I'd give my right arm to make my elbow work properly again

April 13, 2021 10:29 AM

I broke my right elbow badly in May 2019 and while I feel pretty damn functional overall, I don't have my full range of motion and can't fully straighten my right arm and lock my elbow. Biomechanics experts: are there ways I can make increased muscle strength partially compensate for this issue?

I broke my elbow into several large pieces and a lot of dust after falling down a concrete staircase 2 years ago. It was surgically corrected immediately, but as healing and rehab proceeded after my cast came off, it was obvious that my elbow joint was hitting a hard lock in both extension (straightening) and flexion (bending). While there has been some cartilage degradation, this hasn't led to any pain. I used a JAS device faithfully for months and got as much range of motion as I'll ever get from soft tissue work.

Bending my arm isn't perfect, but I am in the 130-140 degree range and can wash my face and hair, scratch my right ear, touch the nape of my neck, put on and off a bra, hold a phone to my right ear, etc. We're good there!

I'm still at least 30 degrees off full extension, which makes reaching for high/distant things more of a challenge than usual for 5'1" me, but I can ride my bike comfortably and can carry reasonably heavy loads in my right arm. I have no problems supporting my body weight on my right forearm with my arm bent about 90 degrees.

What I can't do is support much weight on my extended-ish right arm with my right hand on a vertical or horizontal surface. It feels as if my inability to lock my elbow is the main challenge as my arm feels reasonably strong in other ways and my right forearm muscle mass seems at least equal to my left forearm. I think I even have slightly increased muscle mass -- a tiny hump -- at the top of my right wrist. (It's not inflammation, I think, as it doesn't hurt.)

So should my goal be to really work on my forearm strength and perfect my Popeye impression? Would additional tricep/bicep strength also help? What should I or shouldn't I do next? (I have started using my JAS brace again for extension only, so that should help with any regression in soft-tissue-related ROM.)

posted by maudlin to Health & Fitness (4 answers total)

Oh wow, that is a lot to deal with. I would not do one single thing toward trying to rehab this on your own until you talk to a physical therapist who can advise you, because it is so easy to mess up injury recovery (possibly permanently!) by doing the wrong thing. The specifics of how physical therapy is conducted vary from place to place but whichever doctor helped you with the initial break should be able to help you figure out how to get services from a specialist.
posted by corey flood at 11:42 AM on April 13, 2021 [4 favorites]

I don't have a specific recommendation for your specific issue, but I severed the tendons on the back of my left wrist and had them reattached - lost a fair amount of range of motion.

It took time for me to learn my new limits and new ways of moving, maybe a couple of years, before I stopped being completely clumsy with my left hand (dropping things, knocking stuff over, etc.).

So time and use will help. Personally, I would work on stretching as a priority especially if you're trying to improve strength.

If you can afford it or its otherwise covered, professional physiotherapy (or kinesiology) can analyze your specific situation and make more concrete recommendations (and follow up to make adjustments to those recs over time as you progress!).
posted by porpoise at 1:09 PM on April 13, 2021

I had an arm break in 2 places and was in a cast for 11 months. My arm would not extend so I started swimming every day with a kick board. I slowly extended my arm straighter over the course of 6 months until I could extend it straight. I just changed the position on the board by a few millimeters at a time. Also did a few laps doing breast stroke in between kick board laps. My surgeon was impressed by the progress I made without professional physical therapy which I couldn't afford.
posted by a humble nudibranch at 2:26 PM on April 13, 2021

Response by poster: Thanks for the feedback so far! I deleted a lot of extra text from my original questions, so I'll put it back here for clarity.

- I had my accident on a Friday night in a small town in Alberta which, luckily for me, had a small hospital with an excellent emergency department just blocks away. They confirmed the scope of the injury that night, got me out to the Red Deer hospital the next day, and I was in surgery first thing Sunday morning, then discharged Monday. I flew back to Toronto on Thursday.

- I went through several months of professionally guided rehab in Toronto to get some range of motion and strength back. My local orthopaedic specialist was very pleased with the gains I made, which exceeded what he expected given the severe nature of my injury. (My original surgeon in Alberta had looked very grave as I was discharged, calling what I'd gone through "a life-changing injury".) When I wrapped things up with my PT and specialist at the end of that year, I was advised to keep using weight training, in a sensible manner, to increase my strength. I'm not trying to do anything belong my limits here.

- Additional stretching is probably good maintenance, as I don't want to to lose what I have achieved. However, I do not expect to see huge differences in my range of motion because even if I can get the world's most fluid and flexible muscles, tendons, and ligaments, I will still never achieve full ROM because my reassembled bones don't fit together perfectly any more. This video shows just how much goes into a smoothly moving elbow joint. My elbow will never work like that again even though my Alberta surgeon did a really, really good job.

- I am pretty damn happy with almost every way my badly traumatized elbow works now. The one thing that feels like a real limitation is my inability to hold up even a fraction of my body weight with my extended right arm. This is why I was asking for input from anyone with some knowledge of arm mechanics.

So here's my rephrased question: As I keep (carefully, sensibly) working on increasing my upper body strength, can I potentially get strong enough that holding up much more of my weight on a slightly flexed elbow is possible? This 1999 research paper (PDF) on C5 and C6 quadriplegics suggests that "generating shoulder and wrist flexor moments" could help prevent collapse when the elbow is flexed significantly, but I don't have the expertise to interpret this paper appropriately. Once I feel more comfortable going out to non-emergency medical appointments here (THANKS, DOUG!), I'll certainly ask my PT about how far I can take things. For now, I'm keep to a moderate strength training routine and trying to satisfy my curiosity.
posted by maudlin at 3:35 PM on April 13, 2021