An item for discussing how to treat symptoms of accidents, such as falls,
burns, poison ivy, beestings, etc.

35 responses total.

I fell off my bike yesterday.  It went left, I went right.  The scratches and
bruises are not too bad, but the elbow area is swollen and it hurts more if
I try to flex the elbow (extend or contract or twist it).  A neighbor who did
something similar suggested it may be a hairline crack, Jim says it is a
sprain (tendon injury).  I was supposed to ice it yesterday.  Too late.  How
should I treat this injury, for the first few days, and then while it is
healing.  I know I should exercise it to prevent the arm from freezing in
place, so a sling is not such a good idea.  
        The pain is bearable, I do not take aspirins if not necessary.  The
lack of an arm is more of a nuisance. I can sort of type, but not write with
my right hand, which is a problem when I am asked to take phone messages or
write things for Jim (who can write but not spell).  Or slice vegetables, or
wash dishes, or hang laundry.  How long am I likely to be incapacitated?
I ripped a tendon over the course of a few months once before and it hurt a
lot more and the arm (same arm, shoulder) was not too usable for four months)
and then froze in place.  ONe of the biggest nuisances it that I cannot bike
(assuming Jim can unbend the bike basket off the frame).
        I would appreciate stories from other people who had this problem, and
advice on how to treat it.

Ice it, and don't make excuses and skip using the ice.

If it stays painful more than several days, or makes any funny sounds or
non-standard positions, get to a clinic or doctor.

My insurance company supplies an 800 number for talking to nurses.  She asked
a bunch of questions, including was there any point tenderness (no) and was
it better or worse than yesterday, numbness, tingling, cold, etc.  Could i
move everything (yes).  Said I did not need to see a doctor unless it did not
get any better (or got worse) for three days or there was point tenderness.
She was not allowed to diagnose the cause of the swelling (sprain) just
suggest treatment of the symptoms.
        Ice for 2-3 days, ibuprofen (aspirin is second-best) until the swelling
went down (about 2-4 days), elevate the hand to keep blood from pooling in
it (I just wiggle my fingers once in a while instead).
        I put a bag of frozen mustard greens on the elbow area (it bent nicely
once it partly melted) for the prescribed 15-20 minutes (4 times/day) but
could not get the child-proof aspirin bottle open one-handed.
        How long before I can bike again?  How long before I can bend the elbow
and unbend it fully?  It is a nuisance trying to tie my shoes and eat
left-handed and I cannot get a t-shirt on so slept in my button shirt.
        Injuries were all listed under sports and fitness. Apparently Americans
no longer get injured doing anything productive.

It's not as easy, but it's very possible to bike one handed.  I do it 
all the time, using the other hand to carry (usually) a beverage cup 
(no water-bottle holder on my bike, nor any basket) or some smallish 
item.  It's also possible to bike no-handed, but that usually requires 
great speed and/or skill and/or a unicycle.

I am too afraid to have another accident.  Someone said a sprain is
significantly better after 2 weeks.  It hurts less now but is still swollen.
I did two days of ice and 3 aspirins.  This is much less serious than the time
I pulled a tendon in my shoulder and could not use the arm for four months
and had only one position to sleep in.  The arm felt much better after
spending yesterday in bed than it does after spending today at Kiwanis.  My
left arm is rather tired from lifting twice as much as usual.  Luckily I had
practice eating left-handed for four months, and washing most of my back. 
And Jim hung up the laundry (after fixing the leak in the machine).
I am trying to look at the good side of this - I did not have to help him
clean up the yard yesterday in 95 degrees.  And there are some advantages to
walking home - I spotted lettuce, peppers, tomatoes and corn in people's front
yards, and a red cardinal steadily chirping in a tree.  And a sign that said
please smell the roses, which is difficult to do from a bike, so I stopped
and sniffed them all.
        What experience have other grexers had with sprained elbows?  I can
type if I rest the arm on a pad, for a while anyway.

