Elbow injury... advice and healing procedure suggestions please

July 14, 2014 8:05 AM

I injured my elbow or forearm while bouldering (climbing at relatively short heights without a rope). I have never had an elbow or arm injury and need some advice on a) what I may have done and b) how to manage it while it heals. Main points: I have gone to a doctor, x-rays were taken, as expected the arm is not broken, nothing further was done at the doc's office. I think it was a purely rotational injury, not compressional. Plenty more details under the cut.

First and foremost, I understand that none of you are my doctor and nothing you respond with should be taken as medical opinion or advice.

Here's the (long, sorry) story:
Friday, 6/27, Bouldering at a gym, about at ~20 ft off the ground. Reaching for a difficult final move, got the hold with my left hand but was off balance and started rotating to my right off of the wall. For a very brief period almost all of my weight was on my left hand on the hold as my body was rotating out from the wall. Let go of the hold and dropped to the mat. Everything landed okay, but because I was still turning I put my left hand down on the mat to keep my balance. There was very little weight on the hand, but my arm/elbow definitely twisted, and I picked my hand up as soon as it felt wrong but clearly didn't completely avoid damage. I absolutely do not think there is any damage from compression, just rotation--I barely put any weight on the left hand at all, it was only to stabilize.

It hurt pretty sharply immediately, but I didn't feel a pop or anything obvious, just some fairly sharp pain that lasted maybe a minute. It calmed down really quickly. No obvious bruising and no swelling as far as I could tell, but it's difficult for me to measure because my right (dominant) forearm is normally kind of significantly bigger than my left, so who even knows if my left swelled at all.

I kept climbing (possibly like an idiot), but it didn't hurt at all. Iced it when I got home and took Ibuprofen, little bit of pain but nothing serious. The next day I'm bouldering outside with no incidents, pretty long day of climbing (maybe 4 hours total of serious work). It didn't even really hurt except for a couple of times and it was minor. The day after that I climb at the gym and it starts to hurt, but again, nothing too terrible. However, the day after THAT it was really angry, so I'm like yeah I fucked up and decide to baby it (still icing, anti-inflammatories, trying to immobilize it as much as possible).

I baby it the entire week. I mostly only piss it off in my sleep--tried wearing a brace (too uncomfortable/compresses too much) and a sling (took it off in my sleep literally every time). I go climbing a week from the initial incident (7/4) again but I'm nice to it. It is a very brief session as it starts to hurt again. A couple of days later (7/8) I go to the doctor, get the x-rays, they're fine, the advice is basically what you'd give for any ligament tear (R.I.C.E.).

I'm not climbing on it anymore, but Saturday (7/12) I went on a 33 mile bike ride. Didn't think this would bother it to much as I wasn't exactly using it, but yesterday it was probably the angriest at me it as ever been. I sat in on the couch all day and tried not to use it.

Now it's stiff and painful with the typical symptoms it's had the whole time, but most concerning to me is the fact that my left hand feels kind of numb/fingers seem swollen. It's only been 6 days since I saw the doc but I feel like it just keeps getting worse.

I marked up this diagram with where the pain is.
Main symptoms: SEVERE pain (7-8/10?) when flexed beyond 90 degrees, getting progressively worse as you bend it more. I cannot bring food up to my mouth and putting my hair in a ponytail is very difficult. Putting on a bra is terrible. Full extension of the arm hurts too. PULLING things toward myself (doors mostly) is VERY painful as well (7-8/10), I think the act of gripping things while the arm is extended and trying to pull inwards makes it like 5x worse. It's easy to tweak even while doing things like typing. The limit of what position it likes to be in and one that pisses it off seems to walk a very thin line. After sharp pain a more dull pain usually follows. Lately the dull pain is constant. It also feels just generally stiff and unhappy. Now my main concern is what feels like slight numbness in that hand. I'm not sure if this could be a side effect of a 33 mile bike trip, though.

What I've been doing for it:
I've been treating it like what I know to do for a ligament tear. Resting, icing in 15 minute increments, but not doing any heat at all. Ice feels nice, I haven't tried heat. It's hard to elevate and immobilize, but I am trying to keep it immobile, which isn't working all that well. Ibuprofen honestly doesn't seem to do a damn thing. The doc told me I can take 400-600 mg 3x per day if I want as long as I am not doing it on an empty stomach but it didn't help at all on pain so I cut back to 400 mg 2x per day maximum, usually only taking the 400 mg in the morning.


