Radial head fracture recovery...

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Radial head fracture recovery...

Postby bella26 » Tue Dec 25, 2012 12:27 pm

Hi all,

well i figured a great Christmas present this year less than 1 hour after putting a deposit down for a new mtb for Christmas, was to go out and fracture my elbow... :(

The details: non-displaced comminuted radial head fracture.
Treatment: collar and cuff sling - I can start to have time out of the sling in a week. Taking less painkillers. Thankfully I won't need surgery.

The Dr doesn't want me doing anything that could lead me to fall on it for 2 months. Two months off the bike will drive me crazy - as will spinning on the indoor trainer during Summer. I am hoping to maybe ride my mtb on a relatively flat county road after 3 weeks. (riding the mtb instead of the roadie to limit the vibration felt through the handlebars) Is this feasible? Anyone else recovered from this before who could give me an insight into what I can expect?

Thanks,

Bella...
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by BNA » Tue Jan 01, 2013 10:23 am

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Re: Radial head fracture recovery...

Postby matagi » Tue Jan 01, 2013 10:23 am

bella26 wrote:The Dr doesn't want me doing anything that could lead me to fall on it for 2 months. [/b] Two months off the bike will drive me crazy - as will spinning on the indoor trainer during Summer. I am hoping to maybe ride my mtb on a relatively flat county road after 3 weeks. (riding the mtb instead of the roadie to limit the vibration felt through the handlebars) Is this feasible? Anyone else recovered from this before who could give me an insight into what I can expect?

Thanks,

Bella...

How confident are you that you will not fall off the mountain bike? That is the question. The vibrations may or may not affect bone union, but a fall would be disastrous.

I would suggest you listen to your doctor's advice. The next treatment option if you fall and aggravate the existing fracture is surgery - and that will carry a correspondingly longer recovery time.

I assume your doctor has referred you to a physiotherapist for early motion exercises?
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Re: Radial head fracture recovery...

Postby elantra » Tue Jan 01, 2013 11:00 am

bella26 wrote:Hi all,

well i figured a great Christmas present this year less than 1 hour after putting a deposit down for a new mtb for Christmas, was to go out and fracture my elbow... :(

The details: non-displaced comminuted radial head fracture.
Treatment: collar and cuff sling - I can start to have time out of the sling in a week. Taking less painkillers. Thankfully I won't need surgery.

The Dr doesn't want me doing anything that could lead me to fall on it for 2 months. Two months off the bike will drive me crazy - as will spinning on the indoor trainer during Summer. I am hoping to maybe ride my mtb on a relatively flat county road after 3 weeks. (riding the mtb instead of the roadie to limit the vibration felt through the handlebars) Is this feasible? Anyone else recovered from this before who could give me an insight into what I can expect?

Thanks,

Bella...

2 months off the bike sounds a bit extreme.
When i had a fractured scaphoid (wrist) a few years ago i was back on the road bike the next day, admittedly only riding short distances and on familiar roads.
And also, my scaphoid was immobilized in a plaster cast for 8 weeks.
I did see a private upper-limb ortho specialist doctor for management of this injury.
He did not tell me to stay off the bike.
I s'pose he assumed that i would make up my own mind on the issue. :?
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Re: Radial head fracture recovery...

Postby Dr_Mutley » Tue Jan 01, 2013 11:47 pm

Given the incidence of non-union of scaphoid fractures, u shouldn't ride for prob 4 weeks at least. Your orthopod prob wouldve just taken this as s given... Having said that I would prob be back on the following day myself :-)

With respect to a radial head fracture, it's quite a stable fracture, but another fall will likely result in it becoming displaced, comminuted, and unstable, requiring excision. Not a big deal in terms of function, but most people want to avoid unnecessary operation/procedures. If u don't want to stay off the bike then a reasonable compromise would be to stick to routes with low risk of falling off. Ie the road, or flat non-technical trails.
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Re: Radial head fracture recovery...

Postby bella26 » Wed Jan 02, 2013 11:33 am

Thanks everyone for your replies.

I spoke to my physio yesterday and she has advised no riding of any sort outdoors until the 6 week mark. Apparently the risk of falling isn't the main concern (although obviously a fall would be a very bad result), but rather the disruption riding would have to the healing of the fracture itself. So indoor trainer it is for me... :( I start physio next Thurs and am currently experimenting with having my arm out of the sling for an hour or so at a time. I'm finding pain is increasing as the day wears on but I suspect that is to be expected. A few sleepless nights but it could be much worse.

I have three weeks of cycling booked in France this coming July so don't want to risk more time off the bike than is necessary.

Trying not to get too down in the dumps but an injury like this on my first day of a two week holiday and just hours after placing a deposit on a new bike...it's getting hard :(
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Re: Radial head fracture recovery...

Postby Dr_Mutley » Wed Jan 02, 2013 11:58 am

Sounds like a very good plan! :-)
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Re: Radial head fracture recovery...

Postby wombatK » Wed Jan 02, 2013 12:34 pm

bella26 wrote: am currently experimenting with having my arm out of the sling for an hour or so at a time. I'm finding pain is increasing as the day wears on but I suspect that is to be expected.

