Aromatherapy And Radial Head Replacement: Healing Benefits?

Radial head replacement surgery is performed to treat severely fragmented fractures of the radial head, which is the bulbous end of the radius bone where it meets the elbow. The procedure involves removing the damaged radial head and replacing it with a prosthetic one. After surgery, patients may experience pain, bruising, bleeding, numbness, and stiffness in the elbow, which can be managed with medication and physical therapy. Early movement and stretching of the elbow are crucial to prevent stiffness and improve long-term function. However, it is important to follow the surgeon's recommendations regarding weight-bearing and lifting restrictions for a safe recovery.

Radial head replacement surgery

During the surgery, an incision is made on the outer aspect or the back of the elbow to expose the joint. The fragments of bone are removed, and the neck of the radius is prepared for the insertion of a radial head prosthesis. Any damaged ligaments, such as the radial collateral ligament, may also be repaired during the procedure. At the end of the surgery, the overlying muscles are repaired, and the skin is closed with sutures.

After the surgery, patients will have an incision on the outer aspect of their elbow, which will be sutured closed and protected by a waterproof dressing. A back-slab plaster may also be applied if there were significant associated ligament injuries. It is common to experience pain, bruising, and numbness around the surgical site, and appropriate pain management is crucial.

The rehabilitation process after radial head replacement surgery is crucial for a successful recovery. Patients are advised to protect the artificial radial head at all times during the initial six weeks to allow for proper integration with the bone. Weight-bearing restrictions are recommended, starting with limiting weight-bearing to "cup of tea" for the first six weeks, followed by a maximum of 5kg for the next six months.

The rehabilitation process can be divided into three phases: Initial, Intermediate, and Advanced. The Initial Phase (0-4 weeks) involves removing post-operative dressings, applying tubigrip to reduce swelling, and commencing scar management and specific elbow exercises. The Intermediate Phase (4-6 weeks) includes continuing overhead exercises and gradually increasing the range of motion. In the Advanced Phase (6+ weeks), patients start seated range-of-motion exercises, capsular stretching, and gradual weight-bearing exercises, still adhering to the 5kg limit.

The rate of healing and return to normal activities vary from person to person and depend on factors such as age and general health. On average, bone healing occurs within 12 weeks, after which therapists can guide patients in increasing weight-bearing through the arm and gradually returning to sports or normal activities.

Physiotherapy after radial head replacement

Physiotherapy plays a crucial role in rehabilitation and recovery following a radial head replacement. The radial head is important for the motion of the elbow, and injury or damage to it can affect all movements of the elbow. Physiotherapy after a radial head replacement can help ensure the success of the surgery, prevent future problems, and help regain full or near-full function in the elbow joint.

1-4 weeks

During the initial stages of rehabilitation, the focus is on controlling pain and swelling in and around the elbow joint. The physiotherapy programme will also aim to maintain the range of movement, flexibility, and mobility, as well as prevent deconditioning of the affected elbow and arm. This early stage of rehabilitation includes:

• Elevation and compression
• Passive range-of-movement exercises
• Strengthening and stretching exercises for the wrist, shoulder, and unaffected arm for support
• Gentle mobility and strengthening exercises for muscles around the elbow joint (biceps, triceps, etc.)

5-8 weeks

After a month of rehabilitation, the focus continues to be on controlling pain and swelling, as well as progressing activities from the previous weeks. Emphasis is given to exercises that improve function at the radial head, particularly twisting of the forearm (pronation and supination). Physiotherapy at this stage includes:

• Continuation of modalities to control pain and swelling
• Active range-of-movement exercises (bending, straightening, and twisting the elbow joint)
• Active strengthening exercises for muscles in and around the elbow
• Strengthening, stretching, and range-of-movement exercises for the wrist and hand
• Strengthening, stretching, and range-of-movement exercises for the shoulder
• Activities for the opposite arm

9-12 weeks

By the third month of successful physiotherapy, there should be marked improvements in the function of the elbow and arm, with no pain or swelling in the elbow. The focus continues to be on regaining full function and strength in the elbow and arm, as well as improving the strength and range of movement in the wrist, hand, and shoulder of the affected arm for extra support and to maximise function. Additionally, there will be an emphasis on increasing cardiovascular fitness and muscle endurance to further maximise the function of the elbow joint. Physiotherapy during this stage includes:

• Continuation of range-of-movement and stretching exercises from previous weeks
• Continuation of strength training for muscles in the wrist, shoulder, and unaffected arm
• Emphasis on strength training and progressive resistance exercises for muscles around the elbow
• Function activities relative to job, hobby, or sport
• Emphasis on independent home exercises

Full recovery after a radial head replacement may take up to 3 months, depending on the patient's commitment to the physiotherapy programme and the initial condition of the elbow before surgery.

