Radial Head Replacement and Lateral/Colateral Ligament reconstruction

Bones, joints and muscles
1

I Shattered my elbow 3 times and had a Radial head replacement, Lateral/Colateral ligament reconstruction and several plates and screws. I am having issues with severe swelling in my wrist, lack of strength and severe pain in my hand, as well as losing movement and severe pain in my elbow. I am 8 months on in this injury and feel very isolated. 

Story:

Four months ago I had a Radial head replacement with a collateral and lateral ligament reconstruction. This was the first time my surgeon had ever done these two procedures together, and I was the first case of my kind at Occupational Therapy. My origional injury happened at the beginning of Januarary when I fell on the ice and fractured my elbow in about 7 different spots. I did not need surgery for that injury as everything miraculously broke in alligement. My ulna was broken clean through with three different breaks, but still, all in line. After a rough PT (my first pt rebroke my ulna whilst calling me a big baby for not being able to do the exercise she wanted, because she had BROKEN my ulna again) I stepped on a cat toy and fell down a flight of stairs in my house. I was trying so hard to protect my elbow that inevitably I landed on it and rebroke it terribly. It was bad, I had surgery to put 7 plates and lots of screws in to hold everything together. One week after surgery while I was sitting on the couch I felt something in my arm dislocate followed by immense pain. I thought, no that did not just happen, and in the spirit of that denial I waited until my follow up four days later to tell my surgeon. All he had to do was look at my arm to see something was wrong. The x-ray showed my raidius had dislocated and smashed into all the already broken bones in my elbow and just decimated itself. So, after second opinions, one week later I had a Radial head replacement with a lateral and collateral ligament reconstruction. 

I am four months post surgery and having some serious complications. I killed my occupational therapy, gaining almost a normal range of motion, I was a little less than 10 degrees off on flexion and extension, my supination was less than 5 degrees off and everything else was normal. During this time the main problems I had were nerve pain and normal regaining muscle and injury pains. My surgeon stopped my Occupational therapy 6 weeks in because it was starting to get a bit more painful and he said that I was way overdoing it.

All my lovely progress ended about 4 weeks ago. I woke up one morning with my elbow and my arm all the way to my fingers swollen and unable to move. This lasted about 4 days during which my surgeon was out of town and none of his partners would see me. Since then, I have lost quite a bit of progress on my flexion, extension and supination. The pain can get quite excrutiating. I find it frustrating, isolating and debilitating. I lost my job to this injury 4 months ago as I was unable to work full time during the injury and recovery process. 

My insurance coverage, I'm in the states sad, ends in 2 months and has cost me a fortune to maintain. Now my surgeon is saying all the metal and the radial head need to come out of my arm. He said we need to wait 6 months between surgeries so I have 2 months to go in this pain. I am taking college classes right now and at the end of a 2 hour class I am almost in tears from the aching in my elbow, and by the end of the day my wrist is severely swollen and I am unable to use my arm. 

I'm lonely, I sometimes feel like I'm the only one in the world having these troubles. I feel like my life is in limbo with an uncertain outcome. 

2

Charlie, I feel so bad I thought my injury 4 years ago was bad. As hard as it is try and keep your head up...don't give in to the depression that is associated with any type of injury but more so with our type because of the pain, inability to use your arm, and now for you another surgery. Maybe you should try another surgeon. I know when I was in PT my therapist wanted me to twist my hand but my Dr told me I was not allowed for 6 months because when my radial head was crushed it severed the ligaments and tendons too, so I refused until she spoke to my surgeon which he verified what I had told her. I need a total elbow replacement at this point which sounds like what you need to. My radial head was completely replaced but I keep losing extension and flexion and suffer from pain and swelling daily. I was told the best for this surgery, which isn't done on a daily basis for most is the Specialty Surgery Hospital in Manhattan. I am going to hopefully put it off forever, I am 59 and as you can see from this forum not everyone does well after the replacement. Good luck, I feel really bad and hope you have a good family or friends that can help you through the he'll you have gone thru and continue to go thru.

