Have a radial head fracture? No time for formal physical therapy (PT)? According to a new study that might be just fine.
The research, “Minimally Displaced, Isolated Radial Head and Neck Fractures Do Not Require Formal Physical Therapy: Results of a Prospective Randomized Trial,” appears in the April 18, 2018 edition of The Journal of Bone & Joint Surgery.
Kenneth Egol, M.D., vice chair for education at the New York University Hospital for Joint Diseases and study co-author, told OTW, “As physicians, we should always be looking at the treatments we prescribe for our patients. We are obligated to provide the highest quality, fiscally responsible care we can. This study identifies one area in which we as providers of musculoskeletal care can accomplish this goal.”
The authors wrote, “Patients who had a nondisplaced or minimally displaced fracture of the radial head or neck and presented to 1 of 2 providers were enrolled prospectively between January 2014 and August 2016. Patients were randomized to receive outpatient PT or perform self-directed home exercise….”
Dr. Egol commented to OTW, “We were finding that patients who didn’t have time for PT did as well as those who did PT at home (for this particular injury). So, we decided to look at it scientifically.”
The authors wrote, “At 6 weeks, the home-exercise cohort had better function as indicated by a significantly lower mean DASH [Disabilities of the Arm, Shoulder and Hand] score compared with the PT cohort. At 3 months, 6 months, and final follow-up, there were no significant differences between cohorts for any outcome measure.”
Dr. Egol told OTW, “When seeing patients with this injury, physicians can counsel them that they will generally have a full recovery with little time lost from their daily lives.”
I had a severe RH and neck fracture (Mason type II) of the left elbow in June 2017 followed by RH plating, LUCL repair and splinting for 4 weeks. The bruise lasted right from my shoulder up to my wrist. So after the splint was removed my elbow practically appeared to be frozen and my wrist wouldn’t turn at all (pronation/supination). It took me a month of useless home exercises to come to no result, so I went back to my surgeon and got an Rx for extensive PT (EAP = Erweiterte Ambulante Physiotherapie) including a CPM machine. This PT took me 3 months and overall lasted 3 hours per day with breaks in between and was VERY exhausting and pretty painful leaving bruises all over my arm and making me swallow painkillers in large amounts. But only this way I got my ROM back with 90% of flexion/extension, 100 of supination and 60% of pronation (which was restricted by the plate seemingly placed outside of the safe zone). Plate was removed 7 months after fracture combined with open joint mobilization procedure (arthrolysis). Followed by plate removal I had another month of PT that gave me full pronation/supination and now in May 2018 as I write these lines I have 100% of flexion and extension (but without 2-3 degrees of over extension like I have on my right hand). I still have some residual ache in my elbow and arm but for a long time since then I can avoid taking painkillers.
So if you ask me if the PT was important on my long way to recovery, I’d say yes definitely it was essential.
Interesting and somewhat unexpected study, but important. Physical therapists are in such high demand and more so all the time that we need to identify areas where formal PT may not create better outcomes.