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How successful in an arthroscopic surgery of the elbow?

Q: I fell from a folding ladder and twisted my arms. I immediately went to a hospital and they put a cast on it. The next day I went to an Orthopaedic Surgeon and the doctor said that my radial head was in three pieces so it has to be taken out surgically. So I had my surgery after four days, of my fall and then my hand was put in a cast for 8 days. After 8 days the stitches were cut, and I was told to do exercise. Initially it was very painful for me to exercise my hand, anyway after much exercise, the range of my motion is measured when I put my hand on a table. Pronation and supination is almost full, but flexion is 70 degree and extension 30 degree, its almost 11 months and it is still the same. I tried with ice and then warm water but there is no improvement and I don't know what to do. I went to many sites on the Radial head fracture, and it suggests then an early movement is necessary, like within 2 days, so the stiffness of my hand is due to the cast which was put for 8 days, so what should I do? After consulting many doctors they said that I should go for arthrolysis operation. I am scared cause I don't know which doctor is right and my hand is very important specially because of the trade in which I am. Can you please suggest the best doctors in India regarding elbow. People say to get the surgery done in South and but I am very confused. Please help me.

A:Your problem is fairly common. I do not think 8 days mobilization is too long. Over enthusiastic mobilization can also lead to excessive stiffness. So, I would not be presumptuous in blaming the immobilization. However, the X-ray needs to be studied very carefully to see if there is anything that can explain the stiffness. Sometimes, bone formation in soft tissues around the elbow causes the problem of stiffness. This is called myossitis. This can lead to severe stiffness. Sometimes small bone fragments may cause bone blocks. Usually the return of movements is very slow. You have not written about the progress of your range of movement over the past 11 months. In case, the range of movement is showing slow but definite improvement over a period of time, I would recommend you continue with intensive occupational therapy till there is no further improvement taking place for at least 3-4 weeks. If it has stopped showing improvement, when did it stop showing improvement? If it is already 5-6 months and it is struck at the same degree then yes, arthrolysis can be an option. However, you must be very clear that arthrolysis may not lead to improvement of range of movement. Initially, you may feel very good but there can be gradual loss of movement. The best person to get this done will be an arthroscopic surgeon. However, there are very few of arthroscopic surgeons who do the elbow joint regularly. It will be simpler for you to contact an orthopaedic surgeon in your area and ask him about someone who does arthroscopic surgery of the elbow regularly.

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