February 29, 2012
This morning I had a consultation with the orthopedic surgeon regarding my right elbow. Four weeks ago I injured it pulling myself up out of a reclined reclining chair. While some range of motion has returned, the healing process has been slow and therefore concerning.
The appointment today was good. The short answer is "synovial inflammation".
The long version goes like this.
I have lots of arthritis calcifications in my elbow. The bone in your upper arm, the humerus, has a niftily little notch where the partial socket on the ulna fits when your arm is straight. On my right arm that notch is filled in (and then some) with calcifications. This is likely what has prevented me from straightening my arm for most of the last 20 years.
There are also calcifications on the rim of the partial socket on the ulna that may be interfering with a full range of motion.
The doctor (whom both Sibylle and I liked) explained that there is a difference between "normal" and "functional". What I have had for a very long time now is an arm that is fully functional but has less than normal range of motion. Medically you can have down to just 100º of range of motion and still be considered functional. Until I hurt my arm four weeks ago I'd guess I had close to 160º of range of motion -- I couldn't touch my shoulder and not quite fully extend my arm.
Since injuring my arm four weeks ago I've lost about 30º when I extend my arm. If I hold both arms out to my sides, palms up, my left arm is parallel to the floor and my right arm looks like I'm midway through directing traffic. Trying to straighten my arm further hurts.
The doctor wants to approach this conservatively. We are going to medicate it with twice-a-day does of a 500mg of Naproxen for 30 days, and I'm going to have PT on the arm starting Friday. Hopefully the PT will include some ultrasound to reduce inflammation of the soft tissues involved.
I go back in six weeks for a follow-up. If at that time I'm still sore and still haven't returned to my pre-injury functionality, then we'll consider surgery. It is possible to perform an arthroscopic procedure on the elbow and "burr" away the calcifications. However, as the doctor put it, "there are a 100 ways I can make your arm worse and only a couple that will make it better."
So, pain meds, PT, and wait and see.
As for the "you have a weird elbow" comments from my primary care physician, it seems that she was misreading the x-ray. The images are of a three-dimensional structure layered onto a two-dimensional film. With arthritis calcifications obscuring some details and out-right altering the appearance of others, she simply mis-interpreted the image.