# Riding after radial head replacement



## gradus (Apr 22, 2008)

So, I recently fell while climbing (on a rock, not a bike) and shattered my radial head. Total bummer - I had to get a new one - I now have a piece of steel that looks like an oversized golf-tee in the end of my radius bone. Deep into physiotherapy and I'm now looking to the other side and the prospect of getting back in the hills.

My question is has anyone else done this, and if so are there any repercussions when it comes to riding? I mean the fact that you are holding onto the handle bars and absorbing hits makes me wonder how my (partially) new elbow will hold up.

Anyone??


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## xcguy (Apr 18, 2004)

*PM NoahColorado*



gradus said:


> So, I recently fell while climbing (on a rock, not a bike) and shattered my radial head. Total bummer - I had to get a new one - I now have a piece of steel that looks like an oversized golf-tee in the end of my radius bone. Deep into physiotherapy and I'm now looking to the other side and the prospect of getting back in the hills.
> 
> My question is has anyone else done this, and if so are there any repercussions when it comes to riding? I mean the fact that you are holding onto the handle bars and absorbing hits makes me wonder how my (partially) new elbow will hold up.
> 
> Anyone??


He had a messed up elbow, don't know if it's the same injury as yours. Good luck.

http://forums.mtbr.com/member.php?u=248045


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## dunnerorg (May 3, 2008)

Hi gradus, been there done that! Sorry to hear about your misfortune. I was mountain biking through forest last July when suddenly a tree jumped out and hit me. I dislocated my left elbow and smashed my radial head to pieces. I now have a shiny new titanium one. I forgot to ask the surgeon if it was shimano.
Anyhow here's the deal. Most people never achieve full range of movement in the joint. There can be instability in the wrist. I have tried cycling since, but due to the limited range of motion it hurts the elbow because I can't extend it fully. This makes the triceps work quite a bit harder then usual so there is a tendency for them to cramp up.
One thing you might consider is what happens if you come off again? This is quite a complicated procedure and it definitely not as good as a real joint. You could seriously mess up your arm if you break it again. So get some very sturdy elbow guards if you are determined to go back on the bike.
Having said all this I am going biking on Monday, but I will take it easy no more fast downhills. I have been told that I have achieved more range of motion than most people do with this injury. I stretch the elbow relentlessly. If your accident was recent, then you may be in for a long period of recuperation. I Think in terms of 1 to 2 years. At the moment I can extend the arm to about 175 degrees (normal for a man is -5) I am not too concerned with flexion but I can just about touch my shoulder with a little discomfort. I have near normal pronation and supination of the wrist. I would love to hear how you are getting on because there is no one else I know who has had this. I am really determined to get full range so if you are doing better than me I would love to hear how. Take care.


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## gradus (Apr 22, 2008)

*more riding after radial head replacement*

At last! someone else with the same thing. Thanks very much for your reply.

How long ago was your accident? Its worrying to hear that an inability to extend the full way is stopping allowing you to bike fully. I guess I never paid much attention to it but I always assumed that I didn't extend my arms on the bike. What about using a shorter stem and getting some handle bars with greater sweep in them so you force your arms to bend more? I also remember when I was riding cross country almost every day a few years back I became very conscious of 'over-gripping'. Once I realized this I made an effort to use as little energy as possible in make the handlebars do what I needed and probably saved myself a load of wasted energy on a long ride.

I'm kind of amazed to find how few people have had this - especially given that all of the sports I do involve some degree of risk of a traumatic injury.

My first thought was - will I climb again? - I did it climbing, or rather falling, or rather stopping falling. After that I realized that I go biking about 3 times a week and so my second thought was will I bike again? These are not good thoughts. Like, I would imagine a lot of people here, mountain biking serves as a self-medication against daily life. Losing the ability to do it would be a real bummer. The obvious chain of thought is here I am on my singlespeed over the handle bars, elbows bent, putting a ton of strain on the head of my radius everytime I hit a bump. What gives? Well probably not the cobalt-chrome head of the radius - its pretty tough - so am I going to jack the shaft of the radius into which it is inserted? Well probably not. In my case the implant is a press fit and after 3-4 months the bone grows onto the porus stem of the implant. In addition the surface against which the implant's head mates (the cut shaft of bone) is flat and the implant head is flat so there will be no moment causing the head to rotate. The real danger comes, I gather, from repeatedly pounding the metal head into the facing cartilage of the ulna and humerus. To minimize this surgeons normally slightly undersize the choice of head of the implant to minimize the chances of abrasion.

I think choice of style of biking will be important. Though I love single speeding its pretty aggressive in terms of stance - its pretty much like old school cross-country - all the way forward over the bars and grunting a lot. So I serviced the hanebrink 8" travel shocks on my neglected freeride bike and will treat freeride as the new cross country. Arms bent, kicked back, lots of travel to soften the blow. I am on the lookout for a singlespeed frame with slack geometry - a post to the singlespeed forum is in order when I am closer to healing.

In terms of my own personal experience - I had the accident about 6 weeks ago. I still have an awesome scar but the swelling and pain has all but gone - it still feels a bit rough inside my pronator muscles though - like the odd stabbing pain - but I bet that will go with time. My flexibility goes from 9deg (extension) to 124deg (flexion) and increasing all the time - I hope to get 5deg (like you) and as close to 140 as I can manage - I do physio twice a week and have physio exercises that I do 6 times a day. Lots of ice and lots of contemplation figuring out how to relax my muscles that serve to guard the joint and limit motion. In my case that comes down largely to the pronator group on account of 25 years of climbing. Muscle relaxants, even though they make me a zombie and strong anti-inflammatories help. Its probably no longer useful for you as it seems like your injury was a while ago, but in the week following the accident lymphatic massage was the business. Its completely counter-intuitive, but it removed 90% of the swelling in my arm in 2 days. Outrageous.

As you may have found out this technique is still evolving. Its vastly preferable to what they did before though - which was radial head resection. Without a radial head you lack all stability at the elbow. As you may already know, one of the of the primary functions of the radio-ulnar/radio-humeral joint is to act as the lateral counterpart to the Medial Colateral ligament (MCL) - the ligament that stretches between the medial humerus and the head of the ulna. Together that stop your forearm from flopping around. I guess future activity should aim to stress this aspect as little as possible - basically avoid shear forces across the joint.

That said all exercise of the sort we do is more than just about fitness - its about being happy - and so if I increase my chances of arthritis in the joint when I am 70 (or 60, or 50 , gulp) - so what. Life throws thing at you like this once in a while. In climbing, my other big sport, all my friends who got injured (and didn't buy the ranch) came back - artificial pieces of back, plates all over etc. So I'm fairly circumspect about the whole deal, keep healing up and figure out other ways to do the sports I enjoy, or pick up a few new vices.

A few good stories : One guy I came across with this prosthesis does body building and can bench some ungodly amount and another friend of mine is an orthopedic surgeon and treats motocross riders often - many of whom go back to the sport - which I have to guess is way more pounding that MTB.

You have to forgive me for going on a bit, its in part due to typing with my left hand (I guess the right side of my brain likes to ramble) and in part trying to provide a little info - since I have has so much trouble finding about any experiences of people doing these sports with this sort of injury.

If you have any other experiences of how this progresses I would love to hear them.

Best wishes, heal up and good luck on Monday - and tell me how it went.


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## dunnerorg (May 3, 2008)

Hi gradus, good to hear from you. It is about nine months since my accident. I can't actually remember what happened because I was knocked out. The result of my lack of concentration was a dislocated humeral-ulna joint posteriorly and this caused the radius to ram into the lateral epicondyle of the humerus. The surgeon told me that it had shattered the head of the radius and part of the radius had become embedded into the humerus. What is really strange is that I had no wrist pain. Usually when I fall off I end up landing on an outstretched arm and this causes pain in the wrist of the arm effected, but not so in this case. The MCL was definitely damaged. If I try to do lateral dumbbell raises the MCL does not like it even now.
Did you dislocate your elbow when this happened? You seem to have better range than me at the 6 week stage. I also have quite a short stumpy prosthesis rather than a longer golf tee type shape. It is also larger than the original radial head in other words it is oversized.
The health service in Ireland is really bad. So the followup treatments are below par. Health insurance here does not cover physiotherapy. So far I have spent about €2,000 on physical therapy treatments. We have two types of physio here. Chartered physiotherapists and physical therapists. The Chartered physio's are affiliated with the hospitals and basically do very very little in terms of treatment. I trained for about 2 years as a physical therapist myself. But I never fully qualified. Physical therapists use massage based techniques to improve and restore normal muscle function. Up until about 2 months ago I was having acupuncture, massage and NMT (neuromuscular techniques) for stretching 1 to 2 times per week. The therapist had a tendency to concentrate on the acupuncture more than anything else so I will be changing to someone else in the next two weeks. I have given up on the hospital physio's as they are absolutely useless. They recommended heat when the forearm was throbbing, swollen and hot. They also told me last week that it was back to normal.
So back to your cycling. I think if you are riding with the arms bent, there will be no problem at all. Most of the force will be on the ulna. You won't even feel the elbow in this position. The radius is not a weight bearing bone, especially in that position. I asked my own surgeon about the prosthesis coming loose and he assured me that it would not. He said I could use it as normal. He also said that the most likely cause of it coming loose was another trauma, from a fall.
Definitely the only difficulty I have when cycling is down to the fact that my position leaves my arms almost fully extended. So the vibration occurs right at the limit of range. Perhaps this is a good thing? I will let you know tomorrow. I haven't cycled since last January so things might have improved.
*Usefull stretching positions*
(1) lie on your side on the floor with bad arm against the ground. Bad arm flexed at the shoulder at 90deg. and outstretched. The humerus lies flat against the floor and the forearm will be unable to lie flat on the floor. Take your good arm and use it to hold the bad forearm. Apply pressure downward and aim to get your bad arm completely flat on the floor. A useful measure of progress is to see which fingers of the bad arm you can get to touch the floor.
(2) Using dynobands and a kitchen table, fold over the band to create a loop. place the open end of the loop under the leg of the table and make sure it is secure. Hang the arm over the end of the table and stretch the closed end of the band up and around the wrist. let the band do the work and relax.
If you have any suggestions I would love to hear them. I am still feeling my way around this problem.


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## dunnerorg (May 3, 2008)

Hi gradus. Well, I went out for a spin last monday for about 3hrs and I had no real problems. I did't do any off road but did a fair bit of hill climbs. The main thing was that because I don't have full extension of the elbow, my triceps had to work at keeping the arms extended so they were fairly tired. However I had no ill effects the following day. This morning I went to the gym and did bench press, lat pull downs, seated rows, bicep curls, triceps extensions and dumbbell flys for the chest. I used about two thirds my normal weight. All went fine.
I also tried a riding position similar to what you had described. Arms bent at the elbow at about 100 deg. narrow grip bent over the arms sitting on the back of the saddle. There was no problems with this position. I use a Giant XTC 2.5 with factory settings. The shocks were set to their firmest setting at all times. Planning on going out next weekend for some forest trails. How are you getting on?


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## gradus (Apr 22, 2008)

Hey there - good to hear about the ride - sounds fantastic ... so jealous. Especially good to hear that it all went painlessly. Thanks for the stretches - v.useful - once the joint is a little less tender I'll get to them.

Your accident sounded quite extreme - what happened? You came to and then walked back? If it was anything as painful as I felt that must have sucked big time. I didn't dislocate either, which I guess would have made things worse. I just sort of shrunk my bone by about half an inch.

What is the riding like where you live? Over here I am watching the last of the wet spring days disappear. Its one of those great 5am drizzles mixed with 60deg weather that reminds me, quite unreasonably, of where I grew up in the north of the UK. At least the fact that it will soon be 100deg in the shade will give me a good excuse for not getting out there.

Anyway look forward to hearing about off road and elbows - good luck.


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## 187 (Oct 28, 2005)

Gradus and Dunnerorg - mind if i ask your age?

i just had surgery to repair my radial head in hopes of avoiding radial head replacement. Doc indicated that if I was older, he would have recommended radial head replacement right off the bat. 

I haven't started PT yet, i'm hoping to get started soon.

Thanks


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## gradus (Apr 22, 2008)

hey there 187 - I'm 40. And though its all a state of mind I guess bones are a bit more literal - this means that mine have done all the growing they ever will do and is are longer made of rubber - so new radial head.

Irrespective elbows are trouble - so don't skimp on the PT - mine has been a godsend - today I got 4deg off having total extension and 133deg of flexion.  Though this pm I probably waaay over extended it dealing with a rattlesnake out back. I guess adrenalin can do wonders for extension too.

I hope the surgery works out - a buddy of mine who is an orthopedic surgeon says he is always amazed how even the most shattered radii can heal up.

good luck with that arm - gradus


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## dunnerorg (May 3, 2008)

Hi Guys, I am 36. Went out last Sunday and did some offroad about 1hr climb and 5 min descent. My arm held up well but was very tired. It has been painful all week though. It is sore along the length of the forearm. I saw a physio last Monday and he reckons its the interosseous membrane. This is a fibrous band which connects the ulna with the radius. Its starting to ease out now though. I think the pain is down to stretching too aggressively over the last few weeks rather than the cycle. No pain in the joint itself.
I am from Ireland Gradus. So mountain biking here is wet and slippery usually. lots of forest trails and gentle climbs probably similar to the UK. Where are you living now? Sounds like its hot, if you have to deal with rattlesnakes. I had a super trip last summer to Tenerife you can check out my blog on.http://teide.mountainbiking.ie It was fantastic to try different terrain. We are hoping to try Colorado in the next couple of years. MTB is so much more fun in the sun.
You are making really good progress with the arm Gradus keep it up.:thumbsup: It sounds like you will get full range soon enough. Will you go back climbing?
How did you break your arm 187? and what age are you?
Take care guys good to here from you.


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## gradus (Apr 22, 2008)

Hey Dunnerorg - sounds like you are well on your way to recovery - no pain in the joint is very good news. Its funny (not) I have pain in the same area of my forearm. I think mine is due to the finger extensors/flexors being sick of doing nothing and sort of cramping out.
I fully intend to get back to climbing - the doc said no probs - and everyday my arm feels more like normal.

The Tenerife photos looked terrific - I dont know if I can totally agree with your sentiment about riding in the sun though - I'd rather have Irish weather. I live in southern cali and this weekend it is 105deg. Its like mars outside and mountain biking is best done at 6am. When it gets to its hottest this summer we are heading over your way to Pembrokeshire (well sort of your way) - whether we end up in Ireland or not depends upon my ability to finish Ulysees and the resulting desire to subsequently drink the book in Dublin. we shall see. I did ride a bit in Pembs last time over, but it was a bit frustrating as there are so many little farms &c and trails sort of stop and start. Still riding up the Prescelli mountains, sunk in peat and getting royally pissed on by horizontal rain was still one of my best on-bike experiences. Those druids knew a thing or two.