So I guess my main questions are as follows:
1) Do you have any idea what might be wrong/how concerned should I be?
2) Do you have any advice for longer term treatment (if likely something minor--small tenon/ligament tear etc) or short term treatment while I try to figure out when I can get to a doctor?
3) If I should be keeping it as immobile as possible, do you have any advice for how to do this (esp. overnight)?
4) If you think I do need to go to the doctor again, who should I ask for? They keep saying they can get me to an osteologist but I thought that was pointless because there's no indication it's broken?


Thanks for any help you can give. The joint and forearm muscles/ligaments/tendons are more complicated than I can figure out and I have no firsthand experience with injuries to them.

posted by six-or-six-thirty to Health & Fitness (9 answers total)

What type of doctor did you go to? Have you seen an orthopedist?
posted by gudrun at 8:25 AM on July 14, 2014

Response by poster: Unfortunately I am on the student health insurance, so I just went to our general Student Health Clinic. I don't think most of them have a particular area of expertise. We have a sports medicine department, who I wanted to be transferred to, but I guess they're not around during summer.

I have to do everything through our clinic and they haven't been very helpful on telling me who I should go to. An orthopedist is probably who I want to be referred to?
posted by six-or-six-thirty at 8:28 AM on July 14, 2014

If I'm understanding your post correctly, this is not on your dominant side, correct? You might try just wearing a cheap immobilizing sling (can buy these at most pharmacies if your SHC doesn't provide one) for a bit to keep you from accidentally overusing/re-injuring that arm while it heals.

When I injured my non-dominant arm, my biggest problem while healing was reaching forward too far while typing and pulling on the injured tendon. So be extra aware of how you position your arms while typing and make any necessary ergonomic adjustments to your computer area.
posted by Jacqueline at 9:05 AM on July 14, 2014 [1 favorite]

Best answer: I recently broke my elbow and yes, bike riding is one of the most painful things until I regained full strength and range of motion. Not surprised it hurt.

In early acute injury recovery you are looking for pain free range of motion. Immobilization is useless. If whatever it is you are doing hurts, stop immediately. I would avoid heavy weight lifting and weight bearing through the arm (carrying groceries or a stack of heavy books aggravated my injury). Bras actually are a weight bearing activity due to the force required to stretch the elastic. Similarly, zippers require weight as well.

Finally in early recovery you can do the following mobilizations:
- extend arm fully and then bend arm to pain free range. 90 degrees is fine to start, I progressed relatively quickly and regained full range after several weeks.
- elbows at your waist, touching your body. Bend your arm so your Palm is face up. Rotate your palms face up to face down, pain free range of motion. Do not let your elbows move from your sides.

You are looking at 30 reps 3x daily.

In addition, you can mildly stretch your elbow 3x daily. You are looking for mild intensity 2-3/10. Extend your arm in front of you, Palm up. Use your other hand to push down on the fingers of the outstretched arm, bending fingers back towards your body with the elbow in full extension.

Once you no longer need so much rest, ice, anti inflammatory (ie, acute phase has passed) you can apply a bit more force in mobilizations to get your range back but now is not the time. Take it easy and return to activity slowly.

Take the referral to whatever doctor but for now put the REST in RICE with limited weight bearing and start mobilizing. Wear a sports bra and ditch your jeans, wear dresses and leggings. Don't lift anything much heavier than your phone if it hurts and definitely do not put weight through the extremity. Moving the joint is much less stressful than weight bearing.

If you are really resting your arm you will need a friend to help you open jars or other activities that require two arms simultaneously applying force.

Start really resting and see what that does. You don't need a brace for that.
posted by crazycanuck at 9:08 AM on July 14, 2014 [1 favorite]

I am by no means an expert, but yeah, I would be going back to the Health Clinic and pushing them to refer you to an orthopedist. You may need an MRI, as an X-Ray is not enough to diagnose non skeletal issues. (The long bike ride was a big mistake. You absolutely use your arm/elbow when riding a bike.) Most of crazycanuck's advice is sound, but I would see an ortho doctor at least once before you proceed much further. The numbness may be because of the swelling, but you should get things checked out. (Cautionary tale - my husband has a permanently messed up tendon in a finger because he put off going to an orthopedist or dealing with it for too long.)
posted by gudrun at 9:21 AM on July 14, 2014 [1 favorite]

Climbing injuries are really quite specific, although yours (not a finger injury) might be less so. It's probably a good idea to see the sports med people once they return (summer doesn't last forever!).

There is a big debate about using RICE vs MEAT for injury healing, see e.g. here. That having been said don't climb on it too early or too hard! Almost every single climber I know has a story of "that nagging finger issue took 6 months to heal because I couldn't stop climbing"... don't do that to yourself. (I know, it's addiciting, but think of it this way: you'd rather get to the end result where you can climb without issues, yes? Better to wait and be able to really climb again than to have a chronic issue.)