Cathy

3

Thank you so much for the encouragement. My surgeon told me I would have been better off breaking everything else but my elbow. I have been thinking about seeing another surgeon. This whole traumatic injury thing is new to me, and navigating it has been quite scary. My surgeon had me get multiple second opinions before he did the radial head replacement, he also had the head of his clinic scrub in on my surgery. I guess I have felt a kind of loyalty to him through this whole thing, which when I think about it is kind of stupid. I am terrified this pain and swelling is going to be normal for me, I am not great with acute pain. They call it chronic now, but with as excrutisting as it gets, I call it actue still. 

I am 42 and I'm finding it surprising how long I am taking to recover. I am used to hurting myself and shaking it off. Move on, always... I can't move on, and it's killing me. 

What do you do for the pain and swelling? I'm finding that otc pain killers don't even touch this pain and swelling? 

I really hope your elbow miraculously gets better, I would not wish elbow problems on anyone. 

4

Charlie, I completely understand where you're coming from & I really sympathise. I'm now 4 months from dislocating & smashing my elbow plus a fracture in my arm which has been fixed with new radial head & lots of metal in my arm. Like you my swelling varies & I have very little strength in my arm so far. The pain in my hand is horrific but I'm trying to de-sensitise the nerves in my arm as there's definitely Ulnar nerve problems in my little finger & ring finger. The pain isn't really in the new joint but in my upper arm which is very swollen. We all have bad days but try not to get too down. Here in the UK I was told about year for recovery. Are you able to use your hand at all? I've been given lots of hand therapy & they are definitely helping. It's late here so I'm off to bed. 

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Hi Fizzy,

I can use my hand a little, but am unable to hold anything of any weight without shooting pains up my forearm and feeling an intense stabbing pain in my elbow. I had Occupational therapy for a couple of months until the surgeon said I was overdoing it and cut me off. I have very little strength in my arm as a whole and can only carry light things if I hold them to my body with my arm. Even then, holding my arm at 90 degrees with something against my body starts to cause massive pain after a few minutes. 

How are you going about desensitizing the nerves in your arm? Because it is horrific. 

I'm trying to keep my head up. I guess I did not expect the massive depression that came with this injury, it caught me off guard. I know that ultimately whether or not I can use my elbow, I am happy. Things happen that are out of my control and I want to respond in the correct way... but sometimes.... HOLY MASSIVE PAIN IN THE ELBOW.  :-) 

Are you able to work right now? I am taking classes and I find that after sitting with my arm up on a desk for an hour I am almost in tears and my arm Is very swollen. 

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Sounds like you are really over doing it. I know it was between 3-4 until I was able to write again. I still have pain and numbing in my little finger and ring finger and it's been 4 years for me. The pain and swelling is still daily. The only thing holding me back from getting the total elbow replacement surgery is after surgery you are only allowed to lift 5 lbs, right now I have no limit only what my arm will allow which isn't much. I know I was under my surgeons care for 18 months after my accident and yours was similar injury only worse than mine. I would get a second opinion if your surgeon is allowing you to lift, move and twist your arm at this stage, you said 3 months post op with numerous injury to same arm. Not sure where your located, I am in S. FL, but if your Dr has released you or you feel you need another before your next surgery I would try a teaching hospital (Cleveland Clinic) for ortho. This injury is bad enough for years to come with a good surgeon on board I would not want to see the end effects if a not so good surgeon operated. Good luck Charles, when I said keep your head up it wasn't personal, I know I became very depressed about 5 months in.

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Oh Cathy, 

3-4 years of pain and swelling? My heart aches for you. How do you handle that. The thought of having this kind of pain for an extended period of time makes my 42 year old butt want to cry. 