Not sure that I'd suspect it's to be expected...

Pain increasing as the day wears on suggests that some swelling is occurring, which is not so good. Did Dr or physio tell you to get your elbow elevated as much as possible ? It's Captain Obvious stuff if you remember that its the E part of R.I.C.E., but unfortunately some GP's and physios (i.e. mine) both thought the other was telling me that stuff.

Taking your elbow out of the sling might be counter-productive, unless you are able to rest it up on something higher. If you haven't already got a compression bandage for your elbow, that can also help - that's the "C" part, and it's best applied after the Ice has knocked any swelling down a bit.

Getting injured early in the holidays is a real downer, but just remind yourself that you are otherwise fit and health and will recover much better than the average couch potato.

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Re: Radial head fracture recovery...

Postby Dr_Mutley » Wed Jan 02, 2013 2:51 pm

Periods of mobilization out of the sling is standard for radial head fractures. They are (usually) stable fractures, and mobilizing will cause some discomfort, but the downside of not doing this, is then dealing with a very stiff elbow joint later on. Granted RICE is a good plan for end of day pain etc, and periods of gentle mobilization shouldn't be to the point of pain. Good advice to follow, and as u say, it's usually the simple stuff that's forgotten :-)
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Re: Radial head fracture recovery...

Postby bella26 » Thu Jan 03, 2013 5:47 pm

Had a follow up with the Dr today and he seems happy with my progress so far. Time out of the sling gradually as much as pain allows is what I've been prescribed. Physio starts in a week. I can think of riding on sealed roads and relatively flat terrain in another 4 weeks so I'm almost 1/3 of the way through the enforced time off the bike. I have moments of concern when seeing how bent my arm is but I can't expect miracles overnight. It's amazing though, no matter how much I will my arm to straighten it just isn't happening.
The Dr said to get into the pool and do some geriatric style swimming which will help with the straightening whilst the water gives my arm some form of support, so will give that a go.
The bike is still to be set up on the trainer - riding indoors in Summer, in a house that isn't air conditioned is hard to get motivated for! I've started walking up my local hill climb which is nowhere near as fun but I need to keep the cardio up!
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Re: Radial head fracture recovery...

Postby The Dude Abides » Tue Jan 08, 2013 8:25 pm

I had this exact injury around 2.5 yrs ago. It hurt like hell to try to straighten up the arm and then to put pressure on the arm (ie pushing off the tap if its a mixer tap, or pushing down on a soap dispenser). Rotating the wrist was a good exercise to do throughout the day. The physio should be a good source for exercises to do for gaining strength and full extension.

It does gradually come back to full strength and movement after a while. I think from memory I was in a sling for a week and begun physio after about 10 days with mine
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Re: Radial head fracture recovery...

Postby bella26 » Wed Jan 09, 2013 7:18 am

I'm looking forward to physio starting properly tomorrow. Having previously worked in the allied health and physio industry, I'm lucky enough to have some good physio friends who have got me started on some self manual therapy sessions. At this stage it's all about squeezing stress balls/tennis balls - not much fun!I went for a swim like the Dr advised on Sunday and have felt stirred up since. I've also just started driving again. Thankfully I don't drive a manual as that would be impossible.

The elbow is extremely bent and just physically unable to straighten. It's not pain that is stopping it from straightening but rather stiffness. 2.5 weeks in and I'm well and truly over this injury. I was speaking to a work mate of mine who also sustained the same fracture when he fell off his bike last year. He didn't get back to riding for 8 weeks so I'm hoping my time off the bike isn't the same as that. As it is at the moment I doubt that I could pull on the brakes with my left hand - how the heck did Cadel ride through the tour with his? :shock:
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Re: Radial head fracture recovery...

Postby The Dude Abides » Thu Jan 10, 2013 10:00 pm

Its amazing what a small fracture can do to stop movement.

From memory I was off the bike for 4 weeks and when I started back it was just small comfortable rides. Whe driving you will feel the elbow and remember the pain if you get too keen going around tight turns...I did that a bit and felt it for a while!
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Re: Radial head fracture recovery...

Postby winstonw » Fri Jan 11, 2013 6:36 am

Very often, the more significant pain stopping you from straightening the elbow is due to swelling and trauma at the back of the elbow. Tell us where you get the pain when trying to straighten yours. In these cases, your physio should do deep probing massage into the space between olecranon process and fossa, while passively increasing elbow extension.

They may also get you to rest your elbow on an arm rest of a lounge chair, and hang a weight from your wrist and put a hot pack under and over your elbow....and sustain for ever longer periods up to 30 minutes, while watching tele at night. If painful after, ice it for 20 mins.
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Re: Radial head fracture recovery...

Postby bella26 » Fri Jan 11, 2013 9:09 am

Well today marks 3 weeks into the elbow fracture. I had my first physio session yesterday which went well. My physio is very happy with my progress and says I'm on track for a full recovery. Those words were so reassuring. Not having done this before I had no idea if I should be concerned about the amount of bend in my arm or if it was normal. Apparrently it's normal. She wasn't happy about my GP's advice re: the swimming though and says I'm at least another week away before I should be doing that again. No wonder I was so stirred up for a couple of days after.

winstonw wrote:In these cases, your physio should do deep probing massage into the space between olecranon process and fossa, while passively increasing elbow extension.