Keep up the good work


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## 187 (Oct 28, 2005)

Thanks for the responses. It's nice to have folks to discuss this with. I'm 34.

I injured myself dirt jumping. I remember sticking my left arm out as I was going over the bars and knowing even before impact that I was going to be injured. i didn't have enough speed/forward momentum to let me roll out of it. I just came straight down on my arms/head.

Upon impact I damaged my left radial head, separated my left shoulder and broke a bone and partially tore a ligament in my right hand/wrist. My Giro Xen saved my head.

I had surgery on 5/2 to repair the elbow. Plates and screws are currently holding everything together. I went for a follow up ten days later and the ortho docs PA wouldn't sign me up for PT and told me to just work on my flexion after a hot shower. No mention of working on pronation. I guess thats an HMO for you. Since i've had screws and plates inserted before, I knew that was bad advice so I worked around them and I start PT next week. The hardware will need to be removed in 3 months. 

It's good to see that you both seem to be recovering well. I can already touch my head with my left arm although it hurts to do so. I also made a fist yesterday and saw a little definition coming back into my arm. Nice.

Dunneroreg - I lived in Spain for three years in the mid 90's. A great time. Pics of tenerife are great.


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## dunnerorg (May 3, 2008)

Hi 187 - Ouch! its sounds like you landed hard. I know what it feels like. Strange that they didn't recommend PT. Mind you I broke my leg as a teenager and had a plate fitted just above the knee and never had any PT on it. It healed up fine. Glad you can touch your head again. I can now eat popcorn with my left hand, yipeee! I couldn't do that 6 months ago! For me flexion has been easier to get than extension. I take it you will be back on the bike in the near future? Take care.


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## 187 (Oct 28, 2005)

Dunnerorg - not sure when i'll be back on a bike. Given that i'm looking at a second surgery in August, I'm not sure if it will be in 2008 or not. I just bought a frame to build up to pass the time.

I had my first PT session today and it was great. Lots of advice and recommendations on exercises. Why is it that PT's seem way better than a doctor when it actually comes to healing from stuff like this? I go to the doctor and they look at everything from a distance, look at the films, make a recommendation and send me on my way. Next. I go to the PT and she's like "get that brace and those shirts off so we can get to work." That's what I'm talking about. 

Enjoy the popcorn!


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## Anthonychirco (Mar 13, 2009)

*Radial Head Replacement!*

Hey guys, 
I'm glad to see I'm not the only one! Obv i'm not glad this happened to any of us, but at least we're still alive, walking and healthy!

I fell off the third story scaffolding and shattered my radial head and disclocated my elbow, as well as a fracture of my spine and a fractured heel.

The doc in the emergency room had to snap my elbow back into place which hurt more than hitting the floor from the fall.
Then after a week I got talked into replacing my radial head because it had shattered into 13 pieces and wasn't worth trying to put back together.
So I got the surgery and it took me a couple months to rehabilitate it and gain almost full motion (bending, extending, pronation, supenation, etc).

\Now it's been about 4 months after the surgery and my elbow has begun making squishing noises! 
Depending on the movement I'll hear popping, squishing and grinding! It's gross and sometimes I have to stop working out just to stop hearing it!

Anybody else??

I'm wondering if this will ever go away?

Apart from that my elbow is still a little weak and it seems fragile, the Drs told me I should avboid lifting anything heavier than 30 lbs on this arm for the rest of my life, I can live with that.

I just hope it stops making noises!

Thanks for reading guys, let me know if you experienced anything like this


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## gradus (Apr 22, 2008)

Hey Anthony,

sorry to hear about your accident. Dont worry - I suspect that things will turn out better than you anticipate. I am back doing fingertip pull-ups again and I have schelepping bags of concrete over the last month with out any real problems.

As for the popping and grinding - well I get clicking like when you crack your knuckles and I gather thats par for the course. It appears to reduce in severity as my joint gets stronger and more stable. It gets worse if I over do it. I think its just a matter of time. Grinding for me was worse earlier on.

Things that worked for me ...
1. ice - frequent esp. after exercise
2. physio - stick with it
3. watch your wrist - as it can get hyper-mobile and is difficult to cure from that
4. Mobic - a prescription anti inflammatory
5. patience

good luck -


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## Anthonychirco (Mar 13, 2009)

Hey there,

thanks for answering so quick! I'm glad to hear ur making progress and u hear less noises as u proceed, it gives me something to look forward to.
I was worrying for a second that I would have a noisy weak elbow for the rest of my life cuz my Doc said it was normal at this point since I have a big piece of Vitallium in there now instead of my radial head, and that instead of it being cartilage against cartilage, at this point it's cartilage against Vitallium.

Do any of you worry that you'll develop arthritis quicker now that there's an external material rubbing away at the cartilage and bone? 

I'm 4 months into recovery but I stopped doing PT after 3 months, since my insurance refused to cover my last two appointments, I spoke with my PT guy and he said it's not necessary to keep doing it but it might be beneficial.

I'm 23 years old, this happened last year when I was 22, so I snapped back into place after a major injury with multiple fractures, but my arm and spine are the onyl things taking a while to heal up 100%.

However my elbow may give me discomfort, but it never really "hurts", so I can go without pain medication.
I just feel the aftermath feelings of the fractures and trauma, kinda like little discomforts, I bet you guys have felt that while healing. I'm prepared to feel these things for at least a year.

Has anyone healed up to 1 year now? Does it get better?


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## dunnerorg (May 3, 2008)

*1yr 7 months after*

Hey Anthony & Gradus.
I am just over a year and a half after the op. Like you Anthony, I had a dislocation as well as shattering of the radial head. I have a physio appointment in half an hour. So that will give you some indication of where things are at. Over the last 2 weeks or so I have had a huge amount of pain creeping into the wrist. Gradus, you are spot on about the hypermobility of the wrist. Unfortunately I work as a service engineer so I with my hands every day. Although I can get full range of motion when I stretch, the ligaments tighten back up. So throughout the day the wrist is being used more to compensate. 
I must admit that I am not big into icing, I know I should do it more but just never seem to get around to it. The clicking has reduced in my case. I also had a nerve conduction study last week which showed that the radial nerve transmits slower than normal ie. it conducts at 30m/s instead of 50m/s. The neurologist thinks that this will improve. 
So - my advice is the same as Gradus' but I would suggest that you keep up the physio for as long as possible, even if it's only once a month. The better your elbow works, the more you will save your wrist, and you are still a young guy so you will need that wrist hopefully for at least another 60yrs. With regard to the amount of weight that you lift with the arm, My surgeon put no limit on it, and I did ask him specifically, I have been to the gym a good few times and have done chins, bench press, tricep extensions, bicep curls etc. All have helped with strength and mobility, but perhaps this would not suit your condition. I don't worry about arthritis. If you had severe arthritis in your elbow chances are they would do a radial head replacement anyway. So what's the difference? Also by the time you get arthritis they might have a cure for it, so don't worry about it. Just concentrate on maximum movement and strength, and mind your wrist. Best of luck!


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## Anthonychirco (Mar 13, 2009)

*Grinding elbow*

I'll take your guys' advice and try to keep doing physiotherapy for as long as I can .. but I'm not too big on icing either, I never really feel enough pain to get the urge for icing... I mostly feel minor discomfort and rarely a quick sharp pain.
How about you guys? Throughout your recovery (whether it be a year, 2, or more) did you feel pain in the elbow or forearm? If so, what kind and caused by what movements?

I don't know what hypermobility of the wrist is .. and as of now my wrist doesn't really hurt at all.

I fractured it when I was 16, riding a quad through the Nicaraguan jungle, I ran into a tree that saved me from plummeting down a steep cliff and I didn't tell anyone for 4 days cuz I didn't want the quads taken away from my brothers.


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## dunnerorg (May 3, 2008)

*Hypermobility*

Hi Anthony, Hyper-mobility is when the ligaments become overstretched and allow too much movement and as a result, instability of the joint. The wrist is made up of two rows of 4 bones held together by the ligaments. The ligaments are elastic and allow the bones to move against one another in a certain direction. When they become too loose the bones begin to move in directions that they are not supposed to. This can lead to them becoming misaligned. This is bad because the wrist then jams up and does not move properly, causing pain. Also the bones start to wear because they are moving against one another in areas where there is no protective cartilage. Hey presto - Arthritis. Because you have dislocated your elbow, you will have damaged your elbow ligaments quite severely. Ligaments do not have a good blood supply or the necessary cells to regenerate properly, So they take two years to repair, and they only repair with scar tissue. The scar tissue does not stretch like a normal ligament this is why your elbow will be restricted in movement. By keeping up your physio for as long as possible you will give yourself the best possible chance of repairing the damaged tissue. This is because there will be an increased blood flow to the area, which means more healing and your physio treatments will help to train the scar tissue fibers to grow in the correct direction. The ice helps because it also allows fresh blood into the area when the elbow reheats. So you should continue icing even when you are pain free, because it will improve circulation. I studied physical therapy for a couple of years and this is my understanding of it anyway. Regards Daragh


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## Anthonychirco (Mar 13, 2009)

*Thanks guys!*

First and foremost I want to say that you guys are awesome and that I probably wouldn't have gotten info as valuable as what you're giving me anywhere else and so I wanna show that I'm grateful.

Secondly I'd like to let you know that I'm not a rider or into any extreme sports, I stumbled upon this website while searching "elbow after radial head replacement" and found this helpful forum, it's kinda like a club for guys with new radial heads!

We could be the New Radial Heads! How many of you thought of the band name: "Radiohead" when the doctors were first telling you about what happened to you?? I did.

Ok so jokes aside, I'm gonna take all the advice.

I had a question though, when you say "Physio" you mean physiotherapy right? Is that different from physical therapy?

Did any of you lose any range of motion later on in recovery? I have almost full range right now, and I'm a little worried that somewhere down the line I might lose some of it somehow (maybe with the generation of scar tissue?)

And did any of you feel major pain when you shattered your radial head and dislocated the elbow?
Strangely enough I didn't feel that much pain when I hit the floor from a free fall off the 3rd story (and I hit asphalt), I picked my arm up and saw it all out of place, but I can't recall it hurting, probably because my adrenaline levels were jacked enough to make it indistinguishable.

I had my arm in a splint for 2 weeks before they operated on me, and then 1 more week in a splint and once they took it off, my arm had shrunk! 
In 3 weeks I had lost a bunch of muscle that I had worked hard to get! At this point (4 months into recovery) my left arm is still a bit smaller than my right, how strange is that?
In only 3 weeks of non-usage your body loses muscle so easily!

Did this happen to anyone else? And what other injuries did you suffer from along with the radial head fracture or shattering?


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## dunnerorg (May 3, 2008)

*Physiotherapy V's Physical Therapy*

Hi, In Ireland we have two schools of people that treat the soft tissue of the body. Physiotherapists and Physical Therapists. Basically there aim is the same but they approach it slightly differently. The physio's tend to use machines to stimulate and mobilize various parts of the body whereas the physical therapists use complex massage techniques and stretching techniques to rebalance the various muscles which may be too lax or too tight. The physio's do use massage also, but personally I have never had a good result from a physio. I have also felt that their massage techniques and assessment were really poor. Perhaps I have just been unlucky. In Ireland physio's work in private practice and throughout the hospitals, and also train in hospitals, but the physical therapists just work privately and train in private practices. The physio's here are chartered which basically means that they are an internationally recognized body who are professional and regulated. The physical therapists have not yet achieved this level of recognition or regulation. Obviously this is not good because in theory, anyone could set up a practice and call themselves a physical therapist. However, this does not mean that properly applied physical therapy is ineffective. It is very effective but you do need to make sure that you have a therapist who is adequately trained. Now about the pain - I had no pain at all at any stage of recovery and had no need for pain killers. But after the injury I could only straighten my arm to 90º I really had to work at it to get it to 180º I could also pronate and supinate (turn the wrist over and back - this movement is actually done at the elbow) to almost full range. But the problem I have is that the soft tissue feels very stuck together. To be honest most of my treatment has actually been acupuncture I used this to help bring down swelling and to stimulate nerve activity. The physio's I saw in the hospital did no treatment just assessment, after 6 visits they told me they could do nothing. The first proper deep tissue massage was actually only done yesterday. The deep tissue massage helps to break down scar tissue, stimulate blood flow, stretch tight muscles and rebalance the muscles in the arm. It actually would not have been advisable to do the deep tissue work at the early stages of the injury because it could destabilize the prosthesis and would also increase inflammation. I had a lot of inflammation at the early part of recovery. So nothing could really be done. Each person's injury is different. You may not have as much soft tissue damage as me for example, your young age would also be a big advantage in recovery. (I am 36) I have also had previous trauma to my wrist over the years so all this comes into play. I would think that what ever movement you have now, you will keep. Your range of movement will probably gradually increase over time slightly just with normal use. You mentioned muscle wastage, muscles actually begin to waste after only 48hrs of non use. I used to do body building through my teens and early twenties and used to read a lot about it. But the biggest cause of significant muscle wastage is nerve damage. If the nerve supplying the muscle fiber is damaged then effectively the muscle fiber just dies. Exercise is the best way to keep things working. I used to use a cross trainer to keep the arm moving in the early stages of recovery. I would just gently mobilize the elbow with no impact or weight, for an hour each day. When the area was nicely warmed up I would stretch it for up to half an hour twice a day. I did this solidly for about 9 months, after that I did it less often. My arm is fairly ok for specific movements in one direction, I have trouble doing compound movements though. I find swimming quite difficult for example, but I can do chin ups and bench press reasonably well.