Btw, it's Charlotte, nice to kind of meet you. 😁 

It's hard for me to recognize that I'm overdoing it because I feel like I'm doing nothing. The surgeon had me start doing all of the stuff he did because the Therapist convinced him that if we kept my arm pinned in a 90 degree angle much longer it would fuse that way. I was in a splint or cast at 90 degrees for almost 6 months because all the accidents happened at the same time. She was convinced that I would never use my arm again if I did not start moving it. My surgeon was going to keep me pinned for a couple months, but he caved. 

I live right down the road from OHSU, Oregon Health and Sciences University, one of the best teaching hospitals, and they are tied to the clinic I'm going too. I called them looking for a surgeon back after my 3rd accident and they wanted me to wait 2 months before seeing me, at the time that was unacceptable because my arm was sooooo bad. 

I am worried about the results of having everything removed, and where that will leave me in the long run. The surgeon was talking about my radial bone migrating into my elbow and causing more damage, and he thinks maybe I have a damaged ligament in my forearm or wrist. 

Shoot, if I fall again, I'm protecting my arms at all costs. I'll break everything else but my elbows. 😊 I also struggle with people understanding why my healing is taking so long. I need to get back to work. Being single, unemployed and almost without insurance is terrifying. I kind of feel frozen, not sure what to do or where to go from here. 

And I totally did not take your head up comment personally, I know how important it is not to let this overtake me. It easily could. 

8

I say that we start a cause to get the joint maufacturers to start taking more of an intest in elbow replacement joints. I am amazed at how many people have had such terrible outcomes solely because the joints made are crappy. It's a bummer that elbows are Such an enigma in the medical community. I don't blame you for holding out as long as possible Cathy. If I Knew how to go about starting this cause, how to make it important to them, I would. 

9

Hi Charlotte, after my accident my surgeon said I would have been better off breaking my hips or shoulders in the fall rather than shattering the radial head of the elbow. He called my injury a Triple Triad, saying most surgeons never run across that type of injury..ever. I started following this site after Googling Specialty Hospital of Manhattan when my surgeon told me I was going to need a total elbow replacement. I see what he meant after reading some of the problems pre and post op that people have experienced on this site. A elbow injury takes so long to heal not to mention the after effects you deal with. My arm was in a 90° splint for 6 months, I had better flexion and extension after I got out of my brace than I do now. I still have constant pain and swelling and like you protect my elbow/arm at all cost. I am putting off the replacement surgery because of the 5lb weight limit after, at least now I have no limit but cannot lift heavy objects like before or use it for long periods of time without pain and swelling. I really feel for you as a single woman especially in the time where insurance is so unstable. I myself am originally from Ohio and when the day comes that I have to have the replacement, which will no doubt be due to my elbow locking up, I will travel either up to Cleveland or the NY area. My thoughts are with you during this rough time.

10

That is exactly what my surgeon called my injury, a Triple Triad. The three surgeons I spoke to said they had never seen an injury like it. I never paid much heed to that. I think my brain held on to the term Traumatic Injury.  I still can't quite believe it happened. 

I was out walking my dog at 6 in the morning the first time I slipped, it was terribly icy this winter. I laid in the snow for about 20min before I could move enough to get up and walk home, thankfully my girl never leaves my side and followed me home because holding her leash was out. The second time I fell, I stepped on a roller ball cat toy, and fell feet first down 7 stairs. I laid at the bottom of the stairs again for about 20min before I could get up and get my phone. (The second time I broke a couple fingers and a rib as well) The third time it happened, I was just sitting on the couch and I felt the bone pop up and dislocate. I had never broken a bone, aside from breaking a toe off when I was a child, before this. I've fallen down my stairs a million times, I'm not what you would call coordinated , but I've never hurt myself badly. So I think my brain is still telling my inner self to shake it off and move on, not doing anything is taking some serious getting used too. The one surgeon that was recommended over everyone else to me, could not be bothered to take the time to look at my x-rays and wanted me to wait a month before he would even get me in to be seen. My case was urgent and needed surgery within a week or I would be in trouble, I did a lot of searching and I felt really good about the surgeon I chose. I still like him a lot, but I am starting to think he does not know what he is going to do any more than I. I am stressed because I need to get back to work, and that's a problem right now. Eekk Thank you so much for talking with me about this. It's nice to know I'm not the only one in the world with these issues. My thoughts are with you as well, I sure hope your pain goes away. 

