Restoring Range of Motion After Elbow Replacement

Total elbow replacement refers to a surgery that creates an artificial joint. Damage to your elbow can initially occur from badly broken bones, severely torn tissues, a tumor in or around the elbow, rheumatoid arthritis or osteoarthritis, or unsuccessful previous surgery.

Your normal elbow joint is comprised of two bones–the humerus in the upper arm and the ulna in the lower arm. When the joint is significantly damaged, surgery is usually required. The artificial elbow joint has two stems of metal, joined by a metal and plastic hinge to allow movement. While most total elbow replacements are successful, surgery can involve significant bone removal, nerve and blood vessel damage, dislocation of the artificial joint, allergic reaction to the new joint and joint loosening over time.

Although the prognosis of elbow replacement surgery is good, physical therapy can be the missing piece to help you regain strength and full range of motion in your arm. Typically, individuals wearing a splint begin physical therapy a few weeks later than those who do not wear a splint.

Initially, you will perform gentle motion exercises. When appropriate, strength training can begin, targeting muscles in and around the elbow to help you regain normal movement. Exercises and treatments may include

  • light grip strengthening to start
  • active elbow and wrist exercises in the second phase
  • flexibility techniques for wrist, elbow and shoulder
  • strategies to relieve pain, inflammation or swelling

When a physical therapy program is planned early on, mobility can significantly improve–with use of the new elbow–as soon as 12 weeks after surgery. Although full recovery can take up to a year, the process is generally much more effective when physical therapy is a consistent part of therapy.

Dedication is key to successful rehabilitation. We can devise an appropriate exercise program to strengthen your elbow.

Arm Yourself After a Distal Radius Fracture

A distal radius fracture–a break near the wrist in the largest forearm bone–is one of the most common injuries of the forearm. The fracture often occurs when a person falls onto an outstretched hand. Other causes include direct impact or axial forces. Treatment depends on such factors as the exact nature of the fracture, your age and health, and previous activity level.

Both surgical and nonsurgical approaches are used to treat a distal radius fracture. If the alignment is reasonably correct, a cast is typically recommended to be worn for approximately six weeks before you begin physical therapy. Surgery is usually called for when the bones must be repositioned to improve their alignment.

It is standard treatment to receive physical therapy for a distal radius fracture–whether you wear a cast or receive surgery. This is because it is considered critical to

  • gently get your wrist joint moving comfortably again
  • prevent stiffness in your fingers, elbow and shoulder
  • ease you back into normal activities

Most patients regain most of their movement if they follow a physical therapy program and aftercare instructions from their doctor. Permanent pain is unlikely, and you can expect to return to normal recreation and work activities.

Generally, intra-articular fractures, which can result in stiffness, pain and a risk of developing arthritis, are the most limiting. For these cases in particular, physical therapy can provide the most significant improvement in rehabilitation after a distal radius fracture.

While active contact sports should be postponed for approximately four months, we can design an individual program that includes functional activities such as bike riding and swimming. By following a carefully designed physical therapy program, you can expect to recover from a distal radius fracture.

Must Arthritic Knees Be Replaced?

If your doctor says you have arthritis in your knee, does that mean you will need knee replacement surgery? The short answer is not necessarily. Fortunately, your body can compensate for the loss of function caused by arthritic damage to cartilage and bone in a knee joint, even if x-ray evidence seems to indicate that the arthritis is severe.

Strong hip and thigh muscles compensate for the knee’s possible weakness as you walk and move about. Individually tailored exercises strengthen these muscles, as well as improve flexibility and range of motion in the affected knee.

Other strategies, too, will lessen pain and reduce the possibility of surgery. These include

  • losing weight if you are overweight
  • avoiding activities that give you particular trouble
  • taking anti-inflammatory medications (if your physician prescribes)

Supportive devices–ranging from knee braces or sleeves to energy-absorbing shoe inserts to canes–also can play an important role in lessening arthritis’ impact. We can, for instance, evaluate your particular arthritis presentation and recommend one of the two main types of knee-stabilizing braces that is right for you:

  • A support brace helps support the whole knee joint and helps evenly displace the weight, or load, you put on your knee with each step.
  • An unloader brace, especially useful if the arthritis affects one side of the knee more than the other, shifts load toward the healthier side.

We have other ways to reduce knee pain, as well, such as ultrasound to help increase blood flow to the surrounding muscles and heat and cold therapies, alternating, if necessary.

Physical therapy can be a powerful tool that may help you avoid invasive surgery to treat arthritis. An exercise regimen tailored to your needs and abilities can help you achieve your goals.

Training in Planes

Many trendy buzzwords and catch phrases are often used in fitness circles, with the phrase “training in planes” heard quite frequently. The concept, which has nothing to do with aviation, sounds interesting, but what does it really mean?

Simply put, every move we make involves one of the following three planes of motion in the body: the sagittal plane, which involves a flexion or extension, such as squatting, walking or pressing a weight overhead; the frontal plane, which is an abduction or side flexion, such as a lateral arm raise or a side bend; and the transverse plane, which involves a rotation, such as a golf swing, a swing of a baseball bat or a throw.