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## gillo (Jul 10, 2009)

*radial head No 2*



dunnerorg said:


> Hi, In Ireland we have two schools of people that treat the soft tissue of the body. Physiotherapists and Physical Therapists. Basically there aim is the same but they approach it slightly differently. The physio's tend to use machines to stimulate and mobilize various parts of the body whereas the physical therapists use complex massage techniques and stretching techniques to rebalance the various muscles which may be too lax or too tight. The physio's do use massage also, but personally I have never had a good result from a physio. I have also felt that their massage techniques and assessment were really poor. Perhaps I have just been unlucky. In Ireland physio's work in private practice and throughout the hospitals, and also train in hospitals, but the physical therapists just work privately and train in private practices. The physio's here are chartered which basically means that they are an internationally recognized body who are professional and regulated. The physical therapists have not yet achieved this level of recognition or regulation. Obviously this is not good because in theory, anyone could set up a practice and call themselves a physical therapist. However, this does not mean that properly applied physical therapy is ineffective. It is very effective but you do need to make sure that you have a therapist who is adequately trained. Now about the pain - I had no pain at all at any stage of recovery and had no need for pain killers. But after the injury I could only straighten my arm to 90º I really had to work at it to get it to 180º I could also pronate and supinate (turn the wrist over and back - this movement is actually done at the elbow) to almost full range. But the problem I have is that the soft tissue feels very stuck together. To be honest most of my treatment has actually been acupuncture I used this to help bring down swelling and to stimulate nerve activity. The physio's I saw in the hospital did no treatment just assessment, after 6 visits they told me they could do nothing. The first proper deep tissue massage was actually only done yesterday. The deep tissue massage helps to break down scar tissue, stimulate blood flow, stretch tight muscles and rebalance the muscles in the arm. It actually would not have been advisable to do the deep tissue work at the early stages of the injury because it could destabilize the prosthesis and would also increase inflammation. I had a lot of inflammation at the early part of recovery. So nothing could really be done. Each person's injury is different. You may not have as much soft tissue damage as me for example, your young age would also be a big advantage in recovery. (I am 36) I have also had previous trauma to my wrist over the years so all this comes into play. I would think that what ever movement you have now, you will keep. Your range of movement will probably gradually increase over time slightly just with normal use. You mentioned muscle wastage, muscles actually begin to waste after only 48hrs of non use. I used to do body building through my teens and early twenties and used to read a lot about it. But the biggest cause of significant muscle wastage is nerve damage. If the nerve supplying the muscle fiber is damaged then effectively the muscle fiber just dies. Exercise is the best way to keep things working. I used to use a cross trainer to keep the arm moving in the early stages of recovery. I would just gently mobilize the elbow with no impact or weight, for an hour each day. When the area was nicely warmed up I would stretch it for up to half an hour twice a day. I did this solidly for about 9 months, after that I did it less often. My arm is fairly ok for specific movements in one direction, I have trouble doing compound movements though. I find swimming quite difficult for example, but I can do chin ups and bench press reasonably well.


hi dunnerorg
have been reading your interesting information on r/h replacement.You seem pretty clued up about the procedure and I wondered if you had an opinion on my predicament.I had a radial head replaced about 6 years ago with a silicon replacement .My injury was classed as a terrible triad injury which is a comminuted fracture,dislocation and fracture of the coronoid process.Because the silicon was compressing and breaking down I was advised to have it replaced with a metal one.That was 3weeks ago.The first week and a half were great then after using the affected hand typing a few sentences on a keyboard problems began arising.The next day major sharpe pains in wrist, back of hand and lower forearm when attempting supination or any hint of minimal lifting with a supination angle.Unfortuntately it hasn't improved at all and I'm really peeved as I cant do the full on physio and I know how important it is at this stage.After some reading and various terms such as radiocapiteller contact,damage to condylar cartilidge,medial ligament,interosscus membrane etc cropping up I'm stumped.Still cant supinate more than about 60 degrees. Would be good to hear from you. I'm in oz

Cheers gillo


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## Griffin_NC (Jun 16, 2009)

I'm 2 weeks into the therapy for my fractured radial head. I was fortunate my Ortho never casted it and let me work out the movement some while it healed. But I still lost about 15 degrees of movement and the wrist causes some pain now. It's been about 2.5 mos since the injury and I'm hoping to get full movement out of it eventually. It does seem tough to get the ligaments stretched back out afterwards. I have 4 pages of stretches that I'm supposed to perform 4-5 times a day and it does seem to help. Serious amounts of PT is about the best you can do.


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## phil33 (Jul 15, 2009)

*Radius Head Replacement*

Hi Guys,

Any help would be greatly appreciated. I recently had a climbing accident and fell 30 feet and have had to have a replacement radial head fitted to my left arm & a few leg injuries ,hip etc. I,m 33 and have no idea what to expect in terms of recovery and how much mobility i,m likely to get back into my arm. I spent 4 weeks in hospital where I was getting physio to the arm daily mostly but now i,m kind of left on my own as i,ve had no appointments as yet to return to physio so i,m doing my own as much as I can. I,m almost 3 weeks home so its almost 7 weeks from I had the surgery. Regarding my own progress I seem to be going backwards instead of forwards. I basically work the arm backwards and forwards as much as I can daily and sometimes end up with a swollen joint the following day that will allow very little movement. I can extend with some work the arm to around 160° and 70° respectively and can supinate the hand to show the back of the hand completely turned but can't turn the palm flat yet. Any movement to full extensions is quite painful and has to be done slowly although i,ve completely stopped all painkillers at this point. Any reccommened exercises etc but be great appreciation.

Phil


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## dunnerorg (May 3, 2008)

gillo said:


> hi dunnerorg
> have been reading your interesting information on r/h replacement.You seem pretty clued up about the procedure and I wondered if you had an opinion on my predicament.I had a radial head replaced about 6 years ago with a silicon replacement .My injury was classed as a terrible triad injury which is a comminuted fracture,dislocation and fracture of the coronoid process.Because the silicon was compressing and breaking down I was advised to have it replaced with a metal one.That was 3weeks ago.The first week and a half were great then after using the affected hand typing a few sentences on a keyboard problems began arising.The next day major sharpe pains in wrist, back of hand and lower forearm when attempting supination or any hint of minimal lifting with a supination angle.Unfortuntately it hasn't improved at all and I'm really peeved as I cant do the full on physio and I know how important it is at this stage.After some reading and various terms such as radiocapiteller contact,damage to condylar cartilidge,medial ligament,interosscus membrane etc cropping up I'm stumped.Still cant supinate more than about 60 degrees. Would be good to hear from you. I'm in oz
> 
> Cheers gillo


Sorry, to here that Gillo. If I were in your position I would go back to the surgeon and see exactly what is happening. I have to point out that I am not qualified to give out medical advice. However if you would like a lay persons opinion. Then based on the assumption that the silicon replacement did not give as much trouble and that things have deteriorated since the operation.
Then a couple of things come to mind.
Perhaps the new replacement head is not in the optimal position, or has moved.
Or perhaps it has changed the length of the radius bone, putting undue strain on the tendons and causing slight misalignment at the wrist. 
Perhaps some of the nerves have become irritated due to the surgery and are now over-sensitive, resulting in pain.
Perhaps the pronation muscles are restricted and this is causing the supination muscles to work harder to turn over the wrist. Or perhaps both sets of muscles are having to work harder if the new head is not rotating easily.
I would think that it is still early days in terms of recovery. I agree with the importance of movement and physiotherapy but at the same time you have to work within the body's limits. So If you feel that it needs rest then I would rest it. I would recommend ice if the area is hot and inflamed and I would also recommend gentle massage to help calm the area. The massage should not be used at this stage to work deep into the tissue, but rather just to calm the nervous system, and also to remove fluid which is bound to be there following the operation. Do gentle strokes with light pressure towards the heart. But definitely ask your surgeon about the alignment and position of the new implant.
Hope this helps
Dunnerorg​


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## dunnerorg (May 3, 2008)

Hi Phil,
That sounds familiar! I am two years since my replacement. To be honest in terms of range it did not improve too much since the early months of recovery. I stretched the arm every day without fail for well over a year. Although I did gain close to full range it gradually has tightened back up to about 160º in extension for most of the time. I am still improving in terms of flexion though and I think that I will get that back fully. The thing about ligaments is that they do not have cells to regenerate properly so they tend to recover with scar tissue. This tends not to be elastic like a normal ligament, so the joint gets tight. One of the other things I found was that as I stretched to full range, the joint tended to click uncomfortably so I have kind of reached a happy medium now between range of movement and stability. I would suggest icing your arm if it is becoming swollen and maybe even do no exercise on it one or two days a week, to give it a chance to recover a little bit. Each person is different too so It's quite possible that you will get full range and no clicking so keep up the hard work, and best of luck - Dunnerorg


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## peter23 (Aug 19, 2009)

*lifting*

First time on the forum...I to have had my radial head replaced. Way to fast on my longboard, a little over years ago. It is crazy to me that of all the places I would find info on this topic is a website I visit regularly. Should have done this a long time ago. My extension and flexion are excellent(very lucky) my pronation is close to normal but my supination is about half of what it should be. This is where my problem lies. I started weight training recently and have had much trouble working out my bicep. Hammer curls work fine with very little pain. Open handed curls are impossible. GRADUS you said you ran into a guy who could lift crazy weight. Did you get to see any exercise he might have done to compensate for the lack of mobility. Any information would be helpful. I feel extremely lucky:thumbsup: when I crashed dislocated the arm, ripped my ligaments to shreds and had had 11 pieces of bone floating in my arm. Luckily I started riding about 6 months after surgery and now ride at least 6 days a week. thanks


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## r0b (Sep 1, 2009)

Hey guys,

This is a very informative thread, theres more in here than on half of the google searches i do!

I came off my bike in my local woods, fractured my right radial head in 3 places with one of the peices depressing slightly, the doctors said it was a bad fracture although the peices have stayed relatively close together. They weighed up the risks vs. benefits and have decided not to operate.

It has been just over 2 weeks now and im to start physiotherapy soon. my arm is majorly stiff at the moment although i am feeling an improvement in range of movement as time goes on, but its pretty poor!

The stuff about returning to biking is great but im wondering about other activities because I also box. Im expecting to lose 20% of my overall elbow range and am wondering if ill be able to throw punches again

I mean when you throw a punch and your elbow locks out, it feels fine on a healthy elbow. but what is it like on a fractured elbow 6 months down the line? does it hurt to snap your elbow straight? wont i be able to throw a punch again without feeling pain?

Also, once i rebuild my bicep back up, do you guys think it will retain its size as it did naturally before, or will this mess up my muscles ability to remain normal?

Cheers guys!


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## mcleodja (Sep 9, 2009)

glad to find this forum. Nov 4 last smashed my elbow which resulted in radial head arthoplasty with a lateral ligament repair,. 10 months later I would say I am doing worse now because I get chronic pain between the wrist and elbow. After discharged from physio stated hearing clicking/grinding/sounds from my elbow but that at least seems normal by what all you guys are saying but my time I can ride is diminishing big time due to pain in forearm. type of handlbars don't seem to change the situation between my mtn bike and my hybrid, upright riding or normal positioning still causes forearm pain. Anyone else have this problem?


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## marnyjo (Sep 20, 2009)

Hi mcleodja
I stumbled on this looking for other peoples experience of this surgery, I'm not a serious mtb rider, ride occasionally for fun and bit of fitness.
I got my injury from a motorcyle accident 2004. Dislocated elbow was put back in in A&E few hours after accident and put in back-slab cast then radial head replacement 6 days later, after I had my pelvis fixed.

I had the radial head replaced, the new 'part' is called tornier-chevux floating radial head prosthesis which is cemented in. This was because the original replacement was wobbling around causing osteolysis around the stem. It shows up on x-rays, looking like a shadow in the bone and causes pain that feels like you want to put the bones and put them back in the right place, if you know what I mean. I also had pain at the elbow, down the forearm and into the wrist.
If your pain continues/gets worse you should get it checked as the earlier they catch osteolysis the better

Its over fives years now since the original surgery and 3 since the new bit all was going well until recently when I am getting pain into my wrist and hand especially around the thumb side. Longer motorbike rides are hurting through lots of pulling clutch in/out and elbow can lock if I'm not careful to remember to change position regularly.

I think the grinding sounds are called crepitus, basically surfaces rubbing together which no doubt will cause arthritis. Normal in our cases I should think not much we can do about that except try glucosamine/cod liver oil supplements.


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## galaxien (Jan 5, 2010)

Sooo glad i found this thread and hope you all are recovering well from this injury.

Well my story is that i dislocated my elbow and broke my radial head back in July 09.

I luckily did not need a replacement radial head unlike most of yourselves on this thread and i cannot begin to imagine how hard it has been for you all as i needed two screws in my elbow which are going to stay with me for life now.

Recovery for me has been very hard, painful and slow like you all. I am 30 degrees off full extension and it,s not improving much now no matter how much physio i do. Also i can,t turn my palm over and my arm gets fatigued very easily.

I get the usual grinding and squelching noises and my physio says that won,t get any better so athritis he i come i suppose!

I get very bad grinding when i lift any weight but no grinding without the weight...Does anyone else get this?

Taking glucosamine and cod liver oil to help but not sure that,s helping or not.

Got another hospital appointment to see the consultant in Feb and he said i may need to have more surgery if nothing improves.

Sorry to sound like a moaner but this has been getting me really down and again i really hope your all recovering well.


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## Da-Sloth (Oct 16, 2006)

WoW, I am quite suprised to see so much radial head replacement. And yep, Im a new member to the club. On December 11th 2009 my wife, my friend and i went out on a mt bike ride. Well, a couple minutes into the ride we encounter a sweet drop, my friend hit it, my wife photoged then I attempted it, of course with no doubt in my mind i would make it...you guessed it, I failed. The result was fractured femur where it meets the pelvis which in turn shattered, a fractured ulna at the wrist and a fractured radial head which they replaced. So, I have a stainless steel strap and 9 screws to replace the shattered area of my pelvis, a stainless steel plate and 10 screws on my ulna and wrist and a stainless steel radial head thing.
My range of motion on my arm is coming along well except in supination, and bringing the arm to a close, which according to my visit with my physical therapist today is normal progression. I had surgery on my arm on the 12th, so i am three weeks into my recovery on it. I had surgery on my pelvis on the 15th, i am not to put any weight on that leg for 12 weeks. Therapy on that is going well and recovery looks good.
I am looking forward to a proper recovery and getting back on the bike. BTW, im 40 years old. Good luck to ya'll on your road to recovery, and keep a positive outlook. :thumbsup:


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## endo70 (Feb 7, 2008)

Another radial head fracture here. Although mine was about 10yrs ago. They pieced it together with a small metal plate and numerous screws. I have about 95% mobility out of it except for wrist rotation where Im about 80%. When I first started biking it was the first thing that came to mind. What if I fall and reinjure? The recovery was long and painful and I didnt want to go through it again. I will tell you over time you will worry less and less about it. I still have nerve issues on my left hand - namely my ring finger and pinky. After a long ride of 3 or more hours they tend to get a little numb. Possibly from the way the nerve runs through my elbow joint and the inability to fully rotate the wrist. It hasnt held me back much though. I still wonder if it would have been better to have been fitted with a new radial head instead. The surgery to repair lasted almost 4 hours. Anyway I am now 40 and moving on without much thought of it. I would recommend intense PT to get back as much range of motion as possible asap. I havent lost any ROM but also havent gained any either as the years have progressed. Good luck all.


