Five weeks ago my life changed in an instant when, while running fast downhill on an uneven rocky trail, I tripped on a rock and tumbled down hard, landing directly on my left elbow on a rock. The impact felt like someone had struck a hammer against the back of my elbow and I sensed something snapped off in the impact. Sure enough, a few hours later x-rays revealed that I had fractured my olecranon – the infamous “funny bone”. Fortunately it was a “clean, simple” break rather than a compound one, but nevertheless the solution for healing the injury turned out to be anything but simple.
It turns out that most olecranon fractures require surgery because they typically displace (the fragments separate too much for the bone to rejoin on its own). The fragments of the bone must then be reduced or returned to their normal position until healing occurs – usually in six weeks. Surgery involves reducing the bone fragments with some type of hardwire – usually a plate and screws. If there are multiple fractures or the bone is shattered, wires and pins may be used. In my case the bone fragments were reduced a little less than an inch so a plate with one long screw was inserted into my elbow and running down my forearm (part of my ulna bone). Like most patients, my arm was immobilized for a few days with a heavy splint and ace bandages wrapped around the dressing of my surgical wound (which I kid you not was four inches long and held together with about 16 staples). Three days later a plastic, removable splint was molded to my arm and I was encouraged to wear it day and night for the next five weeks, with the exception of removing it 4-5 times daily to perform extension movements (bending and straightening of the arm) to encourage range of motion.
The recovery from surgery, however, proved much more painful than the original fracture. In particular the first two days after surgery I was in a lot of pain (not helped by the fact that I refused to take a narcotic – in this case Vicodin- choosing to stick instead with Advil. My entire left arm and especially my left hand was very swollen and black and blue. I was instructed to elevate it as much as possible which was only really possible at night, but which made sleeping virtually impossible. Fortunately, my clever husband rigged up a pulley system from our bedroom ceiling which was attached to my arm and allowed me to elevate comfortable and shift positions as well.
To be honest, until this happened, I never gave my elbows much thought. I took for granted that they worked well and that my relatively strong triceps allowed my elbows to extend and to some degree even hyperextend. That has all changed now that four weeks after surgery my stiff left arm is still far from straightening. I am, however, finding some improvement every day. Today when I washed my hair I was able to wring it out using both arms and I can now floss my back molars without too much discomfort. Just yesterday I was able to scratch my right shoulder and tonight I even made a salad and was able to toss it myself. Ahhh, the little victories are sweet as I slowly get my life and independence back. I really miss my yoga classes and it’s been five weeks since I’ve been able to swim laps, but I’m back in the pool with my clients which I know is really helping my healing process.
UPDATE I: I had a great PT session yesterday and I was told I’m a week ahead in terms of healing and range of motion (ROM). She said I can go without my splint except in situations where I can’t control my environment, such as in a crowd. I will see my surgeon next week for a follow-up and hopefully he will tell me I can begin a strengthening program. Last night I slept without my splint and I’m just about to go for a run without it – can’t wait!
UPDATE II: It’s now been 10 weeks since the injury, 9 weeks since surgery. Saw my surgeon this week for my final post-op. He was thrilled with my ROM and strength and lifted all restrictions. The only glitch was that 10 days ago I developed a grape-size “seroma” (a collection of subcutaneous fluid) on my forearm at the end of the incision where part of the plate is. He assured me it was harmless – just the body’s reaction to irritation at the plate, but he decided to aspirate it anyways and withdrew 3.5 ml (about a thimble-size) of light red fluid – mixture of blood and plasma. He said if it comes back we may want to consider surgery to remove the plate and that he didn’t recommend that until at least 3-4 months after surgery. I just figured I would be living with this thing the rest of my life and would really rather not go through another surgery to have it removed, but he did assure me that the recovery time for plate removal surgery is much less than the insertion was. Hopefully that’s the end of it, but stay tuned….My PT also gave me my walking papers this week, so while the healing process continues she says I can do the rest on my own :)….My downward dog is slowly coming back and now I’m able to swim without even being aware of my left arm – even as I turn to breathe to the right side (where I have to fully extend my left arm) – which was painful for awhile. Now, if I could only have Summer back…..
