Congenital dislocation of the radial head was described by McFarland. The direction of the displacement of the radial head may be anterior or posterior or lateral.
Condition is often unilateral.
The abnormality is usually not detected at birth, but is diagnosed later on in childhood when the elbow is examined following some minor injury.
Usually the elbows are asymptomatic. A complaint of stiffness may be reason of visit to physician in some cases.
The ulna is bowed, the direction of convexity depending on the type of dislocation
- Anterior dislocation-ulnar bow is forward
- Posterior dislocation-backward
- Lateral dislocations the ulna will bend laterally.
In anterior dislocations the range of elbow flexion is limited and the radial head may be palpated in the cubital fossa; in posterior dislocations the elbow will not extend fully and the prominent radial head may be palpated posteriorly.
Radiographs
In a normal elbow a line drawn through the longitudinal axis of the radial shaft bisects the capitellum of the humerus. This normal finding is absent in this condition. The head of the radius is dome shaped on its superior surface.
It is important to distinguish traumatic from congenital dislocations. The types of injury that cause traumatic dislocation of the radial head are missed Monteggia fracture dislocations, fracture of the radial neck, pulled elbow, and occasionally a primary traumatic dislocation of the radial head with other associated injury.
In the newborn and infant, arthrography of the elbow is helpful in the definitive diagnosis of radial head dislocation.
Treatment
When the diagnosis is made in the newborn or young infant, closed reduction may be attempted.
The posteriorly dislocated radial head is reduced by supination of the forearm and extension of the elbow,
The anteriorly dislocated radial head is reduced by flexion of the elbow.
Reduction is maintained in an above elbow cast for four to six weeks.
Closed reduction is often unsuccessful.
In children up to three years of age open reduction should be carried out.
In the older child it will be impossible to reduce the radial head.
The dislocation is left alone until late adolescence, when if symptoms warrant, the radial head is excised.
My heart is bitting hard as I read this post.. Scary!!.. I thanks God for not having this or any of my family.. We all should realized that we are lucky compare to others. Thanks for sharing..
My son is 14, he will be 15 in a couple of months and he wants a total elbow replacement. he is an athelete and I am trying to find someone who will do this for him, he longs for it to be normal so he can fulfill his dreams.
I am not sure if that is right thing to do at this age.
Have you taken a professional advice on the matter?
My daughter has a congenital dislocation in her right elbow, along with signs of developing arthritis. The dislocation was discovered at age 13 when the elbow suddenly became painful (she said that she felt something shift, but the doctor couldn’t explain that). The surgeon said that the condition is related to a very mild case of arthrogryposis, and advised taking no action because she’s unlikely to have any serious long-term problems.
The surgeon also referred my daughter for physical therapy, but the PT said that he couldn’t help because the problem is the position of the bones and she is otherwise just fine. (The PT was also concerned about her awkward gait and offered therapy for that, but she refused to cooperate.) The surgeon told us that excision of the ulna and re-attachment is the only alternative, and that she would probably end up with more pain and less mobility. In addition, he said that in any case surgery is not an option until she stops growing.
Now my daughter is 16. The elbow has become more painful and lost range of motion. (It appears to be at roughly 45 degrees to me; she can force it straighter but it hurts her to do so.) She is an accomplished artist and intends to pursue art as a career, but it has become more difficult for her to use her right arm. The arm is particularly painful when she has to stand and work at an easel. She uses her left hand when possible, but she’s not a natural lefty and some work requires the use of both hands. In addition, it has become more difficult for her to open jars, use a can opener, safely use a kitchen knife, and so on.
Should we continue to let the condition go for now, or should we seek treatment? Is excision of the bone really the only option, or is an elbow replacement a possibility? If the excision is done, is there a way to prevent the cut bone from deteriorating?
Any comments and/or advice would be greatly appreciated.
Dear PJ,
In late discovered cases,the favored treatment approach at present is to defer any intervention until skeletal maturity, at which time resection of the radial head can improve appearance, but not motion.
This problem is generally noticed and diagnosed late.
If I review the literature and data, I would advise you to wait and watch.
Yes! Surgery is an option but it has its own hazards. Your doctor has rightly said that there could be a decrease in range of motion.
Try modification of lifestyle. Because she is young, it would help her to use left hand more often, find workarounds of most of problem.
She must continue with her physiotherapy within limits of pain.
If she still finds it difficult, then you can discuss the option of surgery with your doctor.
Elbow replacement is not a treatment for this disease.
Thank you for the advice. We will set aside surgical options for now, and we will look into occupational therapy in addition to PT. My daughter is also working from a book about learning to write with the left hand (it’s written for people who lose the use of their dominant right hand). Her artwork looks quite different when she uses her left hand, but the quality isn’t any worse. It’s so frustrating to be unable to fix this problem for her, but at least it’s not something life-threatening or anything.
I have congenital dislocation of the radial head in both elbows. I am 38 and my 40 year old brother has it as well. Here is my progression. In junior high, as my muscle and strength increased; throwing and sports became a huge problem. I had to stop, which at that time in my life was a major loss. It was my life. I focused on graduation and college and then found myself unable to even type on a keyboard. My “crooked” elbows somehow pinched nerves that would cause my fingers to become cold and stiff. My high school days watched my handwriting go from a straight up and down signature to angled because of these same issues. I consider myself very creative and artistic and have found that I, too, had to adjust my technique because of pain and it is very frustrating. My mind and my talents say one thing, but my arms cannot deliver.