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## Chris Cumming (Jan 22, 2010)

Hey guys, as mentioned by many of the others on here, I'm glad to have stumbled across this thread to hear the various recovery stories from this operation.

I've attached my initial xray and post op xray. I race a lot of 4x and bmx and had my accident during a training session, flipping over the bars mid-air and landing on my outstretched hand. That was back at the beginning of november and I had surgery in mid-november.

I'm now 9 weeks since surgery and still have a very limited range of movement. I'm 40 degrees away from full extension and around 30 degrees away from full flexion. Pronation is fairly good but supination is still very poor. I'm pushing the physio as hard as I can, various exercises many times a day.

I had an appointment with an orthopaedic surgeon that specialises in elbows two weeks ago and he said that if we don't get an acceptable range of movement back then the prosthesis will have to be removed, not sure on what time frame they give to judge this.


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## jump453 (Aug 1, 2007)

*tighten those screws*

Thought I'd throw my 2 cents in here as well. Typical story, went over the handlbars and shattered my radial head. Lucky for me they were able to screw it back together with a plate and five screws and while I don't have full range of motion, riding is not an issue at all. The only thing I really can't do is throw hard without pain, but other than that all is good. The tough thing is that its just going to take a long time to recover, but persistance pays off.

However, about a year after my surgery to repair the radial head, I began to notice something protruding from under where the incision was made. It didn't hurt at all, but it was really bizarre. At the time I didn't have insurance, so I had to live with it a few months until I could get an xray. When I did, it was pretty shocking to see one of the five original screws was backed almost completely out.

In any event, I had another surgery and removed said screw. I was back to normal almost the next day after that one.

So, make sure they tighen those things down!


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## mtngal (Feb 23, 2010)

To Chris Cumming- I am recovering from a radial head implant/ligament reattachment after ejection from a mountain bike (fall on one outstretched arm/hand) resulting in elbow dislocation/radial head smashed to bits episode- "The Terrible Triad of the Elbow". I had limited range early on but made incredible progress and you can too. I am 6 months from surgery now and have the essentially full pronation/supination of the forearm, I have extension to -4 and full flexion- I measure at 160 flexion and can touch my wrist to shoulder with pressure. I am flexible to begin with which probably hurt me in the crash but helped in recovery. I used aggressive PT- major pain, full time regimen of stretching and exercises, and also some progressive splinting that was very effective. At about 8 wks from surgery (about the time I started splinting) I was extension -40, flexion 140 and supination 0 and pronation 60 degrees. Of note I am a woman and I think all the other bloggers here are men so I don't know how much that changes things if at all.... 
For everyone else....
Does anyone know any women with this injury? I am wondering how mountain biking and specifically downhill went after this surgery. I am eager to ride again really soon and wondering how other people did....


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## mtngal (Feb 23, 2010)

To Chris Cummings- Your email is blocked so I'll post a response here. Good to know you are making good progress, it's a long haul. I used progressive static splinting- from a company in US called JAS, Joint Active Systems. My major issue was that I also had other fractures and dislocation with ligament repair done. My arm is making steady progress now in strength and I haven't regressed as far as range so I'm happy. My arm is still not strong enough to trust on a mountain bike but on the road its okay. Looking at your xray, did they try to reattach the radial head fracture or go straight to the implant? Do they use the same kind in the UK? Mine is Vitallium. From what I understand with the implant it shouldn't limit flexion, only extension as the pressure is on it in extension. I can tell you as far as PT is concerned, I went for almost 5 months 3 times a week and there was major stretching involved. All of this was very painful but likely the reason that I have such good range, I just told the PT to do whatever it took to get the range..... it probably also helps that I'm flexible, my good arm actually passes 0 in extension so that's a good place to start. 
One more thing on the splinting, as I understand it is most likely to work the earlier you use it, I started really early but it sounds like you are still in the window. From my research I would stay away from the dynamic splints that you wear for hours because you may lose range in the other directions from the limits on movement for long periods of time. The splinting I used is very different and better I think.
Good luck with rehab and let me know how it goes over there on the other side of the pond- interesting to see the differences in approach. It sounds like you are doing quite well already....


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## rubysu (May 10, 2010)

*riding after radial head excision*

This page is of great interest to me as I am contemplating a radial head replacement. I had an excision 23 years ago after a fracture dislocation, and in those days nobody was doing replacements except with silicone. I am getting increasing pain in the wrist, forearm and elbow as I get older and it's really interfering with my riding. I love my MTB and don't want to give it up. Does anybody have experience with a delayed replacement? I would love to know if it helped.


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## dennis1 (Jul 18, 2010)

*dennis1*

 Hi Guys Iam New To This Forum But Iam Glad I Have Found People To Talk To And To See If Things Will Get Better For Me.
I Had My Fall On The 2nd Of June 2010 Where I Work On A Building Site I Fell Back And Shattered My Elbow. they had to do sugery to rebuild my Radial Head and pin it together again. In My Left Arm And I Also Have Nerve Palsy In My Fingers , I Can Bend My Fingers I Just Have Trouble Lifting Them Up.
Is Anyone Having The Same Troubles As Me?
I Do My Phiso At Home And At Hospial, Iam also On A Waiting List To Use The Pool At Hospital ( Hydrothearpy)
Does Any Know If I Should Pay For My Own Phiso To Help Me? I Just Feel The Hospital Wont Tell Me Nothing I Just Want To Get Back In To Work Again.


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## navyguy2005 (Sep 27, 2010)

*newly shattered radial head.*

hello all. i apologize in adveance for typos and bad grammar, but i only have one good hand right now. thank you for all the helpful informtion! not a real aggressive mointainbiker (i have one/use it occasssionally) but i am very physically active. i got my injury while running and it seems to be the standard for this site: shattered head/dislopcation. im currently stationed in japan in the navy and awaiting med-evac to go to hawaii to get a titanium head put in.

i was mostly wondering, because i am a bit worried, about post-op pain and full recovery. it seems a lot of the recovery stuff has to do with how agressively i approach my PT afterwards. how bad is the pain? ill be going in about a week for the procedure. how long should i expect to be back on my feet and at least running again? as far as surgical recovery, i have a physically demanding job, will i ever be able to do full pushups again?

thanks in advance for your help.

Nick


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## JHW (Oct 15, 2010)

Nick: 

Focus on regaining your range of motion and minimizing pain first. Get a good PT and do the exercises religiously. I'm 11 weeks out from radial head replacement and ligament reconstruction after flying over the handle bars of a mountain bike while on vacation (47 years old). I go to PT three times a week and replicate exercises on the off days. Talk to your PT about this, but the one exercise that really helped me turn a corner was an "upper body ergometer" (i.e. an arm cycle), which I started at about week 5. I have done it every day after I found one at my local YMCA. 5-7 minutes forward and 5-7minutes backward (in addition to my other daily exercises). At about the same time, I was taking a jacuzzi bath at home and discovered that one of the jets was positioned in the right place to massage my injured elbow/arm. I believe this has helped as well. Lastly, I wore a mesh cloth elbow sleeve beginning around week 4 to help reduce the swelling. It also tended to defuse the pain so that it was not so acute. I have good ROM: with assistance, 0% flex and 140%. Pain and general discomfort have diminished a great deal over the past few weeks. Not pleasant at all before that. Hoping that improvement continues and I don't go backwards. PT massage of the joint beginning around week 4 also has played a big role in my recovery, as well as daily icing. Go to the grocery store and get two bags of frozen peas for top and bottom of elbow. Throw them back in the freezer when you're finished in order to re-use. Talk to your Dr. and PT about all this to make sure it's right for you. All injuries and results are different. Hope this is helpful. Glad to relay my daily routine if that would be helpful as well. Good luck. JHW


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## navyguy2005 (Sep 27, 2010)

JHW,

Thanks for your info. I am about 6 weeks post-op right now, the surgeon was really hesitant to let my PT guy push the limits with flexibility in the early stage. He was nervous because the shearing of my radius went down pretty far and he almost couldn't get the implant to seat in the bone. Right now after warming up I'm getting about 20-25 degrees from full extension, and a couple days ago I was a centimeter away from touching my shoulder (with pain and assistance). Still haven't done any strength building exercise, and it will probably be a couple more weeks before that starts. Pain is down quite a bit (none through the mid-range of motion, and none at rest unless its the first couple hours after I leave PT). I have a little bit of clicking/cracking in my arm when I bend it now though I suppose that is a bit normal. Getting a little bit of wrist pain, but nothing horrible, and also have a little bit of hyper-sensitivity in my right hand with any sharp or hot sensation. But the numbness/tingling is gone, so I'm told its a part of the healing process.

Good advice on the peas, for some reason I hadn't thought to use two at a time. Also, good call on having a good therapist. I lucked out on mine and my surgeon who both have a lot of experience with this kind of injury. 

Thanks again, I'll keep you up to date and ask if I have any more questions.

How is it doing now, JHW? Are you able to put any weight on it (pushups/weight lifting)? I'm in the military and trying to gauge my odds for staying in.


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## JHW (Oct 15, 2010)

I'm about 16 weeks out now. Swelling has continued to go down. Elbow looks close to normal except for the two scars on top and bottom. Yes to clicking-cracking. Some occassional and lingering pain and discomfort above elbow (for some reason) and in wrist-hand. I'm continuing my PT excercises every other day, which includes bicep curls, triceps, and arm extenions (for shoulders) with 5 lb dumbells, along with basic isometrics. On alternative days, I do the ergometer (arm cycle) and stretching at my local Y. I massage my arm a couple of times each day with a hand held massager. To answer your question, at my age, I'm not really concerned about weight lifting -- just being as pain free as possible!

At this stage, I'm trying to wean off of daily Aleve and Tylenol for swelling and pain, which tends to increase during the course of the day. I've now been off for about 4 days and doing good. Hope improvement continues!

Make sure your PT is massaging your entire arm at the end of your session. That will help. Over the course of my PT sessions, I went from 29 to 19 to 17 to 9 to 5 to 0 on extension, so your progress sounds fairly consistent. I was a little slower on flexion. I can only now touch my shoulder with assistance.

Hope your improvement continues. Any special tips from your PT? Let me know if you have any questions since I'm about 10 weeks ahead of you.


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## navyguy2005 (Sep 27, 2010)

Just now at 16 weeks. Doing the arm cycle and some basic weights at PT. 3-4 lbs for bicep curls, no weight for tricep extensions as that motion of my arm still hurts quite a bit (when the arm is above my head). The clicking and cracking seem to primarily by on the flexion motion primarily, but the more I let it crack the worse it will hurt later. Currently able to get to 130/17 in flexion/extension. But my progress in extension seems to has stopped. Using dynasplints for pronation/supenation and different ones for flexion/extension. If you haven't heard of those I would recommend them. You can just google dynasplint for more info to find a rep near you. Those are likely the only reason I am as far as I am with extension (as I was stuck at 30 degrees for about 4 weeks). They are a passive stretching device that you wear while you sleep.

How is it now at 26(ish) weeks for you JHW? Still off of pain meds? How has your strength come back?

Thanks again, hope you are doing well.


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## Purrsey (Feb 8, 2011)

I'm new to this forum. It's the only forum I've been able to find with recent responses regarding Radial Head Replacement post surgeries. I'm female and my injury wasn't caused by biking but by slipping on ice in mid Dec. 2010. I'm now in my 7th week post elbow replacement surgery. I'm trying to wean myself off from pain pills and am now only taking 1 a day, but may have to go back to 2 a day for the aching and pain is still a little much. At what point are you able to completely stop the pain pills? I'm probably going to have to have the DynaSplint to help with arm extension and pronation. After basic PT exercises, my supination is good. My wrist locks up occasionally. I'm unable to touch my shoulder yet. I massage my arm daily especially around the incision to help with buildup of scar tissue. This also helped with numbness which is now gone. I'm rubbing Vitamin E on the incision to help with scarring. My shoulder has been bothering me like it's out of place or something. I have a Drs. appt. this week so I hope to have more answers. At what point does the arm stop aching? How close to back to normal can you get with this type of injury? Is 6 months or more the norm for recovery? I wish I could turn back time and retract my steps!  This appears to be a rare injury, so it's nice to see feedback from this forum.


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## ryki (Mar 17, 2011)

Hi all. Some great information here from you all, I have bookmarked this page to refer back to for when my PT begins.

Anyway, thought I'd share my story too. I'm a 28 bloke and I was riding to work when I collided with a car at a pedestrian crossing. I was doing about 20mph and not looking at an oncoming car but more concerned with the traffic that was stationary!! End result, a mashed up foot and elbow and a week in hospital! Thank god for my helmet otherwise I might not be here right now.

Heres my x ray showing the damage to my elbow: (you need to be logged in to view it)










My Ulna has a break in it and my Radius has broken and dislocated too.

Heres my x ray showing how it was fixed:










Nice new radial head for the Radius and some metal work and screws for the Ulna, job done!

I'm now 2 weeks post op. I have been back to the hospital this week to have the staples removed (17) and i'm currently rocking a full cast which will be on for another 4 weeks.

Then it'll be time for the PT 

I've noticed that currently some of my fingers aren't able to bend back so my doc has advised me to start PT on those now whilst theres scar tissue healing as it will be much harder to do it 4 weeks down the line when everythings healed a bit better. Has anybody else had this problem?


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## Purrsey (Feb 8, 2011)

Hi Ryki! So glad you were wearing a helmet! You injured your arm pretty good! My fingers were fine, but I had problems with my wrist once my splint was removed. It hurt so bad I thought it was broken. I am about 13 weeks out now and with much PT I am doing better. I am now wearing a DynaSplint at night time, but I still can't extend my arm out fully nor can I touch my shoulder. It's still a work in progress. I did buy an upper body cycle and that is helping me with gaining strength...especially the triceps. My supination and pronation is almost back to normal. My shoulder still gives me fits even though I'm doing shoulder exercises to help. My next Drs. appointment is the first week of April so I'm anxious to hear what the Dr. thinks. Keep us posted on your recovery Ryki. The sooner you can start your PT the better.


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## ryki (Mar 17, 2011)

Thanks for replying Purrsey. Now 6wks post op and my cast comes off today. The whole arm has been alot stronger over the last 2wks but I guess thats all going to change this afternoon once no longer have the support of the cast.

The fingers are back to normal after some modifications to my cast as I couldnt bend them back far enough! 

I've tried to do some slight pronation/supernation movement within my cast, hurts a little but feels strong enough for me to atleast try. obviously the cast limits every movement I do so the PT has been miminal.

Pain overall has been minor really, dunno whether thats because i have a high pain threshold though. Aches during night when im tossing and turning tryin to find a comfy spot, have been taking tramadol to help combat this but my supplies are low!

