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  1. #1
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    Riding after radial head replacement

    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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    Quote Originally Posted by gradus
    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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  3. #3
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    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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    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.

  5. #5
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    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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    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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    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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    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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    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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    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. 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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    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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    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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    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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    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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    Cool-blue Rhythm 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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    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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    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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    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!
    I sense injury - the data could be called pain.

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    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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    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
    I sense injury - the data could be called pain.

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    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?

  22. #22
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    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.
    I sense injury - the data could be called pain.

  23. #23
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    radial head No 2

    Quote Originally Posted by dunnerorg
    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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    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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    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

  26. #26
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    Quote Originally Posted by gillo
    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
    I sense injury - the data could be called pain.

  27. #27
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    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
    I sense injury - the data could be called pain.

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    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 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

  29. #29
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    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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    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?

  31. #31
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    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.

  32. #32
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    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.

  33. #33
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    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.

  34. #34
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    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.

  35. #35
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    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.
    Attached Thumbnails Attached Thumbnails Riding after radial head replacement-chris-xray.jpg  

    Riding after radial head replacement-post-op-xray-copy.jpg  


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    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!

  37. #37
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    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....

  38. #38
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    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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    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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    Smile 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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    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

  42. #42
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    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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    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.

  44. #44
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    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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    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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    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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    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?
    Attached Thumbnails Attached Thumbnails Riding after radial head replacement-mtbr-xray1.jpg  

    Riding after radial head replacement-mtbr-xray2.jpg  


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    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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    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?

  50. #50
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    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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