Climber's magazines often have articles on injury prevention, and there are several dedicated websites specifically written for climbers.

Also I personally don't take ibuprofen very often, once upon a time there was some mention of it hampering soft tissue injury repair. No idea how accurate that is, but you might look into it before taking loads while trying to heal.
posted by nat at 10:42 AM on July 14, 2014 [1 favorite]

Response by poster: Thanks so much for the advice, all, especially re: what (not) to wear/things not to do and range of motion exercises. It is very clear to me now that aside from big things like ill-advised bike trips I clearly was not even resting it adequately day to day. I guess there are just a lot of things I was using my arm for that I didn't think about and they all kind of added up, you know?

Did two sets of the range of motion exercises crazycanuck suggested yesterday and was nice to it all afternoon/evening (no jars/bras) and to be honest it's feeling incredibly better this morning. Also, my hand doesn't feel as numb.

My only remaining concern (and reason I am probably still going to the doctor about it sometime soon) is that, when doing the elbow-bendy stuff, I get that gentle sort of 'pop' that feels like something (like a ligament--not saying it is, just trying to describe) is sliding irregularly over bone or something. Not like I'm tearing/hurting anything but like somethings out of whack. That happened a lot with my knee after my ACL surgery though so not quite sure what to do with that info.

Anyway, thanks again. Got some more reading to do now just out of curiosity (RICE vs. MEAT especially 'cause I've always wondered--thanks nat!) and a doc's appointment to organize.
posted by six-or-six-thirty at 6:19 AM on July 15, 2014

Query doctor or physio on joint popping. We can't tell you if that's significant or not.

The exercises that I suggested to you were the exercises prescribed to me 3 days post elbow fracture by physio after the doctor cut off my splint. I definitely would have queried physio on the popping before continuing. For now, your options are to do the exercise to the range just before the joint pops, stop the exercise and try again in 24 hours, or stop the exercise entirely and wait for medical assistance.

I suggest you find a physiotherapist to help you with the rehabilitation process. You will need physio in addition to the doctor. You might want to look into your insurance coverage.

Even though I referred to the REST in RICE in my post, I actually described mobilizations that are the M in MEAT. Mobilization generally means pain free range of motion, not going about your daily business as if you are not injured.

The advice I received from the doctors was that although I was banned from any weight higher than the phone (you're not), I should be moving my arm as much as possible. And it is easy to get creative in moving your arm around without actually lifting anything with it. Lots of things you do are stabilized with two hands - holding vegetables while you chop, stabilizing your socks while you pull with the other hand, connecting your charger to your phone, etc. The tip is to not actually grasp anything in the affected hand - just lean your flat palm to stabilize and you won't be lifting or forcing the thing.

Since you are not banned from weight bearing then you should resume lifting pain free as soon as possible. Start small, like peeling tomatoes and moving soup cans, then go from there. I bet you will progress fast with rest, doctors advice, and physio.
posted by crazycanuck at 4:01 PM on July 15, 2014

Response by poster: I feel like I should update this for posterity/diagnosis for potential future readers so here we are.

Got to the orthopedic doctor (thanks guys), he made a lot of unpleasant faces as he was bending my arm around and I was telling him my symptoms, asked me what I thought it was, I said ligament, he said 'sounds about right'. I think he was trying to keep things a little close to the chest but he kept sort of nodding more and more grimly as this went on, which was both hilarious and upsetting.

Three days later get an MRI, docs have looked it over, I tore my UCL. Increased numbness sporadically in the palm/fingertips and an intense burning pain on the outside of the elbow joint and in the hand, weirdly enough. Pain disturbing sleeping and generally blowing really hard at all times despite being prescribed and taking NSAIDs.

Before the MRI doc recommended (being as we didn't 100% know the status of anything) doing mostly just straightening exercises, trying to fully extend slowly, hold for a while, relax, etc.

I was initially pretty upbeat because the diagnosis from the MRI scans was 'minor ligament tear' despite some bits apparently being a little difficult to determine, but looking things up it seems like the UCL doesn't heal itself well, like at all. And things suggest if you're having continued pain and nerve issues you should get it legit surgically fixed.

Heading back to the doc next Wednesday to discuss options. Understandably he doesn't really want to say much future-treatment-wise over the phone so I won't know his recommendation (PT/surgery) until then, though I have some pretty hard suspicions in the surgical direction. We'll see.

Thanks for all of your help. Yet another scenario of I-probably-know-deep-down-I-should-just-go-to-the-doctor-because-this-seems-bad-but-I-need-people-to-convince-me syndrome.
posted by six-or-six-thirty at 9:15 AM on July 25, 2014