I've looked into the dynasplint. looks like a good idea but how does it affect sleep pattern? is it comfy to wear?


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## ryki (Mar 17, 2011)

well 5 hours after writing my last msg and the cast is now off. Initially i was hugely cautious and it felt very strange but after coming home and having a good wash (which felt amazing!) my arm feels good. 

I've had a go at some ROM but not alots happening. All of my pain is in the wrist too?? Not sure how this degree stuff is measured so this is a guess but ive got a range of 15 degrees with supa/pronation and about 30 degrees range with flex/extension.

Doc has signed me off for 6 wks (that will be a total of 12wks off work) and I will get my 1st PT appointment at some time this wk.

i shall keep posted.


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## Purrsey (Feb 8, 2011)

Hi Ryki! Sounds like you are coming around pretty good! You get used to the DynaSplint after you have worn it for a bit. I have always tossed and turned in bed, so in order to eliminate that I sleep in a recliner so my arm will stay in one place while I sleep. As you tighten up the tension on the splint it will hurt a little until you get accustomed to it. No pain no gain! I went to the Dr. last week and he said he thought it was helping so he ordered me to wear it for another month. You could wear it during the day if you are concerned about sleep, but you can't really do much but sit with your arm still. That's why I wear it at night. I'm still doing my PT exercises and have been able to lift a little bit of weight with my arm. I still have some pain if I move my arm wrong and my wrist is stiff every day when I wake up. The Dr. said it will probably be like that forever and I'll just have to do exercises to loosen it up every day. My wrist pops a lot when I do the exercises and feels better afterwards. I had a lot of pain in my wrist in the beginning and it will eventually go away. The exercises really helped my wrist. Plus I massaged my forearm a lot. That helped with numbness. I have had to exercise my shoulder too. This is week 16 for me. My next Dr. appointment is next month. I'll give an update soon.


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## Purrsey (Feb 8, 2011)

Hi Ryki! Sounds like you are coming around pretty good! The pain in the wrist is normal. After a while that will go away. The PT exercises helps along with massaging your arm. I discovered that massaging helped the numbness go away too. I remember at first when the splint first came off I thought I had broke my wrist it hurt so bad! The DynaSplint is not too bad. I sleep in a recliner at night because I toss and turn in bed too bad and need my arm to rest in one place. When the tension is tightened it is somewhat uncomfortable until you get used to it. The Dr. thought it was helping me and ordered me to wear it for another month. Currently I'm in my 16th week. I have another Dr. appointment next month. I'll post an update soon.


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## Purrsey (Feb 8, 2011)

Sorry I posted the same message twice...I couldn't find my first message once I posted.


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## ryki (Mar 17, 2011)

think im gonna give the dynasplint a miss, im not one for sitting still alot! 

I had my 1st PT session yesterday. I thought I was going to get 'beasted' but it was prettty miminal in the end. I've been given 5 minute 'gentle' exercises to do every hour until my next app on thurs. My range is 85 - 115 which is what I thought to start with. Loads of cracks, pops and squelchs when doing the exercises, it drives the wife nuts! lol

My wrist doesn't hurt as much now either which is nice!!!

I shall report back next thurs!


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## Purrsey (Feb 8, 2011)

I went to the Dr. yesterday and he said that I have plateaued in progress of extension/flex which is currently 15/125. I still need to continue PT exercises and see if I can get more extension, but it doesn't look promising. He told me from the beginning that it might not ever be the same as it was. My supanation/pronation is very good...no issues there. My wrist pops 2-3 times a day when exercising it. I haven't experienced any clicking noises thank goodness but I can barely touch my shoulder. I'm now at 19 weeks post surgery. I've been released from the Dr. and no more follow-up appointments are needed he said. How are you doing ryki?


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## ryki (Mar 17, 2011)

Hey Purrsey! 

All is going very well I feel for me! For 1st couple of weeks out of cast (weeks 6 to 9 post op) I had two 20 min PT sessions a week and alongside that I did 10-15min exercises every hour every day and things were going smooth! 

Then I went to 1 session a week and plateaued (weeks 9 to 11 post op) as I was starting my PT sessions at 65/120 and finishing at 60/120 everytime! I then changed my PT person and my home excerises and things have improved! I found that massaging the muscles for 10 mins three times a day helps to relax them enough for me to stretch them during my exercises! 

I'm now 55/120 at week 13 post op. I had doc check up last week, my sup/pronation is excellent, prob 2 degrees off perfect! In terms of final outcome for my extension/flexion he thinks 15/125 is what i'll be able to finally manage! He also told me that I split the head of my Ulna too which I didn't even realise!


Went back to work yesterday and also got back on my bike too (to get to work!lol) with my nice shiny new helmet! A bit strange having one arm bent but I'm managing!

Have you managed to squeeze a few more degrees since writing your last comment? Hows the wrist popping? Doe's it ache much still? I haven't got any pops, sometimes it'll sqwelch but its very rare. It really aches around the Ulna on the inside of my arm but thats only when I've exercised.

Got another doc appointment in 3 months.


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## Purrsey (Feb 8, 2011)

Hi ryki!

Sounds like you are coming along well! So glad you changed your PT person! What a difference that made! I haven't changed any from 15/125. I have a feeling that might be as good as it gets for me. My wrist still pops during exercise everyday. It feels so much better once it pops. I don't have a whole lot of aching, just stiffness every day when I get up. Once I start using my arm the stiffness goes away. I still don't have all of my strength back, but I'm working on it. I bought a little red wagon to carry groceries and heavy items from my car to the house. I hurt my other arm (good elbow) by carrying too much trying to compensate for bad arm. I think I have tennis elbow in it or something. I feel like I can't lift much now until I heal further. It stinks! You don't realize how much you lift things until you don't have the option any more. I'm glad you discovered the wonders of massaging your arm. It really helped me with the numbness. I'm looking to purchase a Nike Golf Sleeve to cover my arm for when I go to the pool. I've also been using 100 spf sunscreen on my surgical scar when outdoors. Doctor said to protect it for at least a year. Keep us posted on the results of your next doctor appointment!


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## JAPR (Jul 11, 2011)

*5 weeks*

Hi All,

Really glad I can upon this site. Found it while sitting with my wife in the hospital. She fell of her bike, just street riding for enjoyment. She dislocated her right elbow and shattered RH. The implant was placed on June 1, 2011. She sat in a partial cast for 2 weeks. Originally the Dr wanted her to begin moving within 2-3 days. However because of the extent of damage to the elbow, including the metal plate with 8 screws, he had her hold off for 2 weeks. We began working pysical therapy/phisio therapy (PT) during the third week with just her and I. I've had a lot experience with PT so I did what I could. Her flextion and extension are max at 35 and 105. We've transitioned to licenced PT and it is working well. The concern is that she stiffens up very quickly. Every day when she starts PT she has to work for 20 plus minutes just to get to where she was the day before. The PT is now using heat to loosen her up first then they are using electro stimulation then rolling into the exercise routine. The Dr already told her that because of the amount of repair that she had to have, he would be happy with 20 degrees extension but flextion she can go as far as she can handle. He is concerned about ripping certain sutures which I do not fully understand. I am hoping that she can do better than 20 degrees but I am happy that she is okay. Did all encounter breaking through the same barrier each time they starting a different days PT?

thank you,

JAPR


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## JAPR (Jul 11, 2011)

*Shoulder movment*

Hi there,

My wife's shoulder seems to be over compensating significanly when extending and flexing her arm after the RH replacment. It makes her look like she is extending and flexing further than she actually is and I am concerned about shoulder injury to add to the elbow injury. Did anyone else encounter this problem? Did you find anyway to hold the shoulder still while working on flextion and extension.

thanks,

J


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## Purrsey (Feb 8, 2011)

Hi JAPR,

Sorry to hear of your wife's accident. Did she have an implant put in or were they able to save the radial head pieces with a metal plate and screws? I too had to wait 2 weeks before I could take the 1/2 splint off. When they did take it off my wrist hurt so bad I could barely move. My shoulder hurt when I did my exercises so I began doing shoulder exercises which helped immensely. You might ask your PT to add shoulder exercises to her daily therapy. My recovery has been a slow process and has definitely not happened overnight. Tomorrow will be 7 months to the day of my accident. I still have some stiffness daily, but once I actively use my arm it goes away. Hope this helps and keep us posted on her recovery.


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## JAPR (Jul 11, 2011)

*6 Weeks*

Hi Purrsey,

Thank you for the suggestion.

She had a RH implant plus she broke the Ulna right at the Olecranon as well as shattering a piece of the Olecranan. The Dr had to plate the Ulna to the Olecranon with 8 screws and from what the Dr said the part that kept her imobalized for those couple of weeks was that he had to also suture a couple of things together (not sure I completely understand this part) to compensate for the shattered piece of the Olecranon so that the elbow does not disslocate.

I will surely begin working with her on shoulder exercises and recommend to PT.

With the limited range of motion that these surgerys cause at first, do you happen to remember what exercises you did at the very beginning in-order to work on your bicept and tricept strength?

It is very hard at the moment because her range of motion seems to be limited to passive rather that active motion.

I'm glad to hear that while you do get stiffnes it sounds like you've advanced well in 7 month.

Best,

JAPR


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## Purrsey (Feb 8, 2011)

Hi ryki,

I'm just following up to see how your exercises are going? I'm hoping all is well! Hope to hear from you soon.


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## Purrsey (Feb 8, 2011)

JAPR,

I'm going to provide a pdf link that has shoulder exercises to try. I'll post it as soon as I find it.


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## Purrsey (Feb 8, 2011)

Hi JAPR,

OMG! Her injury sounds to be a little more complicated. I've attached a pdf link that you can go to and print off the various exercises for the wrist/arm/shoulder from The Ohio State University Medical Center. These PT exercises were also approved by my Orthopedic Specialist. The PT can recommend how many reps and how often to do them in a day. The exercises worked for me but it took some time. Be careful not to push it too hard for she can overstretch the ligaments (Hypermobility) and that's a whole other issue. Keep us posted on her progress. 

[URL]http://www.medicalcenter.osu.edu/patiented/materials/pdfdocs/exer-reh/upper/elb-fore.pdf


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## JAPR (Jul 11, 2011)

Hi Purssey and Ryki,

*Hi Purssey*, thank you very much for the link to the exercise routine. We are always looking for different ways to address some of these exercises just to keep them interesting and motivating.

*Hi Ryki*, I was looking at a few past postings and came accross your xrays. They look very similar to what my wife had done. Both the RH replacement and the Ulna and Olecranon plated back together. Did your Ulna and Olecronon completely break from each other and is that why they were plated or did the ulna fracture and they put the plate on plus wrap it with a wire band to help heal the fracture. My wife is a surgery nurse and she is thinking it is a wire band to keep the ulna together. How are you feeling and how is your progress?

PS I will post her xrays once we get them back from the Dr.

Best,

JAPR


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## ryki (Mar 17, 2011)

Hey JAPR, I have been reading your comments and it does sound like your wife has an almost identical injury to mine but on the right elbow. My Ulna was as good as broken completely and yes my Olecranon was damaged too, it 'split apart.' 

The wiring I presumed was to hold the Radial Head and Ulna in position and stop them from dislocating? Maybe I should ask the doctor about this (or listen when he does tell me!) ! Does your wife have something like this too? Or maybe this is what the sutures are doing? Maybe they 'bound' some tissue together to keep things 'snug' and then expect through PT for this to fix itself? These are massive guesses, I'm no doctor!

Great news that she's doing PT already. I seem to be the only one ever to be put in a full cast for 7 weeks for this injury so my PT has been alot different!! I think my muscles built up too well whilst in the cast as I was still using them ALOT (the muscle that runs along the top of the arm from the joint was absolutely massive!) and so now it has hindered me abit as I have alot of scar tissue to try and work as its too tight and strong!

35 Ext is awesome I think. I'm only at 45 Ext and I'm nearly 5 months post op! My doc only expects me to get to 15-20 Ext. 

Flexion is really poor for me. Its something I haven't concentrated on nowhere near as much as Extension, mostly as the Doc said I'd get 115-120 out of it which is what it was at when I had my last appointment in May. It hurts more trying to excerise in that direction and everything around my elbow feels insanely tight to the point were I can see my skin go white from pressure were the plate is poking out!

In terms of stiffening, yes it still does stiffen up this far down the line. Example, I had a PT appointment last fri early morning. I had no time to 'warm up' so went straight to my appointment. At the start of the session I started at 60 Ext which is a barrier I had past a good month ago and it took the whole 20min session too get back to my current angle of 45 Ext. All because it has stiffened up overnight. 

In terms of shoulder movement, my shoulder also 'leans forward' alot which makes me feel like my arm is doing great during exercises when in actual fact its not, its just my shoulder sticking out! Aslong as your wife is concious of that movement she should just try to keep it to a minimum. Maybe exercise lying down?

The exercises I like do at home (when life/work doesn't get in the way!) mainly involve lifting a heavy shopping bag of weights for 30 - 60 secs three times an hour (this is to remove any stiffeness built up) and then just holding a heavy dumbell in my hand and letting my arm muscles relax so that the weight naturally forces my arm downwards. Again 30-60 secs three times an hour. I use my elbow as a pivot (with cushions underneath) and hold the dumbell over the table edge. I first did this lying down to reduce the shoulder movement but have since prefered to do it sitting up. I used to use 6kg and really push myself but have tried out 2kg this week and I can hold it for longer periods and it feels more comfortable!!!!! Whether it will have done me any good, I will find out tommorow at my PT session!

My PT session is once a week. They do 5 mins massage and the rest of the session is spent doing a technique called 'hold and relax' which involves me pulling my arm up with the therapist pushing against my arm for 5 secs and then me relaxing my arm whilst the therapist still continues pushing down (alot more gently though). Gradually my arm will get weaker and weaker until I cant pull up no more! Thats when we stop and measure! 

As I dont check this page much now, if either of you guys (or anyone else who comes across this msg) wants to add me on facebook to chat more then feel free. I'm happy to answer any questions that you may have. My name is Ricky Jordan (Weymouth, Dorset) 
link here (might need to log in to view it) >> facebook.com/profile.php?id=900020353 <<


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## ryki (Mar 17, 2011)

I have a new x ray which is much clearer than the others I posted but this site wont let me display the, until ive made a few more posts so here they come . . . . .


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## ryki (Mar 17, 2011)

little and often is the key to exercises . . . . .


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## ryki (Mar 17, 2011)

make sure she still alows time for recovery too. If it gets too much then reduce or stop the exercise for a day


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## ryki (Mar 17, 2011)

im wittering on now like a mad man sat in front of a computer screen at 12.15am, oh wait I am!