11

Mine happened when I was hanging a shelf on the wall behind my T.V. I had pulled out the stand and when I was done I went to walk away forgetting about the TV wires, I went flying over them landing on my right arm. I saw my arm flatten, it took me about the same amount of time to scoot over to the end table and kick my phone off the table to call 911, then I had to regroup and scoot to the front door and unlock it. I couldn't let go of my elbow because it felt like it was just hanging half attached. Part of the Triad is the elbow is separated. I was in the hospital a total of 6 days. 2 before the surgery and 4 after. They reset my elbow the night of the injury after consulting the surgeon. When I was discharged they told my husband not to allow me out of the house for 10 days other than my Dr appointment a week later because if someone bumped into my arm it could dislocate the elbow and undo everything they did as far as repairs. I am fortunate to have had a Dr familiar with the injury, but every time I went into his office he would grab a Dr in training and tell him/her...this is the Triple Triad I told you about😞 Last time I saw him will be a year this October, he told me then I would end up needing a Elbow Replacement. Obviously this injury doesn't heal like a hip or shoulder. For the first 2 years I used to be afraid the elbow would dislocate, which they said could happen..thank God it never did. I have to be careful how I sleep, my arm has to be at about 30°, if it is straight I have a hard time bending it or if its bent I have a hard time straightening it. That's why I say what will push me into the replacement surgery will be my elbow locking and not able to move it....I will be screaming all the way to the hospital because its painful when you have to try and straighten or bend something that doesn't want to move. Let me know how you are doing when you find out your next step.

12

Hey Charlie,my situation and injury fat less than yours ,had a fractured racial head 14 years ago had orifices with plate and screws ,then had hardware removed and then had a nerve ttansposition and then following much therapy and regained functional ROM for about 6 yrs until about 5 years ago started having complications with bone fragments loose bodies in the joint and osteophytes and PAIN I waited 5 yrs to find a surgeon who would do a arthroplasty and radial head replacement. Now 1 month and a half later all my physicians and nurses and physical therapists again have regained there attitude toward me that I am wrong to still have severe pain with use and exercise of that arm , seeing their faces with loss of compassion and guarded towards me because I am seeking help for the pain is unbearable. Yesterday the physical therapist told me that some people have a radial head replacement and ulnar lateral collateral ligament repair and take to aspirin and never need to take anything else for the pain during therapy,he asked if I had taken something for pain and driven there and then said I could get a DUI for driving ,this feels like punishing me for experiencing pain . I have continued to work after most of these subsequent surgeries with a cast and stopping midway through the shift of nursing to go to therapy for five years and then now 14 years later having had a radial head replacement I am feeling depressed and totally worthless because I guess strong people and courageous people don't need help with the pain 1 and 1/2 months after surgery during therapy.

Thanks Mary

13

Mary, this is a very painful recovery. It's so sad how people are treated today when it comes to pain. You are treated like a drug seeking addict. I was on narcotics for almost 6 months after my surgery and hated every time I went to the pharmacy to have my script filled. I worked as a nurse before my accident which included a radial head replacement and ligament and tendons reattached. After recovery I have yet to be able to return to nursing, even 5 years later. Keep your head up and turn to another Dr for pain control. Surgeons feel you should have pain meds on board for maybe 1-2 weeks post op, my family Dr made sure I was comfortable. You just have to be careful driving to PT if you have taken your meds. Good luck with recovery, depression is a side effect of a traumatic injury but don't let peoples comments bring you down.

