Upper Extremity Surgery and Rehabilitation

Elbow Lateral Collateral Ligament Reconstruction with Arthrex FiberTape and Epicondylectomy

This blog picks up where I left off in my last blog regarding my Upper Extremity Category of my website. The last blog described my history and workup leading into this surgery. For new readers coming to this blog first, please click the hyperlink to be directed to my last blog.

February 16th, 2016: My experience with left elbow Lateral Collateral Ligament Reconstruction and Epicondylectomy as fully described in my surgical report linked herein: lf-elbow-surgery-report
My doctor used Arthrex PushLoc Anchors and Arthrex FiberTape in his reconstruction of my Lateral Collateral Ligament and ECRB tendon and achieved the desired results. In my case, a full graft reconstruction was not needed.

Red Carpet Service

My wonderful and very detailed surgeon, Dr. Thomas Trumble, of Bellevue Bone and Joint Physicians, Bellevue, WA performed the surgery at The Eastside Surgical Center in Issaquah, WA. In the weeks before the surgery, Dr. Trumble and his wonderful assistant Ellie had set me up with having a conversation with their anesthesiologist, Adam at the surgical center as I was apprehensive about dealing with new providers. Adam eased my mind regarding starting an IV because I was going through a phase of my good veins deciding to go into hiding upon being poked. Like a fright/flight syndrome of the vein that I couldn’t control. Also I jokingly had said to Dr. Trumble  on the phone if he would roll out the red carpet of service for me, since I traveled a good distance of 8hrs one way to come for his surgical intervention. Being his last patient of the day, I walked into the surgical center and I began laughing my head off at the red floor runner rolled out in front of my pre-op cubicle. Dr. Trumble, himself, had such a good sense of humor in doing this for me. Dr. Trumble goes above and beyond to connect with his patients in giving excellent bedside manner besides his desire to solve the physical problem with his surgical expertise.

Here are his surgical photos: (click on images to enlarge) Photos in order left to right from incision to finishing up with PRP(Platelet Rich Plasma) Injections and Fluoroscopic Images.

Dr. Trumble told my lady friend after surgery, there was a good size scar tissue that had to be removed besides anchoring the torn LCL ligament and ECRB(Extensor Carpi Radialis Brevis) tendon on the lateral epicondyle. None of this was seen on 2 previous MRI’s. Dr. Trumble had relied upon my detailed subjective history along with his objective tests using ultrasound and stress fluoroscopy for proof of my instability of my elbow.
Fellow patients take note: If an orthopedic upper extremity specialist relies solely on an MRI and its negative and He/She does not due diagnostics showing the joint in motion, please get a 2nd, 3rd or 4th opinion like I had to do or my problem would still have gone undetected. 

February 17th, 2016: Here I am featured the day after surgery in my own YouTube Video discussing how I was doing:

February 18th, 2016: I am featured here with Dr. Geoff Lecovin of Northwest Integrative Medicine as he performs a post op detox acupuncture treatment for me. Please see the hyperlink on his name for the website of his credentials. Besides my surgeon, I go to Dr. Lecovin every time I’m in Bellevue to have acupuncture, dry needling, and/or chiropractic adjustments that are so refreshing especially in easing the tension of traveling. For me having alternative therapies is normal in all my post surgical rehabs that I’ve done. I also had a massage this day to further help detox the drugs out of my system.

February 19th, 2016: At my 3 day post op appointment I am featured in photo to the left. By this time I was off of my post op pain medication, and only took some Diazepam for anxiety to sleep at night. Most of the pain was achy muscles by this point in time. My surgical splint and dressings were changed, and then I was put into my Breg Elbow Brace that had been given to me before surgery during my previous work up appointments. My lady friend and I flew home the next day after enjoying a wonderful meal at the Cheesecake Factory and having a walk in the Bellevue Square Mall. It was a great time of fellowship with my friend over the 5 days we spent together on this medical trip.

 

February 25th, 2016: I had the stitches removed by my local orthopedic doctor at 10 days post op and a photo taken to send back to Dr. Trumble.

February 26th, 2016: My physical therapist had already been passively moving my elbow per doctor’s orders and massaging my muscles since the surgery. I really didn’t have much pain even with the moving of the joint. It just needed time to heal the soft tissue reconstruction. My ROM was coming along just fine. I am wearing the Breg T-Scope Elbow Premier Brace.

