Shocks and needles and electrodes, oh my!

I had a follow-up EMG today.  The regeneration of nerves is such a fascinating thing!  In fact, the whole human body is fascinating.  Bones break and heal, nerves that receive and deliver signals from the brain can just grow back when injured - all right before our very eyes.  It's slow, but SO interesting!

My radial nerve was injured above my elbow and in the past 3+ months since my first EMG, it has completely healed to a point below my elbow, about 3-4" worth of regeneration.  As I had mentioned in an earlier post, I was told it would grow about 1mm a day, or 1" a month.  It has been 5 months since the fracture,  so it does appear to be following the "normal" path of recovery.

The muscle that allows us to lift our wrist is high in the forearm, close to the elbow.  My wrist is working well and the EMG confirmed that the nerve up into my triceps from this point is completely healed. (music to my ears!)  As the nerve travels further down the forearm, it begins to help with the function of the fingers.  There are signs of improvement in my 4 fingers, but very little in my thumb.  The EMG confirmed this.  There are areas of the nerve that are not showing any signal at all.  The Dr. is not concerned, she feels that the healing in this area has just not happened yet.  She feels that although there is no guarantee, at this point she is confident that it will come back over the next 3-4 months.

I had another milestone - NO MORE DYNAMIC SPLINT!  It has served me well!  Both the Dr. and the PT agree that at this point it may hinder the strengthening of the muscles and that using my hand in any capacity as much as possible is the best PT of all.  I thought that when I was done with this thing I would want to melt it down like the Wicked Witch of the West but in a strange kind of way it signifies a lot and I don't want to throw it away.  It kind of represents 5 months of my life this year .... how weird am I?

Month 5 ... let's check the progress!

Well, it's been 7 weeks since I had measurements at PT.  The entire time with my physical therapist has been spent working on range of motion in my shoulder so all of the range of motion work on my elbow has been left up to me.  Have I done the job?  Let's check the progress:

Extension: 8 degrees / 4 degrees with assistance.  4 degree improvement since last measurement, 32 degrees overall!   I was told that I would probably never get more than 10 - 15 degrees because of the placement of the plates.  Ha!  No one should tell me I can "never" do something because that just makes me fight harder.  I hope that when my triceps returns after the radial nerve fully heals, I will get my arm completely straight.

Flexion:  134 degrees with or without assistance.  10 degree improvement since last measurement, 34 degree improvement overall!  I'm afraid this may be the extent of my ability to bend at the elbow because even the PT can not push it even one degree further.  I believe I am right at the range of motion I had prior to my fracture, although I never had an official measurement after all of my surgeries as a child.  I will keep working on this!

Nothing new with the fingers, so hopefully I will have an update to report soon!

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1.02.28

Oh, frozen shoulder!

Great new!  No surgery is needed on my shoulder.  Whew!  I was NOT looking forward to dragging this out one minute longer than necessary and I can't imagine starting all over with another surgery.

So, what is causing me all the trouble, you ask?  Frozen Shoulder, otherwise known as adhesive capsulitis.

In the case of me, they believe it was from the high impact fall when I fractured my arm.  My MRI impression reads:

• Extensive adhesive capsulitis with pericapsula edema and capsualar thickening
• Mild acromioclavicular osteoarthritis
• Moderate subacromial and subdeltoid bursitis
• Low-grade inrerstitial and possible bursai surface partial tear far anterior supraspinatus tendon
• Degenerative glenoid labrum and tendinosis of the extracapsular biceps tendon

So, I got a cortisone injection and I will be stretching, stretching and stretching some more.

Unfortunately, it takes a long time to regain range of motion after frozen shoulder, but I am reminded to be a "patient" patient.  I'm waiting for the radial nerve so I'll wait for the shoulder to show me some love, too.

16 weeks ... let's check the progress!

Today was another follow up and things are going really well with the fracture.  The bone continues to heal well and x-rays show new bone growth which is always what you want to see.  It's hard to see the fracture line in the original x-ray with all of the hardware but I am reminded again of what a terrible location the humerus broke.

the pink line represents the fracture - what a mess!

The Dr. is really happy with the recovering radial nerve.  The wrist continues to get a little stronger each week and now I patiently wait for the fingers to follow!  There was a resident from University of Iowa in the office today so much of my visit was spent educating him about the injury I had and the healing process.  I really like teaching moments because I always learn a little bit more, too.

My surgeon told the resident that he didn't remember the radial nerve showing signs of injury in the ER and the location of the fracture is not indicative of a radial nerve injury so he feels that the multiple surgeries in my arm as a child and scar tissue may have contributed to the trauma on the nerve as it was moved out of the way while they repaired the injury.  We will never know but it is very unusual for this particular fracture.  In fact, I was reading an article that said this type of fracture in adults is very unusual, too.  Like everything else with me -- it's "uncommon."  Shocker.  :)

So, now we try to figure out how to best heal the shoulder.  One MRI with contrast, one more follow up and one cortisone injection ..... never a dull moment!  We will meet and discuss only the shoulder one week from today.

And "a long time" really means ...

A really long time!  Anatomy lesson #2:  The radial nerve grows about an inch a month.  The physical therapist is saying that her experience tells her that it will be about 8 months for the radial nerve to recover.  8 months!  Ugh.  Of course my first question to her was, "Does this mean I will wear the contraption for 8 months?"  Yep.  I guess I already knew that answer. Quite honestly, the arm feels best when in the dynamic splint - it's just ugly!  More importantly, it draws a LOT of attention and I'm really kind of tired of explaining what I did to my arm.  I broke my arm.  Really bad.  Why can't that be enough?

Oh, that's one ticked off radial nerve!

Today I got my cast off!  In a perfect world that would be a great thing, but in reality, the 10 days in a surgical splint and/or cast has just given my hand and wrist enough of a rest that the reality of the situation is so evident - - it's dead.  The radial nerve is ticked off and any hope I had of seeing progress has quickly disappeared.  My fingers are beginning to get stiff and are curling down and my wrist is not showing any sign of life.  The numbness on the top of my hand and thumb is still present, too.  It's going "to take a long time" but no one is saying just how long.

The cast came off, the stitches came out, and the steri strips will
now do their job in helping the incision heal.