14

Wow thanks Cathy, I was also a RN when I fell and broke both my elbows. Do you believe I am a wimp because I am having pain with the use of my arm , and that their are people who have this injury who do not have pain? When he said that it was like a headline that my continual fear that I was a wimp all this time and he just confirmed my fear.

15

I find his comment very hard to believe that people take aspirin after a radial head replacement or they have no pain. They did a nerve block on me after surgery because the pain associated with this surgery is so painful. Sounds like your PT needs to take a Empathy class.

16

Thank you Cathy. Especially thank you for responding. And twice! I started out totally impressed with this PT so when he started to have these responses I Just started to believe that I was in the wrong but leaving therapy and drs offices with the belief that I'm wrong for being in pain and for asking for help with it for during the 6 month recovery time has affected me negatively . It is difficult to continue to choose to do stretching exercises that are to help my recovery knowing the pain that will be debilitating after and then knowing that if i seek help I will only be subjecting myself to more humiliation that will increase my discouragement about progress. Have you found typing or texting equally difficult? Writing, or doing anything just sets me back to doing nothing until pain subsides.

Thank you for responding it really really helps relieve some of the doom. 😊Mary

17

I wasn't allowed to write or turn my hand to the side for 6 months because of the ligament damage and radial head replacement. My arm would be swollen and painful just from writing. I am 5 yr post op and have lost extension and flexion, my surgeon said I need a total elbow replacement. I take Tramadol for daily pain. Cracks me up, we used to give samples away of Tramadol and now they have it a scheduled narcotic because addicts have found a way to abuse it. Pretty soon Dr's will be sending people home telling them to take Motrin after surgery like they did me last month after removing cancer from my breast leaving a 5 inch incision. Please don't be hard on yourself because of the pain you are in. Everyone's pain level is different, this injury isn't your normal..back to no pain after 6 weeks. It continues for some for months and even years.

18

Yes ,these things when I'm feeling manageable also 'crack me up' . I was a nurse for 27 yrs and many of medical professionals are lacking knowledge that I was grateful to have obtained during my nursing career, it is difficult to find a medical professional that I believe I'm seeing eye to eye with, and so I congratulate you on obtaining a physician whom is forward thinking in this day an age to treat your pain without ostracism. I was also told that I needed a total elbow but too young for that severity so they went with the radial head which I am grateful, but I think I would be much more likely to improve if treatment for my pain was considered a necessary part of recovery that is expected to last and increase in intensity over a six month period. Thank you again for visiting with me. It so receives some of the hurt I've experienced in the last couple of days. Finding a dr who is interested in addressing me and my concerns is frightful to me I don't want to go again to someone I had held in high esteem to find that they too believe I should be pain free a month and a half after surgery because that would be even more devastating to cope with.

19

Hey. I was in a really bad car wreck in '79 when I was 9. My right wrist clunked when I rotated it, so they did a suave kupaji (sp) procedure around '92. It fused my ular head and cut out about 1 1/2 inches of my ulna. My wrist still cluncked. It bowed the ulna out and creathed elbow pain chronic tennis elbow. I could not stand the pain anymore, and in April had a capsular release. There was a 3/4 by 1 1/2 bone spur blocking the elbow from moving. I could finally touch my face. One month later at 1st pt visit she pushed my arm up against my body so hard I heard a pop. Doc is afraid to say anything, at first he said nothing was wrong I was stressed. But now he felt the clunking in my elbow and did stress x-ray. Go to 2nd opinion in their office this week but he said maybe radial head replacement with ligament reconstruction. I'm 47 and too young for elbow replacement. Im riddled with arthritis. I've had neck, back and knee replacement already. Total of 24 surgeries. This all sucks. I have a 13 and 8 year hard to take care of my babies. School starts back in 2 weeks. I understand your pain and isolation, but you are not alone!!!