Any ideas on how to soak the upper part of an elbow?  A large pot was awkward,
a long breadpan too shallow.    Gradual improvement until i typed, now i am
back to leftie only.

The neighbor who fractured his wrist pointed out that the swollen area is an
interesting shade of dark purple.  It looks as well as feels like a bruise.
He suggested a dishpan.  Sure enough, I could fit my whole lower arm in
diagonally, and a 20 minute hot soak made the wrist more flexible (after 3
hours of typing made it worse).
Has anyone else every sprained an elbow (or anything) and how long before I
can use it again normally?  I was hoping to bike 40 miles and pick
blueberries, which I cannot do without a right arm.
I have learned to slice zucchini (which is soft) left-handed, so we have been
eating zucchini twice a day for a couple days.  Also canteloupe.

For nearly _all_ injuries (open wounds would require more) remember R.I.C.E.
(Rest, Ice, Compression, Elevation).  Ice can be used 30minutes on then
30minutes off, around the clock if necessary without worry of frozen tissue
(unless there is some vascular compromise, etc).  Continue the RICE as much
as necessary and _don't_ even think about heat until at least 6 months have
gone by (threshold betwwen acute and chronic).
The ulnar process hooks arount the elbow and is quite narrow, and unprotected.
Even a mild impact could fracture it.  I disagree with your insurance company,
and think the prudent standard of care would be to have it x-rayed asap after
the injury.  After a few days, the hematoma formed by normal fracture healing
prevents easy "setting" of the site in case it's not in good alignment or
apposition.  Even a fracture will begin to feel better with RICE and NSAID's.
Once the hematoma immobilizes the site internally, and a bone callous forms,
you're well on your way to healing.  Initially though, I would have suggested
that splint you didn't want to use.  If there were a fracture, you don't want
the fracture site moving all around.  the little osteoclasts and osteoblasts
don't like that and they get all confused ;-)

Good idea to use the frozen food bag for an ice pack.  Alterative, fold a hand
towel or washcloth to fit into a small plastic bag.  soak it, bag it and
freeze it.  you can then re-use it as well (make 2 or 3, they're easy).

A wash basin may be good to soak your elbow as long as you can get it into
it.  Again, a soaking wet towel will work just as well.  Keep a bowl/cup of
the soaking solution nearby and add a few spoonfulls as the towel seems to
dry out.  Keep it on the verge of dripping wet and you get the same effect
as submersion.

Good luck.  Hope you use a helmut (and knee/elbow/wrist pads) from now on :}

I always use a helmet.  Did not land on any joints, just my right palm.
The arm is steadily improving, the swelling is down but still tender.  No
visible swelling or discoloration.  I have complete mobility again. 
What is the icing supposed to accomplish?  The hot water helped with mobility,
I was concerned about the arm 'freezing' in position like it did last time
I injured it and wore a sling for two months.   So am stretching it 'gently'.
The soaking is impractical as I am rarely home anyway.

I am attempting not to lift heavy objects when it hurts.

I tried a wet hot towel but it cooled too quickly.  A rectangular dish basin
in the kitchen sink (which does not hold water itself) works.

How long should I wait before biking again?  Walking is taking up an extra
hour a day.  Should I avoid writing if it hurts?

GIven the rapid improvement, is it really necessary to ice rather than heat?

I dislocated my right elbow by falling "straight-arm" on my hand (slipped
on ice). A dislocation is easy to recognize as the arm feels very 
distorted while the dislocation exists. The dislocation occurs by straining
the capsule of fibrous tissue that holds the elbow joint together. This
injury is very common, and also occurs with excessive tension on the arm,
in particular when parents pull their small children around by their arm. 
The injury healed only very slowly, and my elbow for some time would
"pop out" if I lifted too much weight straight-armed. It is much better
now, but I don't think I'll do any more rock climbing.

