Recovering From a Broken Humerus Head
Broken Humerus Bone
I broke the top of my humerus bone in four pieces. The break happened when I crashed while skiing. I went head-first over the tip of my skis and landed on my head and the top of my shoulder.
Initially, I thought I had hurt my shoulder, but I didn't think it was broken. I tried to stand up and ski down, but as soon as I put a little pressure on my shoulder, the pain shot up to a seven or eight on the pain scale. At that point, ski patrol arrived. They assessed me, but they weren't sure it was serious. Still, they put me in the sled and took me down to get evaluated.
The first thing the doctor did was to remove my jacket, shirt, and wedding ring. Next, they asked about pain. It was hurting pretty badly, but they didn't give me any water or pain meds until they took x-rays.
I stood against a wall, and two to three different angles of x-rays were shot. Quickly the doctor came back and said the good news was my tendons were intact, but the top of the humerus was broken into four parts and I'd need surgery.
Initial Pain Meds
I was given a quick acting pain med that made the pain subside, but it lasted a very short time. I believe it was fentanyl. It seemed like every 30 minutes I needed more pain killers.
It Gets Fuzzy
I was taken by ambulance for trauma surgery. I believe a scan was done, an orthopedic surgeon was called in and they prepared me for surgery.
First, the anesthesiologist asks allergy questions and explains the various risks. Then the surgeon comes in.
He explained that about 30% of people will develop arthritis after this operation because of how blood flow to the shoulder is impacted.
The First Surgery
I had the first surgery in Frisco, Co. After one night in the hospital, I was able to go home with my arm in a sling and a few exercises.
My medication was:
- a slow release morphine - long lasting pain relief
- oxycodone - 3 - 4 hours of pain relief
- stenakot - stool softener
- valium - muscle relaxer
I was able to control the pain, do the basic exercises, but I had to sleep in a sitting position which made sleeping difficult.
Since your arm is healing, you have to do everything with one hand. I needed help taking a shower and getting dressed. An occupational therapist showed me how to put my broken arm through the sleeve of a shirt, then pull it over my head, and then finally push my good arm through before I pulled the shirt down. It takes about triple the time to get showered and dressed.
Right After the First Surgery
Getting Bad News
When I returned home, I made an appointment with the orthopedist at our local hospital. He took x-rays and told me that the screws were now in my shoulder socket cartilage about 1 mm. Part of the ball of my humerus was jagged and sitting low. The net result is I'd need a second surgery.
Cold Trauma Surgery
I researched surgeons and selected to have Dr. Kandemir at UCSF to do the revision surgery. He was the most frequently recommended surgeon when I asked other orthopedists who they would choose to do this type of repair.
Different Surgeons Use Different Materials
The original surgeon used stainless steel plates and screws. Dr. Kandemir used titanium but left the majority of the stainless steel in place. I was told that there wasn't a clinical difference in the recovery based on the materials used to secure the fracture.
My second surgeon did a few other things differently.
- The sling he used had a pillow that kept my arm at a 90-degree angle to help with the range of motion. He felt if my arm was resting at a 45 degree across my stomach, it would be more difficult to get the flexibility back.
- My prescriptions were Gabapentin for nerve pain, 3000 ml a day Tylenol, Vitamin D supplement for bone healing, and hydromorphone for pain.
Surgically Repaired Humerus after Second Surgery
Recovering at the Hospital
After my humeral head surgery, I had a side effect. My leg felt like it had gone to sleep and it wouldn't wake up. They evaluated me and the doctors felt that something must have irritated a nerve like a strap holding me in place during the arm operation. I had come in for humerus surgery and now a complication had made my leg numb. I was very concerned. I couldn't walk and they had to leave the foley in, which I didn't like. Walking after surgery has been really helpful to me for getting my guts working after taking opioids in the past, so I was really disappointed that I couldn't walk to aid my recovery.
Each day after surgery my leg got more feeling back. After two nights I was walking very slowly and my bodily functions worked after eating and drinking. If my pain was under control, I could go home.
I was getting an IV antibiotic and fentnol for when the pain got bad. The fentnol works really quickly when it's delivered by IV. The issue was, to go home, I had to be able to handle the pain without the IV pain meds.
The nurses were great and they put a plan in place to switch to the meds I'd have at home, give them to me on schedule (Gaberpentin and Tylenol every eight hours, Hydromorphone every threed hours and Baclofen daily). I just needed to handle the pain for eight hours to go home. It was getting late into the evening and my pain was pretty bad. The nurses thought one more night in the hospital would be safer because they didn't want to discharge me, have the pain get out of control and have me go to the ER and have to be admitted.
I decided I could handle the pain. My wife picked up my prescriptions and I went home.
Recovering at Home
I met with an occupational therapist that showed me how to put clothes on and a physical therapist that gave me a few exercises to do at home.
The worst part about the surgery is the pain and sleeping. The advice is to sleep in a reclining chair at home. The problem for me is that I'm really tall and my legs are so long that they hang way over the end of our recliner. My wife bought a wedge like pillow for our bed so I could be propped up. It's pretty much impossible to get good sleep. Pain meds need to be taken every three hours, having a sling with a pillow that needs to be worn all the time and a leg that was still partly asleep made it very uncomfortable. I was getting up six or seven times a night and couldn't sleep more than two hours at a time for the first two weeks.
Humerus Surgery Made Hand Swell
I was given a set of passive exercises to do at home.
- 10 shoulder shrugs
- 10 pinching my shoulder blades together
- 10 (in each direction) bending at the waist 90 degrees, letting arm hang relaxed and then swaying my body sideways, back and forth, clockwise and counterclockwise.
- 10 ball squeezes with hand
- 10 rotating wrist forward and backward
- 10 flipping of hand over and backward
- 10 using my good arm to pull my broken arm up like a bicep curl
After a few weeks, I started physical therapy. The therapist works on improving the range of motion. She does this by stretching my arm in the motion of a jumping jack and by stretching from my side to over my head. The initial limitations were 120 degrees to the side and over my head.
Seven weeks post surgery, the surgeon removed my sling, the limitations on my movement and ordered aggressive physical therapy. This includes:
- Five-pound curls
- using a pulley overhead to stretch my arm back and forth
- crawling my hand up a wall
- using a pull-up bar to stretch my arm by holding it and trying to get it perpendicular
The good news is my bone is healing and I'm progressing, but by week 11, if my range of motion isn't much better, the surgeon will do manipulations to break down the scar tissue to increase the range of motion. I understand this is super painful, so it's better to work hard in physical therapy.
Mixing in Different Treatments
My PT mixes in different therapies regularly. These include warming up on a handbike with one hand, putting my forearm against a wall and rotating my torso to stretch for external rotation.
The most unusual treatment has been the cupping therapy. It's a cup that is suctioned to the skin. It's slightly painful and leaves bruises that are over two weeks old, but it can help with blood flow to the injured area, and breaking down scar tissue.
Pain and Healing After Nine Weeks
So, it has been nine weeks since my second surgery. The shoulder is pretty stiff with about 60-70% of the range of motion. I can lift my arm over 130 degrees forward and 120 degrees to the side.
It is still sore with pain levels between one and three. Sleeping is the biggest challenge. The soreness aches enough it wakes me up a few times a night.
The strength is improving slowly. I've been diligent with physical therapy. I do exercises at least twice a day at home and 45 minutes three times a week with a therapist.
I suspect my recovery would have been a lot better if I didn't require a second surgery. I'm looking at about four months more of recovery. My hope is the range of motion improves about 30% and that the pain subsides so I sleep well.