March 2nd, 2016: I finally was able to travel again back to Dr. Trumble for him to see how I was doing at 2 weeks since surgery and for his hand therapist to fabricate a removable cast that I could be more comfortable in because the Bregg Brace, even though fairly light for a brace, was not comfortable for me. I found it to be heavy for my shoulder also.  Because I also have a TFCC and ligament instability of my wrist, the Bregg Brace didn’t accommodate me very well for that additional problem. So to get by, I had to soft cast my own wrist for enough support till I could get back to Bellevue. However, other patients without shoulder and wrist problems may find the brace to be very accommodating for them. Just my opinion. Here I am featured here with Dr. Trumble in one of my favorite photos

So Clyde, the hand therapist at Bellevue Bone and Joint, did an excellent job of fiberglass casting my arm. He bi-valved it and finished the edges off and put stretchy velcro fasteners for easy removing by my local physical therapist to do therapy. This served me very well for the next 4 weeks that I needed to be immobilized and limited on the movement of my elbow. I find fiberglass casts to be very comfortable if they are done right. All I needed to do when my elbow shrunk, was to add in an Elasto-Gel protector over my boney prominence of the Ulna at the elbow and wrist to prevent any soreness. For me, this cast was a work of art and a blessing in comfort; therefore, I’m glad to feature the photos herein: (please click to enlarge):

 

March 21st, 2016: now 5 weeks since surgery, Dr. Trumble was very pleased with my healing as he points to my elbow in this photo( click photo to enlarge): He did an ultrasound to see how the surgical site looked internally and was very pleased.   He then had his hand therapist make the thermoplastic hinged splint to use in the daytime with active movement of the elbow(which was movement only, no lifting anything yet) while I still used the fiberglass cast at night to keep the elbow safe.

 

April 8th, 2016: After completing over 7 weeks post op and ultrasound review of surgery, I was no longer using fiberglass cast. I had been doing physical therapy weekly 1-2 appointments and additional massage therapy during this entire post op period so I was well prepared for each new phase of increased activity that my doctor allowed me too do. The joint was moving well pain free and I had full ROM.  Since I had been active with the arm in the above brace, I was having a flare up of pain in a pointed spot over radial tunnel area of arm below lateral epicondyle. The hand therapist gave me a trial of spiral tapping and encouraged more full arm nerve glides. Then a I bought a Benik Radial Nerve Splint for my wrist to wear at night to see if that would also help my symptoms. Attached are photos of the Benik Brace that has heat moldable insert. (Click on photo to enlarge). I found this to be a good option instead of standard wrist braces as it did not irritate the head of my Ulna bone and it gave support also to my thumb.

May 4th, 2016:  11 weeks

A more functional splint for daytime use was made by my doctor’s hand therapist, Clyde. A specially made thermoplastic VISI (Volar Intercalated Segment Instability) Splint that supported my proximal carpal bones and DRUJ(Distal Radial Ulnar Joint). It had gel padding over my Ulna head on the one side and gel over Pisiform (a small rounded carpal bone situated where the palm of the hand meets the outer edge of the wrist). Rubber bands hold the compression between the Pisiform and Triquetral bones.

I healed very well from the surgery of the elbow; however, my progression to fuller strength training was still being compromised and I’d have flaring up of nerve pain in radial tunnel below where the elbow surgery had occurred.  I felt the elbow surgery helped the joint itself and it felt more stable upon loading it and follow up ultrasounds showed good healing and anchoring of the repaired ligament/tendons without inflammation in area; however, after this point in time, Dr. Trumble and I continued to work on diagnosing any nerve pain in my arm and looking to find reasons for the continued atrophy in my forearm besides the known TFCC-ligament issues of the wrist.

As my diagnostic journey continued, I will write my next blog on the subject of the Brachial plexus/long thoracic nerve compression causing scapular winging of my shoulder and Neurogenic Thoracic Outlet Syndrome.  It is important to rule in or out any shoulder issues, nerve issues in the arm before considering any elective surgical work on the wrist. Dr. Trumble has told me this is very important because all of it can affect the wrist. Work from proximal to distal in dealing with the arm. As time has gone on, this has been proving to be so true. Similar concept to that of working from pelvis stabilization to the foot/ankle which I did as shared in all my other medical blogs. See homepage of my website.  See and like my Si-Instability Facebook Page.

Thanks to all my subscribed readers and new readers that find these blog subjects when searching. And a special thanks to Dr. Thomas Trumble for being a special part of my medical journey. I dedicate myself to writing my stories in order to touch more lives and pay it forward to help anyone I can.
Very sincerely, Kim-Author





DISCLAIMER: I AM NOT A MEDICAL PROFESSIONAL.

The information on this website is not intended to replace the advice or care from a healthcare provider. The information on this website is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments, or treatments. The information should NOT be used in place of visiting with your healthcare provider, nor should you disregard the advice of your healthcare provider because of any information you obtain on this website. Discuss any activities presented in this website with your healthcare provider before engaging in the activity.

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