Dr. Akshay Kumar Saxena
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I had an elbow fracture four years ago. Following this I have limited ROM and stiffness. Now, I am also experiencing numbness, tingling, and pain in my palms and fingers. Why?
Hi,
Welcome to icliniq.com.
You have mentioned that you sustained elbow fracture four years ago. Can you kindly furnish me information that what fracture was it actually and what management was done in your case at that time? Can you kindly furnish me with information that what fracture was actually and what management was done in your case at that time? Also, I would like to see the latest clinical pictures of your elbow showing the range of motion (ROM). X-ray of the affected elbow (AP - anteroposterior and lateral views). Your previous treatment papers by which I can understand your injury details and other things. Also, tingling and numbness actually indicate that there is a nerve involvement and management of which can be decided if I can have a clinical examination and nerve conduction study of the affected upper limb. Kindly furnish me with all the details so that I can see them and then advise you accordingly.
Thank you.
Patient's Query
Hi doctor,
I had a fall from a two-wheeler on my outstretched arm four years ago. The doctor took an X-ray and said it was a partial radial head fracture. I was in a cast for three weeks. After cast removal, I was prescribed active exercise to regain full movement. Ten days after cast removal, I went back to the doctor. I had not regained full movement, so physiotherapy was recommended. The first few sessions of therapy were very painful and I lost the movement that I had before. I took a week's break and started physio again. Next eight months I did everything I was asked to do for regaining movement including using heat modalities like hot water, a heating pad, and bee wax, active exercises, and passive. The therapist could fully extend and flex my hand to touch my shoulder. But, it was increasingly painful and my hand got more stiff. After nine months, I went back to the doctor. As per his recommendation, I got a CT scan done which showed inflammation of a joint. Immediately, I was asked to stop all physiotherapy and only do active exercise. I have not got a measurement of ROM. My full flexion would make a 90-degree angle and my extension would be 120. I might have about 30-degree play in the joint. No pain or discomfort and I am able to lift weights. Because of the limitation in flexion, I experience difficulty in eating with my right hand, combing, wearing earrings, and cannot use my right hand to talk on the phone. I have learned to live with these limitations. For the last couple of days, I am experiencing numbness and pain in my palm and fingers. Mostly early morning and sometimes during the day. I have attached all the reports given by my doctor and scan taken nine months after trauma and another scan taken last year. Please help.
Hi,
Welcome back to icliniq.com.
I have gone through all the details which you have sent me (attachment removed to protect patient identity) regarding initial diagnosis and management done and the CT scan reports. As far as I am concerned I am not able to understand your range of movements. Also, CT scan reports are very confusing because it shows multiple fractures and not only a radial head fracture. Please send me the pictures taken from a camera showing your full extension, full flexion, full pronation, and supination. You can get them clicked by visiting a physical therapist and this will also enable me to understand your affected elbow range of movements. What I can understand right now is that there is only 30 degrees ROM that is from 90 deg flexion to 120 extension which is extremely less especially if this is your dominant hand. Also, kindly get the latest digital x-ray elbow anteroposterior and lateral views, so that I can see what is there with the bony architecture. Anyways to brief you that if there is only a 30-degree ROM, that is clearly not sufficient and we will have to look at surgical arthrosis or opening up the joint so that your ROM can be increased. As it has been four years since your injury, physical therapy alone will not help.
Thank you.
The Probable causes
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Differential diagnosis
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Orthopedician and Traumatology
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