Houston Methodist. Leading Medicine

Hand FAQ

Question:

I don't even know where to begin to tell you what I want to know. First of all, I fell off a cliff while out hiking in the west. I survived but my elbow didn't. I broke the radial head into tiny pieces. They took the top of that bone out completely. While I was recovering from the other injuries, the forearm froze up. Now I can't turn my palm up past neutral. I guess I'm wondering if that's because the radial head was removed -- or is there some other problem?

Answer:

The elbow/forearm/wrist complex is just that -- a complex mix of bones, ligaments, and other soft tissues. Damage to one can affect the others. A loss of motion such as you are having (called forearm supination) can be very distressing and limiting. But it's not likely that the loss of that motion is a direct result of radial head resection (removal). It's more likely that damage to the interosseous membrane is at fault. The interosseous membrane connects the two bones of the forearm (radius and ulna) together from top to bottom. The interosseous membrane accounts for the majority of forearm stiffness. Without this important protective feature, the forearm can't resist force from the wrist to the elbow. At the same time, the diagonal orientation of fibers at a 20-degree angle make it possible to twist the bones while turning the palm up (supination) and palm down (pronation). If you were unable to move your forearm for any length of time due to pain or cast immobilization after surgery, the interosseous membrane could have scarred down. If the membrane isn't torn but just contracted, then a few sessions with a hand therapist might help to release that soft tissue and restore motion. But if it was torn (partially or ruptured fully) at the time of the injury, you may have an additional undiagnosed injury that requires further treatment. The best way to figure out what's going on and what to do about it is to see an orthopedic surgeon. If your community has a hand surgeon, take advantage of that person's additional training in this specialty area. Get a proper diagnosis and find out just what your treatment options are, then go from there. Jennifer B. Green, MD, and David S. Zelouf, MD. Forearm Instability. In The Journal of Hand Surgery. May/June 2009. Vol. 34A. No. 5. Pp. 953-961.

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