What happens as I recover?
Bone takes six weeks to heal to 50% of its normal strength, three months to achieve 80% strength, and continues to get stronger for up to 18 months post injury. If casting was the primary treatment it may be continued for six weeks. After six weeks the ongoing use of braces or slings may be advisable for selected operative and non-operative cases. X-rays will be taken to assess the progress of healing and rehabilitation with a physiotherapist at Peak Physical Therapy will begin as soon as your orthopaedic specialist deems it appropriate to begin. Generally physiotherapy can begin once the cast or splint is removed around 6 weeks post injury. While you are immobilized simple finger and shoulder movements, will be your only exercises. If your wrist is not fully immobilized, gentle bending, rotation, and gripping exercises will be encouraged.
If you have had surgery to fixate your elbow fracture then rehabilitation at Peak Physical Therapy will begin as soon as your surgeon recommends it. Again, based on normal bone healing, this is often around the 4-6 week mark. Surgical fixation aims to make the fracture site stable therefore in most cases the gentle exercises mentioned above for your fingers, wrist, and shoulder are safe to do early on and will often be recommended even immediately after surgery. In some cases, however, no exercise will be recommended until after the bone has shown some evidence of healing on X-ray; finger and gentle shoulder movements are the only exercises permitted. Each surgeon will set his or her own specific restrictions based on the type of fracture, the surgical procedure used, personal experience, and whether the fracture is healing as expected.
Even if extensive physiotherapy for your elbow does not begin immediately, at Peak Physical Therapy we highly recommend maintaining the rest of your body’s fitness with regular exercise. If your elbow has been surgically repaired, maintaining general cardiovascular fitness can be done with lower extremity fitness activities such as walking or using a stationary bike or stepper machine.
After surgical fixation, weights or weight machines for your lower extremity and opposite arm are also acceptable to use as long as the restrictions regarding your healing elbow fracture are strictly abided by. Generally, lifting even light weights with your injured limb will not be allowed and will be difficult as your elbow heals so you may require a friend to assist you with your workout setup if you are keen to continue while your bone heals. Your physiotherapist at Peak Physical Therapy can discuss the most appropriate way for you to maintain your fitness as well as provide a general fitness program specific to your needs while abiding by your doctor’s restrictions.
When the cast is removed or following surgery, you may experience some pain when you start to move your shoulder, wrist, elbow and forearm. This pain is from not using the joints regularly and also likely from concurrent soft tissue injury that occurred when you fractured your elbow. If you have had surgery, the pain may also be from the surgical process itself. Your physiotherapist at Peak Physical Therapy will focus initially on relieving your pain. We may use modalities such as heat, ice, ultrasound, or electrical current to assist with decreasing any pain or swelling you have around the fracture site, anywhere along the forearm, or into the shoulder or hand. We may also use massage for the neck, shoulder, elbow, forearm, or wrist to improve circulation, assist with the pain, and make moving the entire upper extremity easier.
The next part of our treatment will focus on regaining the range of motion, strength, and dexterity in your wrist, hand, elbow, and shoulder. If you have been casted or splinted, your arm will look and feel quite weak and atrophied once this is removed. Your physiotherapist at Peak Physical Therapy will prescribe a series of stretching and strengthening exercises that you will practice in the clinic and also learn to do as part of your home exercise program. These exercises may include the use of light weights or Theraband for resistance work of your wrist, elbow and shoulder. Soft balls or gripping devices may be used to encourage the return of your grip strength. Regularly measuring this strength with a hand-held dynamometer will be one of the ways we determine the progress of your rehabilitation at Peak Physical Therapy.
If necessary, your physiotherapist will mobilize your joints. This hands-on technique encourages the stiff joints of your elbow, and wrist to move gradually into their normal range of motion. Early mobilization and range of motion exercises are particularly important in the rehabilitation of the elbow as without them, a fractured elbow can easily become stiff and lose important range of movement. Regaining the ability to bend your elbow and rotate your forearm is crucial in order to be able to do simple daily activities such as bringing food to your mouth or holding change in your hand. Regaining elbow extension, while also important, is not as crucial to the activities of daily living in comparison to elbow flexion. In other words, losing some extension of the elbow due to stiffness following an elbow fracture will not affect your everyday function as much as the loss of elbow flexion. That being said, for those participating in sport, loss of any elbow extension can be extremely detrimental to the functioning of their upper limb and can severely limit them in the participation of their sport. For this reason, the return of full elbow range of motion, in any situation, is one of the goals of physiotherapy at Peak Physical Therapy. We will keep a close watch on the improvements in your ability to bend and straighten your elbow as well as rotate your forearm by measuring these angles repeatedly over time.
You will notice improvements in the functioning of your elbow even after just a few treatments with your physiotherapist at Peak Physical Therapy. As your range of motion and strength improve, we will advance your exercises to ensure your rehabilitation is progressing as quickly as your healing fracture allows. Graduated heavier exercises and endurance work will be added in concordance with the known healing time of bone in order to ensure these stresses can be withstood.
As a result of any injury, the receptors in your joints and ligaments that assist with proprioception (the ability to know where your body is without looking at it) decline in function. A period of immobility will add to this decline. Although your elbow is not traditionally thought of as a weight-bearing joint of the body, even an activity such as assisting yourself with your arms to get out of a chair, pulling a glass from a cupboard, or pushing a door open requires weight to be put through your elbow and for your body to be proprioceptively aware of your limb. If you are an athlete, then proprioception of your upper extremity is paramount in returning you to your sport after an elbow fracture. For this reason, proprioceptive exercises will be part of your rehabilitation regime at Peak Physical Therapy. Proprioceptive exercises might include activities such as rolling a ball on a surface with your hand, holding a weight up overhead while bending and straightening your elbow, or pushups on an unstable surface. Advanced exercises may include activities such as ball throwing or catching. For athletes we will encourage exercises that mimic the quick motions of the sports or activities that you enjoy participating in. Your physiotherapist at Peak Physical Therapy will liaise with your surgeon regarding the optimal time to start any of these advanced proprioceptive exercises.
Generally, the strength and stiffness one experiences after an elbow fracture responds extremely well to the physiotherapy we provide at Peak Physical Therapy. In regards to returning to activity, most elbow fractures require some limitation of activity for at least three months. People who undertake heavy manual labor or participate in sports that load the arms may take considerably longer. As explained above, some elbow fractures are more complex with joint surface damage, multiple bone fragments, or lost blood supply to bone fragments. These complexities all cause the process of healing and rehabilitation to take longer, and full recovery of range of motion and strength is not always possible which then affects the overall long term functioning of the joint.
Fortunately in most uncomplicated elbow fractures your elbow will return to near normal levels of performance. With our initial one-on-one physiotherapy treatment along with the ongoing exercises of your home program, the strength, range of motion, endurance and proprioception gradually improve towards near full recovery/function over a period of 4-6 months even though the actual final stages of bone healing won’t occur for another 12-18 months after that. If, however, during rehabilitation your pain continues longer than it should or therapy is not progressing as your physiotherapist at Peak Physical Therapy would expect, we will ask you to follow-up with your surgeon or doctor to confirm that the fracture site is tolerating the rehabilitation well and to ensure that if you have had surgery, there are no hardware issues that may be impeding your recovery.