Darrach Procedure: A Case Study

You may need surgery if other treatments do not help, have recurring instability in the elbow, or if you have a complete tear of the UCL. After surgery you will have to wear a cast or splint and eventually have physical

swelling, regain range of motion, and strength. Even if surgery is needed, achieving as much knee motion and strength as possible can greatly reduce complications after surgery. Immediately after an ACL injury, the so-called R.I.C.E. treatment is recommended. R.I.C.E. stands for rest, ice, compression, and elevation.

PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal ligament and incised this

With the muscle separated and the ulnar nerve safely out of the way, the surgeon would then locate the damaged ligament. First scraping out the damaged tissue, then the next step is to drill tunnels in the

The surgery was frist performed in 1974 by orthopedic surgen Dr. Frank Jobe, was named after the first baseball player to undergo this surgery; Tommy John was the major league pitcher whose record of 288 career victories ranks seventh all time. This procedure is made to help a person with UCL also known as ulnar collateral ligament also known as the elbow. The procedure is common among collegiate and professional athletes in several sport, but most in baesball. The procedure goes as follow, the patient’s arm is open up aroung the elbow. Holes to accommodate a new tendon are drilled in the ulna and humerus ones of the elbow. The doctor then gets a tendon such as the palmaris tendon from the forearm of the same or opposite elbow, the patellar tendon, or a cadeveric tendon. Which are ten woven in a figure eight pattern through the holes and anchored. The ulnar nevre is usually moved to prevent pain as scar tissue can appy pressure to the nerve.

Surgery is generally indicated for patients who have displaced or unstable fractures and patients who will not tolerate cast immobilization. There is currently an increasing trend for immediate surgical fixation for both displaced and undisplaced fractures, mainly due to the short term benefits,

Nonsurgical treatment when the joint is stable. Rehabilitation with modified activity achieves functional stability to the knee and can help bring the knee back to the pre-injury state. Strengthen the muscles around the joint and flexibility will help as you move to a healthy joint.

Per the operative report on 10/27/15, the patient underwent right wrist arthroscopy, debridement of triangular fibrocartilage tear, synovectomy and debridement of scapholunate ligament tear.

O: Patient participated in a 50-minute OT treatment session in the outpatient rehabilitation gym to increase functional ROM and strength in the L UE, bilateral use, decrease edema in the distal L UE and education on community involvement. Patient presented with subluxation brace, personal manufactured sling, and compression glove to therapy session. Also, presented with a decreased in edema in the distal L UE since previous session.

Injecting medicine (steroids) into the tendon sheath to reduce swelling and irritation. Injections may need to be repeated.

Treatment plan includes continuation with physical therapy 2 x per week for 4-6 weeks. The goal of physical therapy is to decrease pain, decrease muscle spasm, increase range of motion and increase level of function. The therapy will be administered as therapeutic modalities (hot packs, ultrasound, and electric stimulation) in conjunction with active stretching and strengthening program, therapeutic massage and myofascial technique to reduce muscle spasm in the knee and shoulder.

The Musculoskeletal diagnosis for this case study is a Right Above Elbow amputation. An Above Elbow amputation is an amputation “from the supracondylar region to the axillary fold”(www.orthrofrocs.com). An individual loosing an arm will be faced with many challenges, more so with loosing it above the elbow. The ability to preserve the length of the limb “allows for better movement, and enhances the fit of the prosthesis”(emedicine.medscape.com). The more proximal the amputation the less functional the stump will be. This amputation will cause the loss of the hand, wrist elbow, but good shoulder function will continue( Deverix, Papdapoulos, p.656). The most common cause of an amputation above the elbow is Trauma(Ganz, Gulick, Smurr , & Yancoseck).

c. It would be beneficial for the individual diagnosed with CMT to work with physical and occupational therapy to maintain muscle strength (CMTA, n.d.). “Physical and occupational therapy, the preferred treatment for CMT, involves muscle strength training, muscle and ligament stretching, stamina training, and moderate aerobic exercise” (NINDS, 2007, para.18). Physical and occupational therapy may reduce the degeneration of muscles and prevent deformities of joints caused by the disease. Eventually, individuals may require the use of orthopedic equipment, such as braces or orthopedic shoes, to maintain mobility.

Tommy John Surgery is an operation that repairs an injured elbow for mostly college baseball and pro baseball athletes but also younger athletes. Generally, the surgery is done to pitchers, left or right handed, that throw curve balls and sinker fastballs. Doctors call this the Ulnar Collateral Ligament Reconstruction. UCLR is when there is repetitive stress damage to the elbow which was done first to a former and famous baseball player named Tommy John in 1974 by Dr. Frank Jobe. The surgical operation is done by which a ligament in the medial elbow is removed and then replaced with a different tendon in the body. This tendon is often taken from the hamstring, forearm, or foot of the person (Baseball Reference). The procedure takes the tendon and threads it through like a figure eight pattern with holes that are drilled into the humerus and ulna bone. Most people say it’s called the “dead arm injury” (Baseball Reference).

The second is the humeroradial joint between the radius and humerus which also allows flexion and extension but is also involved in the more complex motion of turning the hand over so the palm faces up or down. The third is a pivot joint formed by the radius and ulna and is called the proximal radioulna joint.