Forthcoming Elbow replacement

[zen4]

I am due for a right elbow replacement next Thursday [ if it doesn't get cancelled!] I wondered if anyone had tips for managing afterwards? I have very poor hand function and no wrist movement but my shoulders aren't too bad. I am not sure how quickly you can use the operated arm. I am hoping quickly as many things for me need 2 arms! I am quite ambidextrous so can manage a few things with just my left hand but many things would be difficult without the use of my right arm, even if just for a little minimal support. Thank you for any comments you have. Jasmine

[Nanainthegarden]

I had both my elbows replaced twenty years ago. As far as I recall it’s doing normal things but gently. No heavy lifting for example. Do the exercises they give you and follow instructions. Good luck.

[zen4 in reply to Nanainthegarden]

Ok Thank you I have lots of pain from the ulna nerve at present so I am very used to taking care now with the arm now. I won't be rushing to put lots of pressure on it but I was hoping I could use it gently fairly early on as many things take 2 hands with my restrictions

[AgedCrone]

Presumably you will have stitches or a plaster that you can’t get wet..so get a shower sleeve…like a big plastic sleeve with elastic at the wrist so that you can have a shower…look on Amazon …they have lots to choose from.

[zen4 in reply to AgedCrone]

I have to wear a night splint to keep the arm in extension and in the day a sling and no I cannot get it wet for at least 6 weeks so the sleeve will probably be useful Thank you

[AgedCrone in reply to zen4]

It feels a bit odd at first…when the warm water hits the sleeve it feels as if you are getting wet…but don’t panic…they really do keep the limb dry.

I used one for the leg as well when I had a foot surgery.

Hope your surgery goes very well.

[BoneyC]

Hope all goes well, I am on the waiting list for a left elbow replacement but will be asking to go on the list again for the right elbow.

Surgeon told me a month ago, 8 weeks after surgery he says only lift a cup of tea as he has to 'divide' bicep muscles, so they need to heal as well as the surgery incision etc. He says it's a more delicate surgery compared to hips and knees.

Like you, I have little hand grip, little to no wrist movement as well as both shoulders in need of replacement (put it off). After surgery, you can't lean on your arms, so if you need crutches he said it will be wheelchair for 8 weeks.

I hope surgery will allow me to drive again, can't at moment as elbow partially dislocates and locks in extremely painful position and wont move for hours afterwards. I also have spontaneous bruising from inside the joint, do you have this?

Fingers crossed you don't get cancelled and good luck.

[zen4 in reply to BoneyC]

Thanks for your reply. I will certainly be very upset if it is cancelled as I have been through various hospitals and seen about 5 consultants and had lots of scans and xrays etc for over 2 years! I may well need my left arm done as well but at present its much less painful.

At the moment I can do most necessary things including driving but struggle to cut and use scissors with my right hand and many things I do 2 handed. NRAS has guidelines and it seems that you can do things gently after a few days but not put pressure on the elbow. We will see! I do not use sticks or crutches although I cannot walk far or stand long these days due to my damaged spine. I don't have bruising and my elbow doesn't dislocate although I have periods of different joints dislocating but then they settle down. My fingers are crossed. Hope you don't have to wait too long Thanks Jasmine

[Kags1068 in reply to zen4]

Hi zen4

I'm sorry to hear you are in need of this surgery, but I hope it will make a big improvement for you once settled.🤞

I haven't had elbow replacements (yet), but I know they've needed doing for a number of years. Like you, very poor hand function, wrist function and shoulders in need of renewal, too. It makes these ops that bit more complicated, doesn't it? I do remember seeing an old "regular" in clinic probably about 15 years ago now. He proudly showed me his new elbow and how well he could move it. Thinking it had been done a while ago, I asked him how long. It was about a week or so!! I've never forgotten as I was so impressed. He was very severely affected too.

I've got the ulnar nerve issues too. Had it transposed in my left arm (the worst elbow) about 12 years ago. Unfortunately, it's come back to a degree now. The right one is a bloomin' nuisance as severely trapped, and my little and ring finger and that side of my hand are completely numb. Hand surgeon won't operate until I've had other neck surgery.

Just before Christmas my left elbow became very, very painful. Rheumy got me straight in (he's very good) and did x-ray. Nothing obvious. Had phone call from him Friday evening to say x-ray now reported on and there is a fracture in my elbow. At least that explains it!! The reason I'm sharing this, is that my arm has pretty much been out of action for about a month. It's my dominant left hand too. The things I've found most difficult are (sorry to say this) toileting duties, getting clothes on/off to attend to toileting duties, pulling on/off duvet, carrying anything, lifting drinks (usually use 2 hands), washing, washing/drying hair. Dressing/undressing generally. Also, trying to eat has been a nightmare as can't put weight on it and struggling to reach my mouth. The only silver lining is I've lost about 3lbs over Christmas!!😄

There are toilet aids should the need arise. Also, various kinds of wipes etc. Clothes wise - baggy knickers (is there any other kind?) Elastic baggy bottoms or long daytime nighties?? Drinks wise I've been using my one or two-handled sippy cups for hot as well as cold drinks. Various body wipes for cleaning if that's easier some days. The latest ones I've got can be heated in the microwave. What a treat, eh?! Depending on length and volume of hair, a microwave shampoo cap could be useful initially. Don't work so well if you've got lots of hair I've discovered. Thankfully, my hubby has now been well trained in the art of doing my hair. 😉 As for eating, finger food can be useful at times. I also ordered a camping "spork" which is supposedly a knife/fork/spoon in one. It will hopefully be OK once I've modified it a bit as the handle is very thin and flat. I think it needs tape, or sponge and tape wrapping around it to make it thicker and easier to hold. Hopefully though, if you don't live alone you will be able to get help at home.