Thanks Rane, that must be why the nurse asked questions about popping sounds
and whether the swelling took a while to develop.  
What I have seems, like ricky suggested, to be a small fracture.  In better
light the outer elbow is still dark purple all over with smaller blotches on
the inner elbow (which I can finally rotate enought to see it).  Hematoma.
Anyone know what the ice is supposed to accomplish?  If the swelling is the
hematoma, which is helping the bone to heal, why reduce the swelling?

How long do bones take to heal all the way?  I guess I will not be going
swimming this year, or helping with the larger pieces of drywall, or brushing
my teeth properly (flossing the upper teeth is possible now at least).

My previous injury took four months but it was a ripped tendon, which did not
get blotchy or swollen but hurt a great deal more.

I will ask the neighbor who had the fracture for more info.

The ice reduces the swelling by reducing circulation. Swelling can
*misplace the bones* so they do not heal in the proper location, leading
to additional scar tissue, and possibly permanent displacements of the
joint. 

There no longer seems to be any swelling, just yellow where it was purple,
so not much point in reducing circulation.  People who have had broken bones
tell me that it takes a 'long time' to heal, meaning a month or two.  That
is a great improvement over four months (of shooting pains) from a tendon.
I can now also floss my bottom teeth and cut cucumbers and tomatoes.
Thanks for the explanation.

falling on your palm can cause direct impact to a whole lot of wrist (carpal
bone) joints, as well as the metacarpal joints.  In #10 Rane described a
dislocation of the radial head...not quite the elbow (ulna), but very painful
until re-located.  That part of the radius is like a round joint held by the
fibrous ligaments and it rotates to allow your had to rotate
(pronate/supinate).  that's why the bone is called the _radius_, it turns
radially when it moves.  the ulna, OTOH, has a 'hook' on it's end which fits
around the bottom of the humerus (upper arm bone) and flexes/extends the
forearm on the upper arm at the elbow joint.  dislocation of this joint is
possible, but not common.  fracture of it is much more common.

by all means, avoid using the injured elbow to lift heavy objects of do
stressful work.  Normal bone healing goes through 4 phases, generally, and
it takes 8 to 12 weeks to get through them all.  You can slow things down
easily, but it's not possible to speed it up very much.  Immobilization of
the fracture site, good nutrition (even galvanic electrical devices) will help
it heal the fastest.

Ice, initially reduces swelling by reducing circulation as rane describes...
however, the bodies reflex to cold ultimately results in _increased_
circulation (so you don't freeze the tissues) and the increased blood flow
last longer after the ice is removed than it would if you used heat to
increase the circulation.  stay away from heat (or diathermy) for at least
6 months, imho.

The swelling doesn't really help the bone to heal...it is a reaction to the
injury.  "muscle splinting" otoh can help immobilize the joint and help proper
healing.  extreme swelling can actually cause enough internal pressure to cut
off blood flow and cause tissue death...that's why you want to keep it down.
also, if you were to need a cast, once the swelling goes down the cast would
become too loose to do its job and you'd need another one.  If you keep the
swelling down, you can get a good cast right away and avoid the extra costs
of a second application withing the first week or so.

I'm not aware of swelling (edema) ever _causing_ mal-alignment of a fracture
site and resulting in permanent deformity of the healed bone.  It could,
however, obscure the observation of getting the bones in proper alignment,
apposition and tension so the site can heal in the best possible way.

(I responded to your e-mail with some of this information already...keep up
the good self-care and you should have little trouble.  If it were my arm,
or my wife or son, I'd like to see an x-ray just to be sure I know what kind
of injury I'm dealing with.  but this long after the initial injury, knowing
if there is a fracture or not would likely not change any supportive
treqatment.).

There is still one tender spot  but otherwise it only hurts if I attempt to
bend the elbow all the way.  Presumably the callus interferes.  I can brush
and floss my teeth again but peeling cukes hurts.

sounds pretty much like what docs would call "the patient is progressing
satisfactorily"...   ;)

keep it up.

