most part. It came back just a tiny bit as I've gained more range of motion, but the loose scar tissue isn't enough to bother me at the moment so I'm just going to leave it alone.

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RECOVERING FROM BROKEN ELBOW SURGERY
​QUESTIONS?

I went into this blog post with a list of concerns I'd had after I broke my elbow. Lots of things I couldn't find on the internet, so I decided to sit down and type it all out in the hopes that it might help someone else. I realize that if you're going through this, you might be after even more specific information. So if I don't have it here, feel free to leave a comment below. I'll do my best to answer it, but remember, none of this is medical advice. 

When in doubt, consult your surgeon. You really don't want to mess around with not getting the most out of your elbow after your surgery, so don't leave it to chance.

I hope this helps, good luck!
Ty

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