I noticed you said you're a little ambidextrous, so I'm sure that will help. Apologies if I've pointed out things you are already well aware of. I was just trying to think of anything that may help.

Finally, all the very best for the surgery. It will soon be behind you and you'll be on the road to recovery. Easy for me to say, I know!! I'm sure it will be worthwhile. Do let us know how it goes. Take care and best wishes, Karen 😊

[zen4 in reply to Kags1068]

Thank you for all the thought that went into that email. I will have issues in doing many things if I am unable to use my operated right hand even just very gently. I have had some practise though as many days I can barely use it now due to the ulna nerve entrappment.!

I've decided I will live in my nightie and a bed jacket and I can eat and drink with my left hand with a light mug and a spoon Washing might be a bit minimal and toiletting is clearly going to be my biggest issue.

Like you I too have a neck issue and had to have a neurological assessment to ensure that my neck is stable enough for having the op. This involved another mri scan but I got the all clear.

When I eat out I usually take my own kitchen knife and I often have scissors with me. I can never open anything even with 2 hands!

I will let you know how it goes Thanks for your reply. Keep strong and positive.

Jasmine

[Kags1068 in reply to zen4]

Hi Jasmine

You are very welcome. Hope I didn't waffle too much.🙄

It sounds like you've thought everything through, and are well prepared! Definitely a good idea to live in nighties etc initially. I'm sure that will help. As we know, sometimes in these situations we just have to "make do" with washing etc in the beginning, and only do what's necessary. I will admit the toileting business has been a pain, but you will find a way, and it will get easier.

I'm a scissors person too! Always try to have some small one's nearby as can't open anything either. If not, I tend to resort to using my teeth which doesn't always end well!😉

I'm glad your neck has been investigated and you got the all clear. I had a C1/C2 fusion some years ago, and now apparently need C3, 4, 5 and poss 6 removed(?) and some sort of cage/cement business inserted. Was supposed to have it done on 2 occasions last year but it hadto be cancelled due to other ongoing issues. Mind you, I'm not exactly in a rush to have it!!

I Hope this op will also relieve the ulnar nerve issue, or that they are going to do it as well at the same time.

Anyway, best of luck again and yes, do please keep us posted.

Karen😊

[Kags1068 in reply to BoneyC]

Hi BoneyC

Hope you don't mind me butting in? Your comments about your elbow locking and the spontaneous bruising caught my interest.

Like you my shoulders are in need of replacement (also put them off). Likewise my elbows - particularly the left. I've tried to ignore it for several years (as you do)! When the elbow is at it's worst, it also tends to feel like it comes out of place, and can lock. I've often wondered if there could be a bit of loose bone or something moving around as that happened in the past with one of my knees prior to replacement. About last March I developed some very strange swelling and the whole of my arm and elbow became very bruised. It was extremely painful for a few weeks too. It was x-rayed as I've been prone to stress fractures elsewhere, but nothing showed up (they often don't initially). Mid-december it happened again. This time the bruising was all around my wrist and hand and up the inside of my arm. Totally spontaneous. It has been agony. At it's worst it felt like it was dislocating a bit almost every time I tried to move it. My rheumy got me in straightaway (he's excellent), and thought it was all a bit odd. Suspected a fracture- as did I, but x-ray showed nothing obvious, just a wrecked joint. My rheumy then phoned me last Friday evening to say x-ray had now been reported on, and there is a fracture. It seems the joint is so worn that it has now become "brittle" and more prone to fracture. I've got to go to clinic tomorrow for them to review it (I think it's starting to heal now). They may send me to fracture clinic although I'm not sure there's much point as they would only immobilise it which I've been trying to do anyway (not entirely successfully)!!

I've explained all this in case it resonated with your experiences? I wonder if something similar may have happened to you at some point? I know from past experience that these types of osteoporotic stress fractures are very difficult to spot, very easily missed (and therefore dismissed), and have a habit of becoming more visible x-rays many weeks/months later. Just a thought??

Hope you don't have to wait too long for surgery🤞🤞

[BoneyC in reply to Kags1068]

Hi Kags1068,

What you describe sounds very much like what is happening with my elbow, but I haven't had any stress fractures. The spontaneous bruising has been constant for over 3 months now. The skin over the bruise is getting thick and dry and I want to avoid an open wound and excuse for the hospital not to do the surgery. GP says it's a kind of dermatitis caused by the bruising and has prescribed a steroid cream and I am to keep applying moisturiser too.