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## ryki (Mar 17, 2011)




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## ryki (Mar 17, 2011)

well switching to a lighter weight and doing more exercise often doesnt to seem to have done me any favours. I should be hitting 50/45 Ext at the start of my PT session, today I was at 55 and I finished on 50. Disappointed massively. Think I'm gonna switch back to the heavy weights and just push myself insanely!


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## JAPR (Jul 11, 2011)

Hi Ryki,

I was just thinking along the same lines as you yesterday. I believe you may have a very good point. Less exercise with more frequency. Right now she is trying to do a full work out two to three times a day which seems to be a barrier because her arm seems to thighten more. I'm going to write up a schedule for her to do stretches every two hours while awake. Then do one full work out each day rotating the part of the arm that she works on from one day to the next. I work out a lot and if I tried to work out my arms every day or more than once a day I'd have nothing left.

You're xray does look very similar to hers The Dr told her that if and when she get to 30-120 he will be satisfied. She has a complete brake in the Ulna from the Olecronon. When we saw it on the xray it looked almost scary. Doc said that bone should grow back in and if it does not then they may go back and put some filler in between the two pieces. For now he did not want any thing in their because of fear that the filler would create friction elswhere and cause asthritis. My wife (a surgery nurse) calls this people bondo like they use on a car.

She is currently wearing a brace for flexsion and extension but it is not dynasplint. We are still fighting with insurance to get the dynasplit. Did you end up using it and what are your thoughts? I read a lot of different opinions on it both good and bad.

The brace she is wearing you crank a knob and then leave it on for several hours. At first she was trying to crank it two quickly and to much and only could stand it for 30 minutes but that did not do any thing.


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## JAPR (Jul 11, 2011)

*Dynasplint*

Hi has anyone used the dyansplint for elbow extension?

If so does anyone know if the dynasplint elbow extension brace work for either a left or right arm?

I know some of dynasplint's stuff is left/right specific but I was wondering if anyone knew specifically about the elbow extension brace.

thanks,

JAPR


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## ryki (Mar 17, 2011)

I haven't used any brace or supports but Purrsey has. What is it that your wife is using? I looked into Dynasplint but was put off at the fact they don't have prices on their website and also that everyone who has used a Dynasplint on this thread has gone through Insurers to get one which made me think it might be too expensive!

I have another PT sessions today. I have been using a heavy weight all week and as a result my arm has been aching loads, hopefully this is a sign of improvement! 

I have found a way to reduce shoulder movement too. If you lie down on your side with the injured arm outstretched along the floor (which should actually be stuck up in the air!) then you are putting all your body weight onto that shoulder that is movng therefore it should be restricted now!


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## JAPR (Jul 11, 2011)

Hi All,

Just got the dynasplint two days ago. It was in fact a battle with the insurance. The dynasplint people do not want to sell them. They want to rent them at a very high rate. The insurance company agreed to pay for a few month but I think our max $$ amount will run out before them. She got a splint for the extension and one for the supination/pronation. You have to wear the extension for 8 hours at a time so she does it while sleeping. Not easy to get comfortable. As for the wrist one that is 3 Xs a day 30 Minutes each. That one works very quickly but looks like something from Terminator.
We go see the doc in 5 days. Hoping he'll note some improvement. Her arm is still very weak. but ROM as gotten a tiny bit better. Now 8+ weeks post op.


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## ryki (Mar 17, 2011)

Hey JAPR, hows your wife getting on with the dynasplint?

I did eventually look into getting one and they have said I can buy one for £1000 which I would like to think is good value for money IF I knew I was going to get some results from it because at this point in time I have been discharged from physiotherapy 

My final ROM is 115/50 and after two months of trying I can get no further than 45 degrees after excerise. I had a doc app yesterday and he said he wasn't particularly suprised at the ROM and that they will probably do another operation to remove some scar tissue to 'free' the arm up a bit. This isn't going to happen until the new year though once everything in my arm has completley settled.

In the mean time I still need to get on with my on physio regime ( 3 times a day) to make sure my arm doesn't recoil backwards and ruin the progress that I have made.

Oh I have a hernia on my forearm too which is probably from over exercising!!! typical!


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## JAPR (Jul 11, 2011)

Hi RYKI,

Your injury and my wife's are almost identical. She is now 3 month post op and she can get to 115/50, with streching from the therapist she can get to 118/45. We saw an elbow speciallist two weeks ago and he said that she will need a surgery soon to remove from the excess scar tissue and also because the gap in the bone that the plate is holding together has not filled in yet so they will need to do a bone graft to fill in the gap. The specialist seemed to think that more PT will not do much good. But he is willing to have her try it for a bit longer. Also he is recommending a bone stimulator machine to try to grow the bone in the area that was broken on the Ulna. She is currently wearing the extension brace for 6 hours during the day time. She is wearing the Flexion brace for 6 hours during the night time and is wearing the supination/pronation brace 30 minutes 3 times a day. YES three braces. Because they are so expensive the insurance would only cove them for a couple of month. I found an extension brace on e-bay for 225USD. I don't know if they are really working. What they are doing is preventing her from regressing. The problem with her is that she is not getting stronger. Without the strength she will not be able to break through any scar tissue on her own. She exercises all the time but needs to push for heavier weights but no luck there.

The brace may help you maintain your ROM but I'm unsure about how well they work for gaining more ROM. I will tell you that she is not dilegent in wearing it exactly how it is suppose to be worn. That is my opinion as I've done a lot of research and watched a lot of video's on You Tube of how they are suppose to be worn. There is a very specific procedure to wear them and that you should sit still for as long as possible. My wife get's rather restless.

Keep me posted on your progress and what the Doc says. We see two more Doc's in Sept and will most likely choose the next path. PS are you back to work? She is suppose to go back Sept 1 but now pushed back to Oct 1 or Nov 1.

Best,

JAPR


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## Purrsey (Feb 8, 2011)

Hi JAPR,

I used DynaSplint and didn't have any issues with it. My insurance didn't pay for the rental of the splint, so DynaSplint worked out a payment plan with me that was affordable. I wore it for 4 months and did see improvement. I wore it at night while I slept but had to sleep in a recliner with pillows propped up beside me under the arm. I tend to toss and turn a lot in bed, so this method kept me still. It was worthwhile for me to use the splint, but you do have to wear it faithfully. Sometimes I had to take a break from it for a night, especially when I had tightened it. I could only wear it for 5-6 hours until I got accustomed to that level of tension. The recommendation is to wear it for 8 hours. I hope your wife is able to stick with it, the results were worth it for me. 

Please keep us posted on her progress. I wish her the best.

Purrsey


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## Purrsey (Feb 8, 2011)

Hi Ryki,

Sorry to hear you might have to have another surgery. I'm glad you are continuing your PT exercises despite the setback of a hernia on your forearm. Hang in there for it will get better! 

As far as my progress goes, my elbow now pops occasionally along with my wrist. I have occasional aches and when I go walking/jogging for long periods of time my arm will stiffen up and I have to exercise it. I can ride my bike now and have started wearing elbow pads for protection when riding. My scar is beginning to diminish somewhat. I've been using 100spf on it when outdoors. My arm is not completely straight, but that's expected. I'm just hoping that I don't develop arthritis in my elbow. Time will tell I guess. 

I hope you keep posting your progress here Riki for I'm not a member of Facebook.

Take care, 

Purrsey


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## JAPR (Jul 11, 2011)

Hi All,

Almost 14 weeks post op. Flexion seems to be doing better. The dynasplint seems to be working for that. However the extension is still stuck at 50 degrees and no improvement there. Supination and pronation also seem to be stuck Doc seemed to think that there was a bit of regression on the supination. Maybe the bone calssification jumped from the Ulna to the Radius. This will probably have to be cleaned up once and when they go in to clean up. For the last week my wife's been unable to stand the extension brace for any period of time. There is an odd swelling at the end of the plate near the forearm. It is also very very tender to the touch. Can't tell if it is swelling from an infection (does not appear to be) or maybe one of the screws has come lose. We see the doc in three days so we'll find out. Hate to have set backs but we kind of figured they would happen.

Will be back soon,

JAPR.


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## JAPR (Jul 11, 2011)

Hi All,

16 weeks. Extension progress has come to a stall. Working on scheduling surgery for a bone graft to fill the gap that is in the Ulna. It will most likely come from the hip. Doc wants that to heal for 3 month then he will do another surgery to free up the arm.

JAPR


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## ryki (Mar 17, 2011)

Hi all! No progress from me. Elbows still stuck at 115/120 and 55/50. Doc has brought my surgery forward to December of this year, The surgery involved is called an 'Anterior Release'. They will remove scar tissue from both sides of my arm. Hopefully they will fix the hernia too and also remove the 'wiring' as the block that holds them together has been irritating me!

Sorry to hear about wife needing a bone graft JAPR, thats quite a big set back. 

Glad your on your bike Purrsey, good idea with the elbow pad, just make sure your wearing a helmet too!!


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## JAPR (Jul 11, 2011)

Hi All,

Wife just had bone graft from Illiac crest (pelvis) to the elbow. Surgery took about 3 hours. Two doctors already warned us that the hip will hurt more than the elbow. xrays show that the gap is packed in very well. Pain in the hip is very uncomfortable. Hurts when walking/sleeping moving around. Doc's say that will take a decent amount of time to heal. Elbow is not so bad but very stiff because doc does not want too much movement until bone graft sets in. wife is using a bone stimulator to accelerate bone healing. two month from now wife will have what we hope will be the final surgery to release the arm (remove the calssified bone and maybe remove some of the metal hardware). BTW the doc had to change two of the screws because they were too long.

Hi Ryki, I hope your elbow release turns out very well. It looks like your "release" and my wife's will be about one month apart. Please keep us posted. I'm very interested on how you progress. Best of luck, keep posting.

thanks
JAPR


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## JAPR (Jul 11, 2011)

*Update*

Hi All,

My wife just saw the surgeon last week. Xrays show that the bone graft is healing well. The next surgery to release the elbow will be the first week of February. According to the Doc he may have to remove the radial head and clean up the scar tissue and then put in a new radial head.

All the best,

JAPR


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## OldschoolBMXer (Sep 25, 2008)

*Radial head replacement isn't the end*

Hey everybody, just wanted to let all of you know I read this thread after blowing up my radial head into 8 pieces in Oct 2011. I can't thank all of you enough for giving me inspiration and confidence to make it back in the saddle again.

The surgeon I had did a wonderful job in removing the pieces and replaced it with a prosthetic. After 6-7 months of PT and me stretching and exercising, I was able to get back to 93-95% movement, I gingerly made my way back to riding again. PT can do wonders; the more you put into it on your own time the better your results will be. The surgeon explained that I'll never have it 100% again and obviously warned about the risks with riding again, but I think in anything we do there's inherent danger and minimizing the risk can help.

I've been happily back riding for 9 months and trying to enjoy a different side of riding I didn't appreciate before (trail riding). I've been slowly building back confidence and being better at focusing on my riding because it's this part that got me hurt (being too relax about what I was doing). I have to say I didn't know I could actually be better at just riding and controlling a bike on the ground. So there's a light at the end of the tunnel.

I'm getting a little more comfortable everyday and hardly notice that I have a repaired elbow and only reminded of it when I'm trying to do more than I'm suppose to. I'm still trying to work on the strength, but as time passes, it's been harder to be disciplined.

I wrote a review on the POC pads I would recommend to you all. I spend a lot of time researching safety pads and these have been the best I've used. Take a read if you like here. I encourage you all to have hope and determination to get back on the saddle.

Happy Trails... :thumbsup:


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## JJHonu (May 17, 2013)

Aloha - I too had a mountain bike accident. Shattered both my elbows in 2006. Screws in both. The right was worse and after years of pain and issue I had a elbow replacement 5 months ago. Got the green light 4 weeks ago to to things, helped my husband move a dresses and rotated the radial replacement head 180 degrees. Crap. So last week had surgery for the Third time on my elbow and he removed replacement and now there is an empty space in my forearm. 

I was a rock climber - not any more. I have been surfing since i was 14 (now 43) and hoping to be able to again. Got the green light to surf till I lifted that damn dresser.

Anyone with no radial head? Activities? Any advice would be great. Sure wish my doc told me not to lift heavy items.


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## ryki (Mar 17, 2011)

hey all, quick update. 

Over two years have passed since my injury. ROM is still pretty poor for me. 115 - 45, so a window of about 70 degrees. It hasn't hindered life much. Struggle a bit these days now that my 18mth little girl is getting heavier to carry, aches the muscles around the elbow in the evening! 

Comfortable on the bike even tho I cant outstretch but Im still able to stand and hold the handle bars with comfort. Swimming is interesting, I go round in circles a lot (just kidding!). 

Verdict, PT every second you can as it will benefit in the long run. Sadly I cant really do much PT now as life gets in the way and the PT I have tried doing recently has been painful for the days afterward which has an effect on the quality of my life so I made the decision not to continue.

If you have time off work with the injury, use it to its full capacity in doing PT!


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## bryndav (May 2, 2014)

I am 53 years old and I had a radial head replacement in my right arm after an MTB accident 1 year ago, in May 2013. I was devastated at the time but would like to give some hope to anyone out their in the same situation, because a year later I am riding as much as I ever did and doing quite rocky, bumpy trails with no problems at all. Best advice in no particular order: firstly, be patient! I fell in May 2013, started smooth tar rides in late August, and was back on MTB trails by the end of November. I was in a brace for 6 weeks, the first 2 of which I was not allowed any movement at all. I did intensive physio 3 times per week from week 3 after the surgery, and the physiotherapist encouraged movement of the joint very early in the process. After the brace was removed physio was quite aggressive and painful, but I am grateful for that, as I have heard that others who followed a more conservative approach with regards to movement did not get good ROM back. It is vitally important to religiously do your home physio exercises every single day, and do them properly. There are no short cuts! I did physio twice per week for 4 months, and daily exercise at home in that period. I also started strength training at the gym in about month 4 after the operation, and I am still doing that once per week. Avoid free weights and stick to gym machines that are based on pulling and pushing cables, and keep the weight under 5kg. Don't attempt any exercises that involve the arms above the head. Besides the ROM problems, don't underestimate the loss of strength and muscle in the rest of the arm, especially biceps and triceps, and watch out for shoulder problems because of using the shoulder to compensate for loss of reach. After all that my arm is now as good as straight, extension is full, but flexion is not as good but nevertheless fully functional. Supination is almost full, and no problems with that at all. But the very best thing that I did was go to a good biokineticist (who participates in MTB and has a good understanding of the demands on upper body) in January of this year, and he gave me a set of 7 exercises to do using a theraband, 4 times per week. I am still doing those exercises and will continue for another 6 months at least, if not make them a permanent ritual, as they help so much. They have made a massive and positive difference and my arm is strong and the elbow joint is stable and strong, and I have no problems with MTB at all, except for a mild ache in the forearm, especially on long rides. But I have done road cycling events in excess of 5 hours, and my arm coped well. I avoid carrying heavy weight in my right arm, as the surgeon warned against doing so, and I am always conscious and aware of the fact that my right arm is no longer "normal" and so I need to be careful with it. But I am once again fully functional on my mountain bike and I ride every weekend, albeit a little more carefully!