The aim of training in planes is to prepare the body for any movement during activities, whatever they may be. Training in planes

  • exercises the body in a balanced manner
  • builds functional strength in virtually every major muscle group
  • keeps all movement in proper proportion
  • helps the body move more effectively because it emphasizes movement in three dimensions

Another important benefit is that training in planes usually benefits the core muscle group, also known as the midsection, which provides the basis for a person’s ability to move. This aids virtually everything we do, giving us strength, agility, balance and body control.

We will be happy to meet with you to develop an exercise program that involves all three planes and benefits your core muscle group while meeting your individual needs. Your body will thank you as it moves through its daily activities with increased agility, stability, endurance, strength and general fitness.

Physical Therapy for Skier’s Thumb

Thumb injuries are quite common, especially among skiers. During a fall, a skier’s thumb can easily catch against the ski pole, resulting in a tear of the ligament that stabilizes the thumb. This ligament, known as the ulnar collateral ligament, normally keeps the thumb from pointing too far away from the hand. When it is injured, typical symptoms include pain, bruising, swelling over the torn ligament and weakness when grasping objects.

Treatment depends on the extent of the tear. To repair a partial tear, wearing a cast or modified splint for four to six weeks might be sufficient. For a full tear, especially where a person experiences significant instability, surgery may be needed to reattach the torn ends of the ligament.

Usually, surgery performed within the first few weeks following the tear offers the best outcome. A cast afterwards provides protection while the torn ligament heals. This is an ideal time to see us to design a rehabilitative program. After your cast is removed, gentle motion can usually start. Suggested exercises typically focus on helping you to

  • normalize strength
  • regain flexibility
  • enhance coordination
  • improve range of motion

By following the program, you can expect to return to skiing or playing sports approximately three to four months after surgery. It is crucial that you avoid stressful postures or any direct forces during the rehabilitation phase to give the ligament enough time to properly heal.

Once you add physical therapy exercises to your treatment regimen, you can expect to get back into skiing and other sports soon. We can address your particular needs and help you attain your goals.

Elbow Excellence Through Tommy John Surgery

One of the major advancements in sports medicine in the last 35 years, surgical repair of the ulnar collateral ligament (UCL) is named for Los Angeles Dodgers pitcher Tommy John, the first person to successfully undergo the procedure in 1974. John returned to the mound two years later.

This procedure, invented and pioneered by Dr. Frank Jobe, reconstructs a torn UCL by using a tendon from somewhere else in the body, such as the forearm or hamstring. The UCL, along with the lateral collateral ligament, gives the elbow stability. Before this operation, pitching careers usually ended when the UCL was damaged. The surgery is now common among collegiate and professional athletes in several sports, most notably baseball.

Tommy John surgery is necessitated when these two ligaments, which connect the humerus (the bone of the upper arm) to the ulna (the larger forearm bone), are

  • torn by injury or dislocation
  • damaged or overstretched from improper healing of an injury
  • stressfully overused, as would be typical of a college-level or professional pitcher

As important as the surgery itself is the rehabilitation period, which–to return to the previous level of expertise–can last approximately a year for pitchers and about six months for other baseball players and athletes. After a week to 10 days during which the elbow is immobilized, rehabilitation includes working back to a full range of motion, followed by gradual strength training at about four months postsurgery. Also crucial during this period are exercises to improve flexibility and coordination, as well as aerobic conditioning to improve overall fitness.

Contact us before surgery and then when you are ready to begin the physical therapy phase of your recovery. We can devise a course of exercises that will get you back on the athletic field, physically fit and ready to pitch strikes to retire the opposing team in short order–perhaps, winning the game!

Navigating Recovery After a “Ship” Fracture

A scaphoid fracture refers to a fracture of the wrist–specifically the bone shaped like a boat, which is why it is often called a “ship” fracture. A fracture of this bone can result from falling on an outstretched arm, sustaining a direct blow to the wrist or receiving a severe twist of the wrist.

A scaphoid fracture is commonly missed, which can lead to long-term weakness and a poor hand grip. For this reason, it is important to receive early diagnosis, treatment and physical therapy.

If you initially suspect a broken wrist, see a physician immediately for an x-ray to assess whether your scaphoid bone is involved. Treatment depends on the location, fracture type and fracture location in the bone. Because the scaphoid bone has an unusual shape, blood supply can be obstructed, thus slowing down the healing process. For those patients who suffer from delayed or poor healing, surgical intervention may be needed to ensure bone fusion.

If you undergo surgery, your wrist will be placed in a cast and then in a splint for several weeks afterwards to hold the bones in place as they heal. Once your cast has been removed, it is important that regular physical therapy be performed on a gradual basis, to enable you to slowly return to previous physical activities. For some people, this process may take one month while for others it may last longer.