Passive stretches and mobilisations of the elbow

Patient Positioning

It is crucial to position the patient appropriately to ensure the effectiveness and safety of passive stretches. For elbow mobilisation, the patient is usually placed in a supine position with the elbow at the edge of the treatment table. This allows for a full range of motion and comfortable positioning for the therapist.

Therapist Hand Placement

The therapist's hand placement is specific to the type of mobilisation being performed. For example, during a humeroulnar distal glide, the therapist places their fingers on the proximal ulna over the volar surface and reinforces it with the other hand. In contrast, during a humeroulnar radial glide, the therapist's hand is placed just distal to the elbow joint, with the distal forearm supported by the other hand.

Mobilising Force

The direction and angle of the mobilising force depend on the type of mobilisation. For instance, during a humeroulnar distal glide, the therapist applies a distraction force to the joint at a 45-degree angle to the ulna, followed by a scooping motion along the long axis of the ulna.

Types of Mobilisation

There are several types of elbow mobilisations, including humeroulnar articulation, humeroulnar distal glide, humeroulnar radial glide, and humeroulnar ulnar glide. Each type targets specific structures and aims to improve the range of motion in different directions.

Timing and Progression

The timing and progression of passive stretches are essential for optimal recovery. Early mobilisation is often recommended to reduce the effects of immobilisation and prevent adhesion formation. However, it is crucial to progress the stretches gradually, starting with gentle movements and increasing the range of motion as the patient improves.

Combination with Other Treatments

Passive stretches and mobilisations are often combined with other treatments for better outcomes. This includes combining elbow mobilisation with pain-relieving modalities, active exercises, stretching, and functional activities. Additionally, botulinum toxin injections, continuous passive motion machines, and splinting can be used in conjunction with passive stretches to enhance recovery.

Precautions and Considerations

Passive stretches should be performed with caution, especially in the presence of certain conditions. For example, in cases of heterotopic ossification, aggressive passive mobilisations might be avoided to prevent further complications. Additionally, patient comfort and pain management are crucial considerations during passive stretches and mobilisations.

In conclusion, passive stretches and mobilisations of the elbow are valuable tools in the rehabilitation process following radial head replacement or other elbow injuries. They help improve the range of motion, reduce stiffness, and restore function to the elbow joint. However, it is important to work closely with a qualified therapist to ensure proper technique, progression, and individualised treatment plans.

Therapeutic modalities for pain and swelling

Once the fracture has healed, therapeutic modalities can be used to help control pain and swelling. Physical therapists may use a variety of treatments, including:

• Heat therapy
• Ice therapy
• Electrical stimulation

These modalities can help to reduce swelling and improve pain management.

In addition to therapeutic modalities, physical therapists will also recommend exercises to improve mobility and strengthen the muscles surrounding the elbow joint. These exercises may include:

• Elbow ROM exercises to improve elbow mobility
• Wrist-strengthening exercises to build up weakened wrist muscles
• Handgrip-strengthening exercises to improve hand and wrist strength and function
• Shoulder mobility exercises to improve shoulder movement and flexibility

The main goals of physical therapy are to improve upper-extremity range of motion, build strength, control pain, reduce swelling, and improve overall upper-extremity function.

Recovery time

Full recovery after radial head replacement surgery may take up to three months, but this is highly dependent on the patient's commitment to their rehabilitation programme and the initial condition of their elbow.

The first four weeks of rehabilitation after surgery will focus on controlling pain and swelling. Gentle strengthening exercises for the muscles of the affected arm, as well as the muscles in the opposite arm, will also be included.

Between five and eight weeks, the focus will continue to be on controlling pain and swelling, with an emphasis on improving the range of motion, strength, and flexibility in the elbow joint.

By the ninth week, patients should see marked improvements in the function of their elbow joint and arm. The focus of rehabilitation will continue to be on regaining full function and strength in the elbow and arm, as well as improving the strength and range of motion in the wrist, hand, and shoulder of the affected arm.

Overall, radial head replacement surgery followed by a comprehensive rehabilitation course can help ensure the success of the surgery, prevent future problems, and restore full or near-full function within the elbow joint.

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