It also hurts when I move large computers, but I stop doing whatever hurts
and the other volunteers have mostly been trained not to hand them to me.
I guess I will not plant fall greens this year either.

by this stage in your healing, even if it is/was a fracture, you likely
_could_ plant this fall if you wrap your elbow to minimize it's motion and
provide compression...just be careful.  Of course, if you wouldn't be too much
put out just skipping the planting, so much the better.

Before planting I would have to dig and rake.  I can always buy mustard greens
and Chinese cabbages instead.  I can now lift medium sized computers and most
phonographs without pain, but undoing screws still hurts and the break is
tender.  Interesting experience.  Makes me think more about other people's
problems, those with worse problems than mine.

The tourque motion on pronation/supination (un-screwing motions) can put a
lot of stress on the site that "normal" extension/flexion movements would not.
I'd just try an electric screwdirver (my Makita was one of my best purchases
in years).

There are other people who can use the screwdriver instead of me, or I can
manage slowly left handed, but thanks for the idea.  Too much bother to have
to drag whatever I am unscrewing somewhere near an outlet and plug it in in
such a way that nobody trips over the cord.
        I weeded what was left of the garden and the arm has been sore for a
couple of days since, not such a good idea for the arm but it was for the
beans.    Why would the inner surface of the elbow still be sore?  The part
of the bone that hurts is on the outer surface just below the elbow joint.
It is a month now, when should I risk biking again?

soft tissues are usually injured when a fracture occurs.  if the bone was
broken on what you call the "outside" (posterior) the "inside" (anterior)
could have suffered soft tissue strain or sprain.

to reiterate...the basic four phases of normal bone healing take 8-12 weeks
to complete.  you can't really speed things up very much, but you certainly
could slow them down (with improper immobilization, overuse, etc, etc...).
if it's been a month, give it _at least_ 2-3 more weeks before "testing" it.
some docs release arm fractures at about 6 weeks anyway (when they've been
in a hard cast for 6 weeks, that is).  

If you get soreness from things like weeding, or other things you begin to
do when you finally begin to "test" your arm, remember R.I.C.E.  It still
works and can minimize local swelling, increase local circulation, decrease
pain and minimize any detrimental effect the overuse may have caused.  don't
resort to heat until it's been at least 6 months (IMHO).

I will then plan on switching from walking to biking mid or late September
and give up on the garden this year.  Chopping green beans to freeze also
hurts but we have two refrigerators full of vegetables to be frozen ASAP so
it has to be done.  Zucchinis and tomatoes will be easier.  We already did
half the bushel of lima beans (unshelled).  Glad I did not wait a month to
fracture the elbow, at least I can use it for most things now.  And I will
pick pears left-handed instead.
        How does overuse delay healing?

overuse = inadequate immobilization = delay of osteoclast/osteoblast activity.

The pears were no longer there (the tree was replaced by a small ornamental
that was presumably not so messy).  The apples will not be ripe for another
couple of weeks, so I will give my osteoclasts and osteoblasts a break.  Just
how does using the arm affect this activity?  Does it cause more damage that
needs to be repaired?  I am refraining from biking not because it would be
a lot of exercise but because I do not want to risk another fall.

Yes, it causes more damage. The osteo*s are rebuilding bone cells in nice
orderly rows, and moving the fracture grinds them up again. I think it
is about time you have a doctor x-ray that elbow and put it in a cast
if necessary. You can be doing permanenet damage that could lead to worse
things than pain. Unless it heals solidly and soon, you could even fall on
it and complete the fracture in such a way (multiple breaks) that it 
cannot be repaired and may have to be permanently immobilized or removed.

The elbow is getting steadily better, it only hurts if I overuse it and I was
just wondering why.  I do not plan to fall on it, as I will not be biking
until it has not hurt for at least a week.  Or bike on the ice.  It will be
6 weeks this Wednesday, I will wait at least 2 more to bike.  Also hurts a
bit if I try to bend the elbow all the way, but less every day.  But thanks
for your concern.

