I broke my elbow in a car accident and now I'm in rehab to try and get the motion back. The therapist has me in a special splint to keep the elbow from freezing up. But it hurts so much, I can hardly wear it. Are there other options for me? I'd like to be able to go back to the therapist with some ideas.
Your therapist may actually have some alternate ideas to share with you. Don't hesitate to let him or her know of your painful response to the splint. That's not an uncommon reaction but it is one that needs to be corrected. Without some form of holding device, your elbow will only get stiffer.
There are different kinds of splints. Some are more dynamic than others -- meaning, they have more elasticity or give to them. It's possible that with a static (hold in one place) kind of splint, your muscles on either side of the joint are contracting at the same time. This sets up a pain-spasm cycle that is counter productive.
Your therapist will know if there is a different kind of splint (or way to adapt your current splint) to take the painful pressure off but still get the job done. In some cases, serial casting is used to replace splinting. The elbow is moved to the farthest point of motion and a cast is placed around the elbow and forearm. Gradually, the muscles will relax and your elbow will move farther. The cast is removed weekly, the elbow moved to the new end range and then recast. This process is repeated for several weeks.
Another option is the use of Botulinum Toxin A (BOTOX). The BOTOX is injected into the muscles that are contracted. It acts as a paralyzing agent to prevent muscle contraction of the muscles injected. Splinting continues but with much less pain and more five in the muscles.
Conservative (nonoperative) care is the best approach. But if all measure fail, then surgery may be a consideration. Before you go that far, work with your therapist and your surgeon to find successful alternatives.
Peter J. Evans, MD, PhD, et al. Prevention and Treatment of Elbow Stiffness. In The Journal of Hand Surgery. April 2009. Vol 34A. No. 4. Pp. 769-778.
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