Yep that is exactly the treatment I had yesterday. It was painful at first but actually felt very good. My physio also got stuck into the the upper biceps and triceps where my muscles have tightened up from being in a sling for so long. Again hurt a bit but feels good for it now. Admittedly today the elbow is feeling a bit stirred up but that is to be expected after yesterdays treatment.

I don't find I have much pain with trying to straighten the elbow - I just can't physically straighten it. Most pain I have is when I try to push off with my arm. For example driving to work the other day some idiot cut me off. My reaction was to toot my horn - bad idea. Trying to press on the horn with that arm only resulted in some super pain :oops:

The Dude Abides wrote:Whe driving you will feel the elbow and remember the pain if you get too keen going around tight turns...I did that a bit and felt it for a while!

Yes this is definitly the case with me as well. I don't like roundabouts where I need to go right!!! Driving in Canberra you can imagine there are a fair few of those...

My physio has given me more exercises to keep occupied with. Again working through my range of motion, pronation and supination of my wrist and flexion and extension as far as possible with the arm. I've now ditched my collar and cuff sling except for when I'm in high traffic areas - supermarkets, work corridors etc. and that is more as a protective blinker for people to give me space and not bump into me.

I asked again whether I could get back to riding earlier than the 6 week mark but my physio was adament that 6 week is earlier for the fracture I've sustained. I risk doing more harm than any good getting on the bike early might give me and I just can't afford for this to not heal correctly. So it's on with the walking for the time being. I did notice that my arm does actually swing when I walk which is a marked improvement from even just 5 days ago.
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Re: Radial head fracture recovery...

Postby The Dude Abides » Fri Jan 11, 2013 8:03 pm

bella26 wrote:I don't find I have much pain with trying to straighten the elbow - I just can't physically straighten it. Most pain I have is when I try to push off with my arm. For example driving to work the other day some idiot cut me off. My reaction was to toot my horn - bad idea. Trying to press on the horn with that arm only resulted in some super pain :oops:


My elbow was the same, couldnt move it not for the pain but just couldnt, my physio used the analogy of a hinge on a gate, if it doesnt open and close for a while it becomes rusted shut. Because the elbow has been immobile for a period of time and the swelling and fluid associated with the injury just all gets in the way the the joint sort of seizes up in a way. Just keep working away at the exercises amd you will be back to full health.

My physio gave me like a length of rubberised thin tubing that if you imagine the circumference of a sock that would fit around your quad type size. All I didd was stand on one end of the rubber with my feet and hold the other end with my injured arm (he cut me off a 1m sized long strip). Basically I started off doing bicep curls trying to bring my wrist to my shoulder whilst leaving my elbow by my side near the top of my hip and standing up straight and tall.

Then another exercise started out the same by standing on the rubber and holding the tube at a length. With your elbow tucked into your side and your arm at right angles (paralell to the floor) hold the rubber inbetween your thumb and index finger so that it is reasonable tight and have your palm facing the floor, then rotate your palm to face upwards to the sky using the rubber as the resistance. Then change it over and start with the palm up and rotate it so that the palm ends up face down.

Then the last one I did after another week or so building up was to stand on the rubber with your heel and have it stretched out behind your back and reach behind you and hold it with your injured arm with your wrist near your ear. Then use the resistance in the band to do tricep curls by keeping your elbow in place and trying to straighten your elbow and back, repeating this excercise. This was the toughest exercie because the rubber was so much more stretched so the resistance was tighter so you were using alot of strength through the elbow. I must stress that this was towards the end of my movement recovery.

I remember these exercises as I did them religiously to try to get full movement back.
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Re: Radial head fracture recovery...

Postby bella26 » Thu Jan 17, 2013 7:33 am

I've been given a few different exercises from the physio but at the moment it is all about moving the arm through its range of motion. So lots of pronation and supination of the wrist, flexion and extension of the arm both with and without some form of resistance. I also have the very uninspiring exercises of squeezing stress balls! There are also a few isometric exercises thrown in there as well.

It's amazing seeing how much my muscle has wasted away in my forearm after just four weeks (hit the four week anniversary of the fracture tomorrow!) :shock: I'm looking forward to getting onto the strengthening exercises and getting that muscle back. Having not been on the bike for this long has seen me get quite down in the dumps so when I can finally get going again with my riding I'm sure that will help a load. I think this past week has seen my arm able to straighten slightly better than it did 7 days ago but it's hardly progressed leaps and bounds.

I'm still walking loads to try keep up the fitness. There is a new cyclo sportif which is being held here in the Snowies on the 24th March and I am hoping to be firing for that. 160kms of hills may be a bit much to ask for - especially as I will have only aprox 7 weeks to train. I guess I'll just have to see how I go. From those who did sustain the same injury - how did you find your form once you finally returned to the bike?
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