Some images may be unpleasant, there is no blood or actual broken skin, but there is bruising.
On Jan. 16 I fell on some hidden snow covered ice and landed hard on my arm. As I lay there in the snow, unable to move, I had this realization that things had changed. I finally managed to scramble to my feet and edge my way to a fence and along the fence. I was on my way to pick up an order from my farm CSA, which is about 2.5km from home. My arm hurt, a lot, but I kept going, met the farmer and packed my items with one arm, slung my pack over my shoulder, and walked home. I texted a friend and she told me to go to Emergency and get checked out.
I headed to the hospital a few hours later. The admitting nurse examined it and shook her head. “This isn’t broken,” she said, “You wouldn’t be able to move it like this, and it would hurt a lot more.” I almost left then.
Eventually X-rays were taken, the emergency room physician looked at them and said “You won’t be leaving here without a cast.” But we had to wait till the attending orthopedic surgeon saw the X-rays and he was in surgery. So I waited. When the surgeon came in, he said it looked like surgery was going to be likely, but whether to remove the bone fragment or to reattach it was not clear. He ordered CT scans the next day and sent me home for an uncomfortable night’s sleep.
Since surgery seemed likely, I decided not to eat breakfast, and headed to hospital on the bus. I had the scan and saw another doctor and it was finally determined that the bone chip was too small to bother re-attaching and not so large that it couldn’t be left in. It wasn’t interfering with the joint in any way. There was nothing to heal, so I was cleared for moving and sent home! I picked up some sushi and miso soup since I hadn’t eaten since breakfast the day before.
The bone that was broken is the radius. It ends in a golf tee shaped head and a portion of the radial head was broken off. The radius articulates with the humerus (upper arm bone) and the ulna. It radiates around the ulna to produce the movements we know as pronation and supination. There is a strong membrane between the two bones called the interosseous membrane. It’s likely that I landed on my hand and the radial head was pushed up into the humerus and broken. This would have impacted the structures around the elbow and the membrane between the two bones as well.
The first day the swelling was quite localized, but a few days later the arm was swollen from mid humerus to the wrist. Then it started bruising. It wasn’t pretty and it was quite hot to the touch and painful.
Range of Motion: On day one my pronation and supination were almost non-existent, with only a few degrees in each direction. Bend your elbow until your forearm is horizontal with the thumb pointing up. From that place, I could only rotate my forearm to move my thumb a few degrees right and left. By the second day I had almost full ROM back, the examining nurse at the fracture clinic confirmed. They were really good to me, showing me each X-ray and explaining it all to me, and when the CT was done, a nurse and a surgeon both went through the images with me separately. I think they enjoyed having a patient who was so involved and interested.
Flexion and extension (bending and straightening the elbow) are very limited and painful.
I am doing my own PT but am not allowed to lift anything heavy or strengthen it, which is fine because I need that ROM back first. Exercises include finger flexion, extension, wrist flexion, extension and circles, forearm supination/pronation, flexion/extension of elbow, flexion, internal and external rotation of the shoulder. Sometimes I lie the forearm on the counter like in the picture above and back away from it, extending the elbow without the forearm loading. I sit against the wall with the arm outstretched on a stack of blankets and bolsters so it’s straight out to the side at the level of the shoulder (good for drainage) and try to straighten it. I have a flow series that incorporates a lot of the above movements.
Having an injury gives you insight into the role the elbow plays in many activities that you wouldn’t normally consider to involve that joint. Just raising the arm (a shoulder movement) affects the elbow because the weight of the forearm in gravity loads the elbow as the arm is raised. Having your arm hanging straight down puts a tensile (pulling) load to the structures of the elbow. Both are painful. I don’t use a sling but I do put my hand in my pocket when I’m walking, as swinging the arm is not comfortable. I try to load the elbow as tolerated with the weight of the forearm when possible. I want to slowly and gently stretch the tendons that are currently not allowing full extension. The swelling is also limiting movement.
Here is a list of things that are difficult to impossible with the use of one arm.
- eating/drinking with that arm – you simply cannot reach your face
- scratching your nose, etc. – so many times I’ve gone to scratch my nose or face or brush hair back with that arm
- putting hair up – making a bun with one hand and then the other needs to put the elastic or clip in. No go. Using a hairdryer and hairbrush at the same time is also difficult.
- flossing teeth – two hands needed, preferably close to the mouth
- lotion on face – my habit as a right handed person is to use the right hand to squeeze the lotion into my left palm. Then the left hand spreads it. I would often find myself standing at the mirror in this predicament.
- cutting vegetables, spreading butter – you need to hold the item with one hand and push towards it with the other. This puts a strain on the holding arm’s elbow. Weird huh?
- raising arm – gravity on the forearm puts a strain on the elbow, not something I was aware of before. Note: I can use the other arm to raise it and be successful, or raise it lying down. This has implications if you are a teacher or dealing with injury; sometimes a movement can be accomplished on another plane.
- getting dressed. Baggy elastic waist pants and cardigans are my friends. Pulling something on, pulling cords and tying them, all painful. A cardigan or jacket can be pulled over the damaged arm first. Raising arms overhead or using the hand to pull the sweater is no fun.
- Zipper pulling. You need to hold the material with one hand and pull the zipper with the other. The non-pulling hand is essentially pulling down against this force, resulting in pain.
- Pulling open ziploc bags, any pulling or pushing. I can open cans by squeezing with the left hand and turning with the right – the cats are grateful!
- making a bed or folding laundry, lifting a yoga mat by the ends and shaking it.
- opening the fridge, or any door, twisting the handle and pushing or pulling
- pulling the lid off the kettle
- opening screw top jars, either holding the jar or twisting lid with the injured arm is painful. The only way is to hold the jar between my legs or feet and using one hand to twist off the lid.
- Sweeping. Forget it.
- Shoveling. One arm pushing only. There is no lifting and throwing snow.
Here are things that feel good (it’s a short list):
- lymph drainage. I use my soft face brush to skin brush from the elbow to the armpit. I have no idea if it is helpful but it feels lovely.
- epsom salt soak. The Dr. told me to ice, ice, ice. I iced it when it first happened (when I got home) but not since then, per the Be Calm Protocol. Instead, a warm soak with salts.
- drinking lots of chicken broth, tea, and water
- keeping the arm raised above heart level on a stack of blankets
- massaging it with some Busted Joint Ointment when I go to bed and wake up
- walking (my arm hurts but the rest of me needs to move! It’s also good for the mind to stay positive.)
- being positive and informed. Looking at lots of online info on exercises and learning about the injury.