Out of interest, how long have you put off your shoulder surgery? I started seeing an upper limb surgeon in 1998 after a GP thought perhaps they could remove a slither of bone to improve my right shoulder. Since then, I haven't had either shoulder or elbow replaced, but have been seeing an upper limb surgeon ever since. However, Covid stopped the hospital sending out routine appointments so I've found it extremely difficult to get an appointment with my current surgeon who has known me for at least 15-20 years and offered replacement of all 4 joints years ago.

On top of that, our GPs handed back their NHS contract last year and we have a temporary agency arrangement. Better than nothing, but they don't know my history, don't read notes and most of them don't want to listen either. They marked my elbow x-ray as 'satisfactory, no further action' back in June when the report said 'known RA, severe OA, chronic remodelling of radial head' or like you say 'totally wrecked' joints. They then referred me to MSK Triage so that has delayed me getting to see the surgeon. When I saw him in December, prompted after an A&E visit, he said the wait is about a year to which I replied, 'crikey, that long' and he said given the bruising I'll list you as a 'P3' - which I hope means 3 months but I forgot to ask and GP didn't know.

Only yesterday, I asked GP to make a referral to same surgeon for right elbow. That one is having to work harder to compensate for my left and is also very painful. I don't want to end up without a functioning arm. GP agreed but when I arrived home, a text came through referring me once again to MSK Triage - I can't believe it! My shoulders and elbows are completely wrecked by arthritis and no amount of physio will help, it's just another delay tactic to avoid me going on the waiting list. When they phone to make an appointment I will have to say but I can't drive whilst waiting for left elbow surgery.

[Kags1068 in reply to BoneyC]

I'm so sorry to hear all that. I really do feel your utter frustration. It's so wearying and disheartening, isn't it?

In terms of my upper limbs experiences, I was offered shoulder and elbow replacements about 20 years ago too - similar to you. You put it off as long as you can though, don't you? I've always seemed to have other bits which have hadto be prioritised too. I haven't seen an upper limb surgeon for some years now. I did have a left rotator cuff repair in 2012. Limited success (which I was warned about), but helped pain wise. I'm told the right has a bad tear now as well. My right shoulder is the worst of the two. Recent x-ray showed a "high riding humerus" whatever that is, plus extensive damage and rheumy said something about it looked like it was "fragmenting" so could easily fracture? Also the joint nearby, amioclavicular(? that's not the correct name but it's something similar🙄) is very damaged too.

Rheumy made a referral to upper limbs last March, and I've not heard anything despite him chasing. Following this recent fracture in left elbow (which I wasn't actually referred for then), he got his registrar to chase it that day. I received a text from them (ortho) asking if I still had a problem and did I still require an appt? They must be in a mess too. I don't know if the rheumy is thinking if he sends me to a fracture clinic it might circumvent things?? I'll see what they've decided tomorrow. Rheumy is very good at coming up with "plans" to try and find ways around things. They don't always work, but he tries.

I remember your posts about lack of consultant input and I thought it was very bad. I think I must have been very lucky, as mine is very involved - I haven't had to go through GP for any of these things. Rheumy will phone various surgeon's and speak directly with them too. Unfortunately your situation is compounded by a poor GP service. I really despair of what some are having to deal with. Again, my GP surgery is generally very good and I've been with them all my life. The 2 partner GP's (there's only 3 in total) have both worked on rheumatology rotations during training, so do have RA knowledge too.

I do know what you mean about the fear of having little or no function. I can just about reach my mouth with my right shoulder. No higher! Can't scratch my head!!😄 I agree that all these various invented "triage" stages are just not very subtle delaying tactics. Even so, you'd think they would still be prioritising on urgency?? I dread to think who does the triaging.

I hope you hear something soon.

[BoneyC]

Unfortunately the rheumatologist allocated to me (not my choice) is ineffective. He said he would cc the surgeon in on his letter but that's all he could do. When I saw GP to show him the bruising, he said he could write to expedite surgeon's appointment, but rheumatology can't! That was ineffective too. It wasn't until I rolled up at A&E that I got to see an orthopaedic surgeon. At every twist and turn there's protocol and hurdles. I hope other patients don't have to endure these issues, it's a wonder anyone gets any treatment or surgery at all.

I too cannot raise either shoulder, right being worse than left. Doing normal day to day things like self-care, basic cleaning and cooking is a problem and I have stopped driving until my elbow is replaced as even if I was able to drive a few miles, I wouldn't be able to do anything when I got there and, if it started to dislocate, I would be in agony and not be able to drive home.

Hip replacements were a must as I couldn't function at all in constant pain and discomfort. Ankle replacements were refused by foot surgeon as in his opinion the result wouldn't be good and in any case only last 10 years and he thought I was too young in my 50's. Thankfully the ankle pain did subside once both ankles fused on their own, although at the time I didn't believe it would. Spinal decompression and fixation was lifesaving and absolutely essential.

Thanks for your insight, it really does help to hear other patients' stories. Hope you get your appointment very soon.