UPDATE III: It’s been almost 13 weeks since the injury, 12 weeks since surgery and yesterday I finally had the courage to run to the place I fell. Previously every time I thought about doing so I became both nauseas and nervous. Yesterday I was still a bit nervous – not that I thought I would fall again), but I felt ready to face it. Interestingly I discovered the way I fell wasn’t what I thought. rather than fall downhill, I actually fell on an uphill slope. I realized and remembered that I slid on loose rock, my feet coming out from under me, and I landed to the left the way the hill sloped on a rock. I saw so many large rocks sticking out of the ground yesterday that I’m not sure which was THE ROCK, but it’s clear that it could’ve been any number of them. I felt a real sense of relief afterwards and strangely fatigued as well as though I was able to put down a burden I’ve been carrying for the past few months. When I do run on that trail again I will be extra cautious as I can see now how rocky it is and how easy it was to fall in various places. Overall my elbow is doing well. I’m working on getting the final degrees of extension (straightening the arm) and my strength is almost there in most ways. For example, I can now pull the hatchback trunk of my car down completely with my left arm with no pain and with relative ease.
UPDATE IV: It’s now been 15 weeks since my olecranon reduction surgery and my elbow is doing great. I’m even back to doing power yoga and though my left side plank is still a little shaky, I can even do wheel pose and “flip my dog”! But….I went to see my surgeon last week because my forearm, (not where the injury was, but where the metal plate and screws are) still gets very irritated when I place it on a table, or even on my leg when doing side angle pose in yoga. I wanted to ask the doctor about having the hardware in my arm removed. He said that because I don’t have much padding there I will always be irritated by the hardware and that I’m a good candidate for removal surgery. So I’ve scheduled to have my plate and screws removed 3 days before Christmas. The recovery is supposed to be much faster and easier than the surgery to have the hardware inserted, plus I won’t have a broken bone and torn muscles to mend this time. However, I will have to avoid any heavy lifting for about 5 weeks. I’m excited to have my arm eventually return to it’s previous pre-injury, metal-free state. When the hardware is removed I will initially have holes in my ulnar bone where the screws were, but with time the bone will fill in. All for now….stay tuned.
UPDATE V: 12/23/14…Yesterday I had surgery to remove the titanium plate and six screws in my left arm. It was definitely a case of deja vu in returning to the surgery center – almost exactly 6 months to the day from the first surgery to have the hardware installed. I’m very happy to report that so far my pain is far less than the original surgery and very manageable. In fact in 24 hours I’ve only taken one 200mg Advil when I got home yesterday (and I probably could’ve done without it but they keep telling you in recovery to “stay ahead of the pain”). I’ve not needed to take anything else – even last night when I thought the pain might kick up in my sleep. The other main difference is that, unlike last time, my arm and hand are not at all swollen or discolored despite the fact that I haven’t been elevating them as much as I probably should be. I have a huge, bulky temporary cast from my shoulder to my wrist that doesn’t allow me to straighten my arm, but fortunately I only have to wear it for 2 days after which I will transition to a sling for a week or so. The only complication with my surgery was that the bone had started to grow around the plate at the elbow requiring the surgeon to dig into the bone to remove it. Hopefully that won’t delay my healing. This is another reason I’m glad I didn’t wait any longer to have the hardware removed as apparently the longer it’s left in, the more likely bone can grown around it, making it more challenging to remove. All in all, I’m very relieved to have had the hardware removed. I asked for it as a souvenir and it’s a bit eery to see what I’ve had inside my arm for almost six months, but his was my Christmas gift to myself and I’m very glad I did it.
UPDATE VI 12/24/14…Saw my surgeon today for my 48-hr post op appointment and it felt like an early Christmas gift. He removed the bulky temporary cast and was very pleased with what was underneath – so much so that he said I didn’t need to wear a sling. Additionally, he said I can get back in the pool next Monday, a week earlier than he’d previously said I could. I’m now wearing a light dressing over the incision and a “sleeve” to protect it. My pain remains very manageable and I haven’t had to take anything for it. My elbow is a bit swollen and stiff and tender to the touch (feels like I’ve scraped and bruised my arm), but really not that bad. I have to be careful for the next 4-5 weeks (no pushups or significant twisting motions), but once I get the sutures out I don’t have to go back to the Dr. unless there’s a problem. Hallelujah!
Be Well and Happy Holidays,