"Protected function"...ie; use of the arm _while maintaining immobilization
of the fracture site_ is the theory behind AO/ASIF techniques (plates and
screws).  As long as you don't upset the osteo*s, the more you use the body
part the faster and better it'll heal.  that does _not_ include weight bearing
or tension (heavy lifting), but does include range of motion and some muscle
strength _providing the fracture site is RIGIDLY immobilized_ (hence the
internal plates and screws used in this technique).

At this point in your story, I'd just be sure to give it a full 8 to 10 weeks,
and perhaps even a few weeks longer if you've tried to push it too soon.  an
external cast at this point in time will not likely offer any better healing
than you're already getting (unless you _are_ upsetting the apple cart, so
to speak).

the bone callus, which may linger for 6 to 18 months, can inhibit full range
of motion when you try to extend your elbow all the way.  Be sure to wait a
full 3 months before you try and press that issue.  There are a variety of
PT and other exercises that can help get the ROM back once the bone is healed.

If I give it 12 weeks it will be icy weather by then so I would not be biking
anyway.  I think it is time to find that protective outersoling material I
was going to put on my new shoes before wearing them as they will be getting
a lot of wear this year.  I am doing lots of light lifting.  Went to a lecture
once which pointed out that bone does not grow unless there is some tension
on it.  (Problem of astronauts in weightlessness).  So I am using the arm
normally but mostly avoiding lifting heavy objects or whatever else hurts.
The part that used to be tender  is now barely perceptible, presumably the
callus is nearly done forming.  No bump.  But now it hurts above the elbow
when I bend it all the way, wonder why?  A nerve or muscle or tendon hitting
the callus?  Anyway, it is nice to be brushing my teeth properly again and
worse things could happen than having to walk everwhere for 3 extra months.
Maybe next year I will have time to go swimming in a lake.
        How does bone know where to form?  I think I read that during
development nerves grow first and other cells use them as a pattern.
        The nerve numbness is all gone.

How do any cells know where to form/move? Chemical messaging, all
encoded by the genes. 

I think nerves extend themselves to cellular (and hence organ) targets
after the latter form. Otherwise they would have no support, nor 'know'
what their destinations are.

This Wed. will be 8 weeks.  The bone has not been tender for at least a week.
Yesterday I had a choice of biking 3 miles each way to a meeting or being at
least half an hour late so I biked.  On the way back I walked where I could
not see clearly (including around bright porch lights and car lights).  How
long might the soft tissue take to heal?  (Assuming I stop lifting monitors).

I think biking was a mistake, as the bone hurts again now.  Two more weeks?
It only hurts slightly, but I did have my weight on the arm for a while.  In
the same way as when I fell off the bike.

<remember R.I.C.E.>  The biking probably wasn't too bad if you didn't jar your
arm too much by hitting bumps or potholes.  the pain at this point is more
likely soft-tissue reaction (local reactive inflammation) since the arm hasn't
been used this way for awhile.  Better to go slowly...do a short bike ride,
then increase the time/distance by just a little bit each day.  Use RICE after
the rides and _gently_ stretch the muscles/tendons/ligaments, especially after
your rides.

Hang in there...seems like you're well on the way to recovery.

Cutting up half a bushel of apples was also not a good idea, as I got the old
shooting pains again, which is probably a nerve hitting something.  This was
not a long bike ride, only a few miles across town, and it is definitely the
area on the bone that I felt hurting slightly again.  I will try only a mile
or two next time, in a week or so.  Thanks for the encouragement.

October 2 I resumed biking, after the arm had not hurt for a week, and it
still does not hurt despite cutting up a bushel of tomatoes and running them
through a hand-cranked juicer.  8-10 weeks it was.  Now my lower back has been
hurting a bit (muscle aches) since Saturday, possibly since I was out of shape
for biking.  Jim claims biking keeps his back from hurting and it always
starts hurting during non-biking season.  Or this could have resulted from
going back to work on the house, crawling around the attic scraping bumps off
the floor, which is where I should be right now.  Thanks for all the advice.

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