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## css233 (May 30, 2014)

I'm sorry to hear about your accident. I hope you are doing well. I also had a severe injury. I was working construction and my ladder kicked out on me. I free fell 15 ft on to my left arm (dominant). I dislocated my wrist and fractured my ulnar as well as dislocation my elbow and shattering my radial head. And I am only 23! I didn't have the best ER doctor which set my joints and plated my fractured ulna. I went through 2 months of being casted and 6 months of intensive therapy. I have so much pain and loss of motion in my whole arm. I got referred to mayo clinic in rochester. They are absolutely amazing. Last week I had surgery on my wrist. It was too far damaged to try to fix so I had the option of a full wrist fusion or a procedure to take out the nerves in the wrist the sent pain signals to the brain. It went very good. I have no more pain in my wrist!!! And doctor is hopeful that it will last long enough into the future till I'm old enough to get a wrist replacement. I have also had my elbow assessed here at mayo and have surgeru in a couple of weeks. I am going to have a radial head replacement as well as removing broken fragments and a ligament graph. I have full confidence in the doctors here. I believe they are the best in the country. I know what you have all went through and I can sympathize! I am also a very athletic person and have played sports my whole life. (Played a year of college football). I am ready to get this done and get my life back on track. I am glad you guys have posted your stories, for they were very helpful and reassuring. I hope all is doing well and are still able to enjoy your sports and activities!!!


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## davblck (Aug 28, 2013)

bryndav said:


> I am 53 years old and I had a radial head replacement in my right arm after an MTB accident 1 year ago, in May 2013. I was devastated at the time but would like to give some hope to anyone out their in the same situation, because a year later I am riding as much as I ever did and doing quite rocky, bumpy trails with no problems at all. Best advice in no particular order: firstly, be patient! I fell in May 2013, started smooth tar rides in late August, and was back on MTB trails by the end of November. I was in a brace for 6 weeks, the first 2 of which I was not allowed any movement at all. I did intensive physio 3 times per week from week 3 after the surgery, and the physiotherapist encouraged movement of the joint very early in the process. After the brace was removed physio was quite aggressive and painful, but I am grateful for that, as I have heard that others who followed a more conservative approach with regards to movement did not get good ROM back. It is vitally important to religiously do your home physio exercises every single day, and do them properly. There are no short cuts! I did physio twice per week for 4 months, and daily exercise at home in that period. I also started strength training at the gym in about month 4 after the operation, and I am still doing that once per week. Avoid free weights and stick to gym machines that are based on pulling and pushing cables, and keep the weight under 5kg. Don't attempt any exercises that involve the arms above the head. Besides the ROM problems, don't underestimate the loss of strength and muscle in the rest of the arm, especially biceps and triceps, and watch out for shoulder problems because of using the shoulder to compensate for loss of reach. After all that my arm is now as good as straight, extension is full, but flexion is not as good but nevertheless fully functional. Supination is almost full, and no problems with that at all. But the very best thing that I did was go to a good biokineticist (who participates in MTB and has a good understanding of the demands on upper body) in January of this year, and he gave me a set of 7 exercises to do using a theraband, 4 times per week. I am still doing those exercises and will continue for another 6 months at least, if not make them a permanent ritual, as they help so much. They have made a massive and positive difference and my arm is strong and the elbow joint is stable and strong, and I have no problems with MTB at all, except for a mild ache in the forearm, especially on long rides. But I have done road cycling events in excess of 5 hours, and my arm coped well. I avoid carrying heavy weight in my right arm, as the surgeon warned against doing so, and I am always conscious and aware of the fact that my right arm is no longer "normal" and so I need to be careful with it. But I am once again fully functional on my mountain bike and I ride every weekend, albeit a little more carefully!


Your post is encouraging. I am a 46 year old male that is 4 months post injury with one messed up elbow (terrible triad as the doc likes to call it) Anywho, my radial head was fractured into multiple pieces but the doc felt it had potential to heal so followed their advice and waited patiently, PT, bone stimulator, etc. but unfortunately the fragments haven't unified. So getting ready to do the replacement in two weeks. Being told i should be able to ride again in 3+ months. I'll be diligent in following whatever they throw at me again. I actually have recovered fairly well with the exception of the weakness and pain in the forearm up through the thumb (due to non-unified radial head). i can do a lot of things but pushups are limited to assisted knee. Haven't attempted a full pull up yet but i have hung form the bar and pulled up about 20% without pain or problems. Just can't wait to get back to non-hindered life style and getting back on the bike and exercising again at full throttle.

Cheers:thumbsup:


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## RGV (Jun 12, 2015)

Hi all.
I too have busted my Rh last week and had it replaced with a prosthetic implant.
How are you guys getting on?
I also work as an AV engineer so will have to be doing some lifting, drilling with power tools...and manual labour.
Are there any safe limits?
Have any you returned to kind of pre-accident normality?
Any post would be appreciated.


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## Meugene517 (Jun 19, 2015)

Not sure if I am happy or sad to see so many people on this thread having gone through a radial head replacement... I am on my third one...

October 2013 I went head first at 40mph downhilling and shattered my clavicle and radial head... I now have a plate in my neck with no feeling from the neck through the shoulder and just went through my third radial head replacement from two failures.

Some thoughts for those who read this and have just gone through the replacement surgery... GO SLOW on your recovery... Like you all, I am an extreme sports junkie still at age 48... I've never had a physical compromise in my life until now. It's critical that you do not take this recovery lightly, and please do not think you can resume your old life the way you did before. Your body is no longer the same and it's going to be important to take your recovery period very seriously.

Radial head replacement is a rare injury and surgery. The recovery ensures the bone "grabs" the prosthetic and holds it in place. Slight movement or slippage is a very painful thing, believe me on this. Go through your PT at the beginning to only focus on stretching and range of motion. Working with your PT, only then determine when to go to minor strength training (Right now I am three months into my third RH and just picked up 1lb). 

Plan with your PT to set a long range strategy on when you should start any weight bearing activity as this WILL loosen the RH if you go too soon. Next plan long range strategy on when your radial rotation is strong enough and flexible enough to do... HEAR ME on this... Your radial rotation (arm at 45 degrees and rotating wrist) is the most common action you need in riding, paddling, etc. IF you try to get back to activity too soon, this will pop the RH prosthetic post right out. This occurred after my SECOND replacement the first time I went paddle boarding at 4 months post-op.

Hopefully this isn't being too much of a downer for those who are just going through this, but I would rather have you ready reality check, than see a post from you that you have had yours re-done from trying to go too fast.

Hang in there and take the long slow road to your recovery!


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## docendo (Nov 18, 2013)

RGV said:


> Hi all.
> I too have busted my Rh last week and had it replaced with a prosthetic implant.
> How are you guys getting on?
> I also work as an AV engineer so will have to be doing some lifting, drilling with power tools...and manual labour.
> ...


I started a bit of a thread with my experiences a couple years ago: http://forums.mtbr.com/rider-down-i...l-head-replacement-3-months-after-887851.html


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## Greencane (Oct 24, 2015)

This is a great thread. It's helpful to read other similar stories.
I fell and dislocated my ulnar and shattered my radial head. Had the replacement surgery early august and doing the recovery thing. Im 42 years old. Doc didn't want me to start pt until the 6th week. Making progress but still sore every day. I'm at 20/110 now at 11 weeks out and still struggling with pronation/supination. I started doing cable based machines at the gym with light weight and that seems to help alot and I feel the strength building. Just started the dynasplint at week 11 so I will see how that goes. Anyone use one of these dynasplints? I got good feedback from a coworker that used one but he didn't have a radial head replacement, just a fracture. I see mixed reviews online.
One thing I didn't see much in this thread was pains from quick movements. If I move my arm fast to say catch even a soft rubber ball or even a jumping jack there is a brief pain from the quick movement. Doc and pt say to expect this but was wondering if anyone else experienced this and how long before it went away. I miss riding and playing hockey the most and this this quick movement/impact pain will be the main limiting factor. I hope I can do those things again.


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## docendo (Nov 18, 2013)

Greencane said:


> One thing I didn't see much in this thread was pains from quick movements. If I move my arm fast to say catch even a soft rubber ball or even a jumping jack there is a brief pain from the quick movement. Doc and pt say to expect this but was wondering if anyone else experienced this and how long before it went away. I miss riding and playing hockey the most and this this quick movement/impact pain will be the main limiting factor. I hope I can do those things again.


Totally anecdotal: I went indoor karting last Thursday on a super twisty track. So lots of arm-jerking back and forth under lots of muscle stress with semi-complex movements(flex/extend/pronate/supinate, you get the idea) and it didn't bother me at all. If you're still only 3 months out you've still got time and a ways to go 

Right now your worry should be motion and after that it's just a lot of time getting back into comfort - which'll happen naturally if you keep moving the arm. Once in a while yeah, I'll still get achiness or a ping of pain out of nowhere, but they're getting more infrequent as time goes by. Honestly I'd say that somewhere between the 9-12 month mark was where I finally kind of went "hey I hardly notice this anymore"


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## anne1684 (Nov 4, 2015)

I'm not a biker but I lived on this forum when I had my radial head replaced a year ago. There wasn't much information on the web and this was about the only place I could get real life stories of recovery. It was these stories that gave me hope that I could recover. Imagine my surprise when I saw a new post. I had to join just to answer.

I'm 49 years old and had my radial head replaced Nov, 2014. I used the JAS splint and had good luck with that. It took me 4 months to get to 5/143. Pronation and supination are great. I didn't do any strength training until I got my movement back. I did PT 5-6 times a day following the advice I got on here. I did all the PT on my own. 

At a year out I can do jumping jacks pain free. The quick movements don't bother me at all. My elbow feels stiff when I extend it but it hasn't slowed me down. I'm still mindful of my elbow only because I'm not interested in re-injurying it. Totally not worth going through THAT again.


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## C.C.Buzzcock (Jul 4, 2017)

Hit a 4x4 on my motor bike back in march (day after mothers day, mother was chuffed) and shattered my left radial head, looked like someone dropped the china. I had to have it replaced, as well as the ulnar and right clavicle plated and the fore arm shortened by about half an inch. I found this thread while trying to see roughly how long it was going to take me to get back to work. There was a lot of helpful and reassuring info on here so just wanted to thank you guys. Hope everyone's doing well and healed up best they can.


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## xxotxx (Sep 26, 2019)

I'm so happy I found this forum, I am actually going into surgery tomorrow morning 4 radial head replacement in my left arm after experiencing an accident about 5 days ago. They are so little out there as a relates to actually recuperating and living with this type of injury. It's been such a wonderful experience reading about how all of you have been able to recover successfully from this type of injury and repair. I know the last posting was a while back but if anyone is still here I would love to get updates on how all of you are doing and any insight you might have on the best PT regiment moving forward so that I can hopefully regain everything that I have lost.


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## Adamd12 (Apr 12, 2020)

This is an awesome thread. Thanks to all of you who posted and shared your stories. I am curious how you are all making out now with your new radial heads. 

I broke mine back in November in a Judo accident. It was a minor break with no displacement. Doc told me that it would heal on its own, to use pain as my guide and I should be back to regular activities in a few months. 

Physio disagreed and refused to touch it—said I was not healing properly. The doc did not like it and said to do physio at home or find a new physio therapist. In short I just went about my business and waited for my next X-ray at the end of December. 

At the next X-ray my doc said I will need surgery to remove bone fragments. He booked my in for Jan 31st. When I went in for surgery I had another X-ray. This time the doc said I needed a new titanium head (say whah!) because I wasn’t healing. So here I am, a little over 2 moths post surgery waiting for bike season. 

I think about the arm often and hope that I get back to 95% of where I was, but I have a long way to go. It is weird some of the things that cause pain and some of the things the don’t bother me at all. I also hope to be able to resume activities mind you I think that heavy weight training is going to be a no go—any feedback would be appreciated).

I am now shopping for a fat bike as I think that it will provide a nice slow tank to hobble along over obstacles with minimal shock to the arm. 

Anyhow, at 40 I am hoping that this recovers and causes no issues for the next 40 years—by then I figure I’ll have other issues to worry about that are ore pressing than my arm.


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## txduc (Sep 7, 2011)

It will be 4yrs at the end of May since I did mine in at age 50. Mine was a terrible triad injury that left me with a replacement radial head, and about a foot long plate running from my elbow up the forearm. Upfront I will say from what I was told my recovery was not typical. 

I was told to expect a limited range of motion, arthritis and would possibly need to have immobilization of the joint. I have no pain/discomfort, was back on the MTB in 5 months. Since then I've gained full range of motion, raced XC, Gravel, Enduro and log 70-100 miles a week. This does not mean I'm not in for a world of hurt down the road but fingers crossed all will remain good. 

Good luck with your bike shopping and continued recovery.


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## alskkmu (Jun 12, 2020)

I was accident elbow radial head broken,2month ago, and replaced with radial. head Prothesis . Then I went to physical treatment,of elbow stiffness, to improve range of motion. At home. Basically I workout. Exercise by dumbbell both flexion and extension.
To improve flexibility and relaxed. Including strengthening. 
It recovery well,but Not. Stable like elastics, now I try to exercise and follow workout
To stabilize range of motion as possible enough.
Thank you for information in this forum


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## txduc (Sep 7, 2011)

The recovery process sucks no way around it. Make sure you're focusing on rotation (palm up to palm down) and not just bending vs extension as both are important. also, tricep strengthening will be important as you get further along. I was told no more pushups ever so lots of elastic band extension focused work. Weighted dips were one of the few exercises I really enjoyed pre-injury


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## Playdoh (Oct 19, 2021)

This thread has more personal experiences than any other source on the internet!
I'm 40 years old and 8 weeks ago I came off my bike trying to avoid a rider on the other side of a blind jump. I think I instinctively got on the brakes whilst in the air which resulted in me going OTB and dislocating my elbow and shattering my radial head in the process. I had a radial head replacement and installation of a gryphon tail (??) to reattach the RCL and LUL as they had been torn off as well a week after the accident. I was not put into a traditional cast but had to imobilise my arm through the use of an aerocast that allowed limited movement for the following 4 weeks. I started therapy and mobility exercises the day after my surgery to assist in maintaining movement of my elbow as well as exercises to regain the movement in my fingers. After only 2 days of completing the exercises I had complete movement in my fingers and wrist. I still had significant pain at the incision site and at the bicep and tricep attachment points closest to my elbow. The tightness and sheer pain restricted my elbow flexion and extension. I took pain killers around the clock and iced the pain areas for the first two weeks. The pain would often keep me awake at night and the only way I could sleep was by taking Endone, which I was not fond of.