Physical therapy facilitates recovery from a scaphoid fracture through exercises that promote stability, along with stretching and strengthening. These exercises will help to

  • improve your range of motion
  • reduce stiffness from immobilization after surgery
  • build strength
  • increase coordination

With our support, most patients can expect a positive outcome after treatment for a “ship” fracture. Since so many daily activities require use of the hand, we can design a program specially suited to your rate of recovery and your individual requirements.

The Case of the Wandering Kneecap

Kneecap dislocation occurs when the patella, or kneecap, slides to the outside of the joint, thus stretching and possibly tearing the ligaments that hold it in place. The patella is probably the most commonly dislocated bone in the body, with kneecap dislocation occurring most often in teenage athletes and adult women.

Kneecap dislocations fall into two categories. Those involving an accident, such as a blow to or a twisting of the knee, are called traumatic dislocations. Atraumatic dislocations occur when the person is “loose-jointed” or the kneecap is misaligned (tilted or shifted), thus making the joint less stable.

 

 

Symptoms of a dislocated kneecap include

  • bleeding under the patella
  • bruising around the patella
  • swelling of the kneecap
  • tenderness along the edge of the patella
  • pain and clicking when the patella pops out of its groove and then moves back into place
  • actual dislocation of the patella when it moves out of the groove and gets stuck out there

Surgery is required when significant damage, such as muscle rupture, bone fracture or detachment of the ligaments, occurs or when kneecap injuries become recurrent. When recurrent injuries or serious damage are not involved, however, the patient usually engages in protective rehabilitation for three to five weeks to prevent the kneecap from moving laterally and relieve pain.

The second phase of kneecap rehabilitation, which should take anywhere from two to four months, involves rebuilding and strengthening the quadriceps muscle to prevent dislocation from happening again. We will be glad to design an individual rehabilitation program that will address your particular needs and get this complex joint functioning smoothly and strongly once more.

 

Straightening the Curves of Scoliosis

Scoliosis is a condition in which the spine is curved toward either the right or left side. Thus, the upper back seems to be rounded, the lower back appears to curve inward (swayback), and one shoulder and/or hip looks higher than the other.

About 80% of scoliosis cases occur in people 10 to 18 years of age, and the condition is far more common in girls. While most cases among both genders are mild and require no treatment, girls are more likely to progress significantly without treatment.

For a diagnosis of scoliosis to be made, a curve must measure 11º or more; a curve less than that is labeled spinal asymmetry and is unlikely to get much worse, although a pediatrician or an orthopedic surgeon can monitor it with visual inspections and x-rays to be sure it does not move in that direction.

The following procedures are commonly used to treat scoliosis:

  • A brace is the most common treatment for children who have scoliosis spine curvatures of 25º to 40º and who have not finished growing. The brace will not correct the curvature, but it will keep it from worsening.
  • Surgery is an option for more severe cases, in which the curves are 40º to 50º or more.
  • Spinal fusion, which joins vertebrae permanently, is effective but is not used for children whose bones are not fully grown because growth will no longer be possible in the fused area. Thus, fusion is often performed for older adolescents.
  • Metal implants and bone grafts are utilized to straighten the curve, although a zero-degree curvature is not possible.

Scoliosis does not usually cause back pain, but in severe, uncorrected cases, it can compromise overall health because there is less room in the chest cavity for the heart and lungs to function properly.

While physical therapy alone cannot cure scoliosis, exercise helps maintain good muscle tone and a healthier heart and lungs, and it may reduce discomfort. We will be glad to work with your physician to design an exercise program to augment the benefits of a brace or surgery in the treatment of this condition.

Why You Need Crutches After Meniscus Surgery

If only surgical treatment worked so perfectly that the patient would hop off the operating table, cured, with no painful recovery required. For knee surgery, that is not the case.

Today, most surgical procedures on the crescent-shaped, fibrous knee joint cartilage called the meniscus are performed with tiny incisions, cameras and instruments. Thus, the recovery timeframe is much shorter than for the once more common open-knee surgeries.

The meniscus, the knee’s shock absorber, is composed of rings of spongy cartilage located between the thigh bone (femur) and shin bone (tibia). When the meniscus is torn by injury and surgery is recommended, postsurgical measures frequently include the use of crutches. How long you use them will depend on several factors, including whether the meniscus tear was actually repaired or if, more simply, a piece of it was just removed (partial meniscectomy).

With a partial meniscectomy, crutches may be needed until you can walk without limping (usually five to seven days). With a proper rehabilitation program, you can usually expect to resume sports within four to six weeks after the surgery.

Following a repair, you will typically use crutches for at least three weeks to allow the repaired tissue to become attached and to avoid retearing the meniscus. Maximal weight training is not allowed for two to three months, and a return to running and agility sports is permitted after three to four months if strength and motion have returned and there is no pain in the joint. Of course, your pre- and postoperative condition and the progress of your overall recovery will influence that timeframe.

In addition to using crutches, you may also engage in physical therapy to

  • strengthen your leg muscles
  • strengthen and regain full motion in your knee
  • return to a normal activity level

We will be happy to work with you and your surgeon to customize a physical therapy plan that will meet your goal of returning to work, home responsibilities and sports as quickly, comfortably and safely as possible.

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