Q: My friend had a fall on an outstretched hand and broke his elbow (radial head) into 3 pieces, he got it excised after 4 days and his hand was in a cast for 9 days, after removing the cast his range of motion was 30 degree extension and 70 degree flexion, pronation and supination is ok, this range was there for a year no improvement at all, though on the X-ray there are no bone fragments left. After a year he went for a second operation - Arthrolysis of the elbow, the results were good initially for 1 month, extension was 10 degree and flexion 130 degree, pronation and supination is full, then gradually his range of movement decreased, now nearly after 10 months the range of motion is 20 degree extension and 95 degree flexion, when he exercises for 10 minutes his range of motion comes to 15 degree extension and 115 degree flexion, pronation and supination is full, but after a while say an hour it goes back to the normal range 20 degree extension and 95 degree flexion, he cannot sustain the range of motion, the doctor said keep on doing the exercise; it is only the soft tissue block, it will be ok, so he is still exercising. So I want to know how long it will take to improve more and there is anything more can we do beside exercise to improve the range of motion? So I guess he doesn't have to go for the 3rd operation.

A:Your friend seems to have developed a complication called Myositis ossificans. Reduction of range of motion is one of the early signs of this complication. Vigorous passive movements, passive stretching and massage are contraindicated in such cases. Basically, he should rest the elbow for 2-3 weeks. After that, active exercises with roller skates should help in improving the range of motion of the elbow joint. The regime of exercises is progressed towards achieving full range of active movement and functional use of whole upper extremity. Surgery is rarely indicated in Myositis ossificans. Surgical excision of the myositis mass is undertaken only after the radiological evidence of its consolidation. It may take 6-9 months for the myositis mass to consolidate. Since there is a high incidence of recurrence, the role of surgery is controversial. It is usually undertaken if the elbow is ankylosed in a functionally unacceptable position. So, I suggest, your friend should concentrate on the exercises keeping the above in mind and aim for the best functional range of motion he can achieve and not force the pace at the moment.