Weeks 2-4 post surgery I was allowed to begin using my arm and hand again. The OT introduced exercises to rotate my radius through pronation and supination. Initially this was difficult and could not utilize a computer mouse or even a standard keyboard. This was going to be a problem as my job involved long hours in front of a computer. These two weeks I was extremely focused on my exercises and determined to regain movement. I had overcome significant spinal injuries and surgery in the past and defied the prognoses given by surgeons, I was determined to do it again. I am assuming I over did it during this period though as my elbow flexion and extension was down on the previous week and I began experiencing pain, swelling and lack of movement in my wrist.

By the end of week 4 my arm began to feel more like an arm and less like a vulnerable piece of meat hanging from my shoulder. My milestone for this time frame was I had managed to get my fingers to my nose after about 15 minutes of constant stretching. I had stopped taking any painkillers throughout the day but continued at night as I had difficulties sleeping still. I had stopped taking the Endone by this point. My wrist continued to concern me with limited range of movement. My hand and fingers also gave me trouble as in certain position pain would radiate down them.

Life continued like this until week 6 post surgery. At this point I had been given clearance to use force and weights to assist regain movement. I was told I would not be able to reinjury my elbow at this point unless I fell on it again. I was instructed to lay on my back with a clay heat pad on my wrist to assist with extension. After 15 minutes I was able to get my arm to lay flat on the ground. I could also use the assistance of my other arm in flexion and radial rotation exercises. I had a session with the OT Friday morning, but Saturday afternoon I felt I had made significant gains particularly in my elbow movement range and this showed in the follow week's OT session. I had gotten creative with the exercises and felt a lot more comfortable pushing through the pain. The clay heat pad was upgraded to a 1kg exercise weight and then to a 2kg weight over the course of the week. I had also begun to put my forearm flat against a wall and lean into the wall. My flexion had jumped nearly 20 degrees in the following week's OT session! My elbow's full range of motion at this point was measured 10 degrees through to 154 degrees (normal for an adult male is 0 to 145 degrees). I can't touch my shoulder on my good arm, my biceps are too thick and forearms too long to achieve that, so I don't expect it on my injured one. I could feed myself again, brush my teeth, scratch my ears, pick my nose

In the past week I have returned to work fulltime and have gotten very slack with the exercises which I feel is letting me down and hindering my recovery. Unfortunately I am stuck on, consecutive phone and conference calls for hours at a time and can't get away to complete the exercises as much as I had been doing them and find myself trying to play catch up at the end of the day after work. I have a session with the OT again tomorrow, so we will see if I managed to progress - I highly doubt it. I still experience pain and weakness in my wrist and fingers but my elbow is virtually pain free and just feels stiff. I still have bruising along my ridge of my ulna which the OT is related to the pain in my wrist and me compensating for the stiffness in my elbow by overexerting my wrist. My bicep and tricep is still very tight and hinders my movement unless they are massaged or have heat applied or I thoroughly warm the muscles with exercise. I experienced a similar issue with my back muscles for a year or more after my spinal surgery so this doesn't concern me too much. My incision site and scar is very stiff still and feels like it's attached to something deeper down as my skin pulls into creases creases and divots in the surface of my arm when going into extension. I have been massaging it often throughout the day but seem to be only release the ends of the scar at this stage.

I really hope to get back to riding one day.


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## UP MTNBIKE (Oct 31, 2021)

I thought I would share my experience in hopes that it will help others that have suffered one of these injuries. Its been one year since I suffered a terrible triad elbow injury which left me with a radial head replacement. I under went surgery three days after the break. I spent 3 months focused exclusively on range of motion (flexing, extension, pronation and supination). I started with strength training at about 3 months and by that I mean I worked with 2 pound weights. At 6 months I got back on the bike for some pavement riding. At 7 months I got back on dirt. At 8 months I started riding my dirt bike on single track trails. At 11 months I completed a 60 mile xc race on technical single track. At one year out I am able to do push ups, pull ups and moderate weight training. In the gym is where I notice this injury the most.

Its not all good news. I can probably count on one hand the number of days that I have not had some pain or discomfort. I still stretch every day multiple times a day. Everyone's injury is different, trust your doctors and therapists, do the work and know that some of us have done pretty well with our rehab, so it can be done. I cannot stress though how much I prioritized my arm over everything else. At work I stretched, on conference calls during meetings whenever. While spending chill time with my family, I am almost always stretching. 

One last bit of advice I can give is that this thread is the best source of real world experience I could find. I spent too much time looking online for answers which only put me into a state of depression which I had to battle. I could have saved myself some trouble by listening to my surgeon and therapist and reading this thread.

Best of luck and know that there are others with the same injury that have gotten back out on the trails.


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## Decked (Dec 31, 2021)

About 8 years ago I came off and smashed my radial head. Despite having regular physio and couple of keyhole operations I couldn’t stand the pain, crunching and lack of mobility any longer so I went back for a more drastic option.

So about 5 years ago I had the radial head removed, leaving noting… Putting noting back in it’s place. Sounds weird as you’d expect it to be there for a reason, but I haven’t looked back. I’ve had little to no pain since. My arm nearly goes straight, it rotates happily and the strength is back. I was riding daily with no problems (I’m only out of action due to another accident, but that’s another story). The only thing I can’t do is play golf (big deal).

If you’re in this position I’d recommend it.

My elbow now:


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## UP MTNBIKE (Oct 31, 2021)

Thanks for sharing your experience with radial head removal. This is something my surgeon has discussed with me if or more likely when i need a revision surgery. Glad to hear it does not come with too much limitation.


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## DaniHersey14 (10 mo ago)

Hi!
I fractured my radial head and dislocated my elbow a year ago, after 2 surgeries it was decided I needed a radial head replacement, ligament graft, open capsular surgery and some work on the ulnar nerve. They performed all four of these in one surgery

I'm now 12 weeks post operation I'm militant with the exercises, in physio twice per week and doing everything I can to get as much extension back! For how many weeks after surgery did you all notice progression? I'm already on the backfoot as my arm has been locked for nearly a year so pushing as much as I can. 

Are there any every day arm supports or an anything anyone can recommended or they use when put and about etc? 

Also did anyone experience any numbness in their hand?


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## UP MTNBIKE (Oct 31, 2021)

My injury occurred October 13, 2020 and it was something like July 2021 before it seemed progress really slowed. Now in March of 2022 I still spend some time stretching each week. Seems the scar tissue is stubborn. I used a JAS splint for awhile but mostly used a lot of the stretches described in this thread in addition to PT three days a week for three months (December - February) followed by some guided strength training several times a week.

I do not recall numbness unless I try to sleep with my arm overhead then my pinky finger goes numb.

All that said I was back biking in May 2021. It just got better with a little additional time.


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## DaniHersey14 (10 mo ago)

DaniHersey14 said:


> Hi!
> I fractured my radial head and dislocated my elbow a year ago, after 2 surgeries it was decided I needed a radial head replacement, ligament graft, open capsular surgery and some work on the ulnar nerve. They performed all four of these in one surgery
> 
> I'm now 12 weeks post operation I'm militant with the exercises, in physio twice per week and doing everything I can to get as much extension back! For how many weeks after surgery did you all notice progression? I'm already on the backfoot as my arm has been locked for nearly a year so pushing as much as I can.
> ...


Thank you for the response - i feel like this i


UP MTNBIKE said:


> My injury occurred October 13, 2020 and it was something like July 2021 before it seemed progress really slowed. Now in March of 2022 I still spend some time stretching each week. Seems the scar tissue is stubborn. I used a JAS splint for awhile but mostly used a lot of the stretches described in this thread in addition to PT three days a week for three months (December - February) followed by some guided strength training several times a week.
> 
> I do not recall numbness unless I try to sleep with my arm overhead then my pinky finger goes numb.
> 
> All that said I was back biking in May 2021. It just got better with a little additional time.





UP MTNBIKE said:


> My injury occurred October 13, 2020 and it was something like July 2021 before it seemed progress really slowed. Now in March of 2022 I still spend some time stretching each week. Seems the scar tissue is stubborn. I used a JAS splint for awhile but mostly used a lot of the stretches described in this thread in addition to PT three days a week for three months (December - February) followed by some guided strength training several times a week.
> 
> I do not recall numbness unless I try to sleep with my arm overhead then my pinky finger goes numb.
> 
> All that said I was back biking in May 2021. It just got better with a little additional time.


Thank you for the response I feel like this is such a complex injury! Movement wise are you managing extension/flexion/Supination? (if you dont mind me asking?)


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## UP MTNBIKE (Oct 31, 2021)

DaniHersey14 said:


> Thank you for the response - i feel like this i
> 
> 
> Thank you for the response I feel like this is such a complex injury! Movement wise are you managing extension/flexion/Supination? (if you dont mind me asking?)


Movement now is at 95% all the way around, maybe a little less on pronation. The little bit of loss of movement is so minimum that I really do not even notice it. It was a long road to this point though. I wish I would have kept better track on how I progressed. 

Twelve weeks would have been around the new year for me and at that point I was still in pretty bad shape. It also seemed like everything I gained during the day I lost over night and I had to start all over again. My best advice is to keep at it.


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## HornedFrogCat (10 mo ago)

Decked said:


> About 8 years ago I came off and smashed my radial head. Despite having regular physio and couple of keyhole operations I couldn’t stand the pain, crunching and lack of mobility any longer so I went back for a more drastic option.
> 
> So about 5 years ago I had the radial head removed, leaving noting… Putting noting back in it’s place. Sounds weird as you’d expect it to be there for a reason, but I haven’t looked back. I’ve had little to no pain since. My arm nearly goes straight, it rotates happily and the strength is back. I was riding daily with no problems (I’m only out of action due to another accident, but that’s another story). The only thing I can’t do is play golf (big deal).
> 
> ...


I just ran across your post and I have a quick question. I recently had a similar injury, but had an implant put in. Unfortunately that implant has loosened so I have a decision to make. One option is to remove and and not replace the implant. My question for you is in regards to your comment about not being able to play golf. That is a huge negative for me and I am Hoping you could explain what advice you were give specifically about golf? Any input would be greatly appreciated.


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## Decked (Dec 31, 2021)

HornedFrogCat said:


> I just ran across your post and I have a quick question. I recently had a similar injury, but had an implant put in. Unfortunately that implant has loosened so I have a decision to make. One option is to remove and and not replace the implant. My question for you is in regards to your comment about not being able to play golf. That is a huge negative for me and I am Hoping you could explain what advice you were give specifically about golf? Any input would be greatly appreciated.


Sorry for the late reply. I guess I could play golf, but it's not the same. I was a better than average golfer. The stability, power, rotation and force when letting rip on shorter irons just isn't there. Woods & long irons are ok where your not digging into the ground. Over time it's got stronger, but it's nothing like what I was.


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## HornedFrogCat (10 mo ago)

Decked said:


> Sorry for the late reply. I guess I could play golf, but it's not the same. I was a better than average golfer. The stability, power, rotation and force when letting rip on shorter irons just isn't there. Woods & long irons are ok where your not digging into the ground. Over time it's got stronger, but it's nothing like what I was.


Decked,

Thanks for the reply and information. I have already been told I can’t do push ups, pull ups or Burpees, so the thought of not being able to golf in the future would be another blow. I play at a lesser level than you and do it mostly for fun, but as the years pass me by I had hoped it would be a good source of exercise. Just trying to figure out what option presented allows me to do the most in the future. 

Cheers,

HornedFrogCat


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## Bangtime (8 mo ago)

Posted this on another thread last evening. New to the message board so trying to get feedback wherever I can. Thanks
Radial Head subject...I realize this is an old thread but I hope someone sees this. I had a RH implant done 12 weeks ago. After warmed up, stretched by my PT I have 15 degree extension and 140 degree flexion; so decent but I'm having the JAS brace ordered for extension. My implant was for osteo arthritis. They used the newest DePuy model (so it is smooth shaft and floating so to speak). My concern, question is this. With different movements (for example a pronated standing bicep curl w/ no weight); 1/2 way up there is big pain in the forearm. Other movements can cause it also. Everything I'm reading is perhaps it is "overstuffed"; which it can be too long or perhaps too big of a diameter. The surgeon did xrays at 4 and 8 weeks and the spacing with the humerus looks good with the positioning. But the $1M question in my mind is the diameter. It seems the system seems pretty much fool proof as it can be read at their webpage how it is done but this pain after 12 weeks (which I noticed and told the surgeon about immediately) starting with the PT at 4 weeks, just doesn't seem right. And the fact that it is not at the site of the surgery. Anyway any insights would be appreciated. Thank you. Ps to add insult to injury he had to remove and reattach my lateral collateral ligament complex to have room to get the implant installed....so if he has to do revision surgery...I don't even want to think about it.


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## ciasttek (4 mo ago)

I was offered an endoprosthesis!
Currently I do not have it, now I have a full extension of my elbow, Ole blows my hand a bit and hurts.
what to do or insert endo?


RESECTION of parts of the head of the radial bone.

My name is Szymon, I am 27 years old. 27/12/21 I suffered a snowboard injury, today is 9 months. I landed in a hospital in Zakopane and was supplied there.

Recognized:

left elbow injury
Fracture of the head of the left radius with complete dislocation of the fragments
elbow dislocation and proximal epiphyseal fracture.
In the first stage, the left elbow is repositioned. Then, surgical revision of the left elbow. ** RESECTION of parts of the radial head **. Sewing the ligaments of the left elbow.

Currently, I have full joint mobility and slight lateral osseous instability. The only problem I have is not being able to lift weights (gym) riding a bike kayaking and other sports that were very present in my life.
The symptoms I feel at that moment are:

Numbness of the first 3 fingers
pain from sudden jumps in the wrist and elbow
bounces of the hand, e.g. when wiping the head with a towel
obvious pain at the change of weather t from tearing the hand.

The medical recommendations are: - saving the elbow - avoiding axial loads and dynamic pressure on the hand as well as motor activities that do not cause the risk of falling on the hand and axial load on the limb!

insertion of an endoprosthesis


I am 27 years old and want to return to fitness and the sport that I have practiced, is it possible?


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