In the last 5-10 years, I have noticed that while I am living the normal life of raising three kids and all that entales; my wrists are now turning inward. This is a much bigger issue than the elbows ever were. I can dislocate my arm just by talking on a cellphone or driving a car and then my wrist gets involved in the pain along with my fingers. It is like my wrists are turning inward as I pour a gallon of milk everyday. My left arm/wrist is worse because I baby the right arm. The right arm is what got hurt the most in sports when I was younger, so I switched; however, I am inflicted with this in both arms.
I recently had an option from my doctor to sleep in a special cast that would turn my wrists back to a more normal position. He said that it would be painful. I am not quite willing to accept that yet. What is the lesser of two evils?
When I was little in the 70′s, the doctors waited for me to “grow up” and then they would perform the surgery that would give me range of motion; however, I would lose a lot of strength they said. Once I did actually grow up, the doctors said that they didn’t encourage the surgery anymore. That the success rate was low. (I am sure you have read articles on the internet.)
PJ, I am a mother, too. I am not trying to scare you. I would love to see your daughter using her left hand, as well. I would love to have the option. I have arthritis. When it is cold outside, I run for gloves, a coat – you name it; to try and take care of myself. If I don’t wear a scarf for example, the arthritis in my neck and back becomes unbearable and I then need the anti-inflammatory and pain medications. (I have a hip and knees that dislocate as well.) I had severe problems with my knees changing my first babies diapers on the floor. Second baby, I bought a changing table and the problem was solved. I try to fend off dislocations and arthritis before it happens. I cannot tell you how many times I have been made fun of for wearing scarfs and gloves when no one else was. My mother always said to me, “Ache for no one!” I am sitting here right now in a turtle neck sweater, thanks Mom! I need to close because as I said earlier, typing causes me a great deal of pain; but I thought this chat was worth it. (And like your daughter at her easel; I find I have to type on a laptop with my hands down much lower than normal. If I type at a regular desk or with my laptop on the desk; I cannot manage for even minutes.) I hope this helps. Feel free to ask me anything. Have faith!
Lori,
That was very inspiring and motivating read. It is always interesting to know how people cope with and overcome their challenges.
I follow a lot of people with limitations and deformities in my clinic, both congenital and acquired. Each one of those has a brave face that defies the limits and circumvents the obstacles.
One of such patient was a young girl with bilateral deformed forearm and hand who used to sew clothes with her feet for livelihood.
As I saluted her spirit and ability to struggle. She said something I would never forget in my entire life.
She said, “I do not have an option”.
One must not give up.
Take care.
Hello Dr. Singh,
It is so comforting to read information on this disorder. My son, who is now 7 years old, was recently diagnosed with this condition. My oldest son discovered it while they were playing a game. After his pediatrician could not figure out what was wrong (she also noticed something wrong), we were referred to a pediatric orthopedist in Southwest Florida. We went for our consultation, and he was diagnosed. He mentioned that it was rare and only maybe saw one case per year. My concerns are for his future quality of life. Amazingly enough, he is a very active child. Involved in soccer, football and a drummer, his doctor was pleased at how he has adapted to it. My concerns are for the future of course……….he will be visiting his orthopedist 2 times yearly until his 18th birthday. Can you let me know if there is anything I need to look out for? Is arthritis common? I feel helpless not doing anything about it. He is fine now and never complains of pain or stiffness however do conditions like this worsen as they get older? Any information you have is helpful to me. THANKS SO MUCH
Hi!
I am a 25 year old with a congenital dislocation of both elbows. I need some help and maybe this is the place to start. It was discovered at age 4 when i stopped being able to use my arm without stiffness. Since then, It would pop in and out each and every time I would straighten or bend my arm. It hurt constantly and would wake me up. Finally, at 21 I had my radial head excised. I gained some relief of pain but lost some mobility. Shortly after the surgery, my wrist became dislocated due to the previous surgery. Now, I am having trouble finding a doctor to understand and need to know what my options are. I have been told I am too young for an elbow replacement but it hurts so bad I can no longer function.
I am started relying more on my left arm but it hurts and I can no longer lift my daughter and I can hardly type or write. I can’t work and am beginning to feel like I’ll have to live in this pain until I’m 40 and they’ll replace it. I just would like to know if there is anything i can do. Thank you so much for your caring of this subject, it seems to slip through the cracks.
Kristen
Kristen,
Have you been suggested that elbow replacement is the treatment for this?
That is what I think I need but every doctor tells me I’m too young and no one would even consider a replacement until I’m at least 40. I just can’t imagine another 15 years of pain. I guess if a replacement is my option at what age would you recommend it?
Kristen,
The elbow joint consists of 3 bones and 3 joints.
The bones are the distal humerus, proximal ulna, and proximal radius. The ulnotrochlear joint is between the olecranon process of the ulna and the medial condyle of the humerus. This joint is responsible for flexion and extension of the elbow.
The radiocapitellar joint is between the radial head and the lateral condyle of the humerus. This joint allows both flexion and extension and forearm rotation.
The radioulnar joint is between the radial head and the proximal ulna. This joint allows forearm rotation.
You can see the pictures here to have an idea.
http://en.wikipedia.org/wiki/Elbow
When radial head is dislocated, congenital or otherwise, it hinders the rotation of the elbow. This rotation is responsible for turning forearm.
But ulnotrochlear joint is normal and flexion and extension is not affected much. It might be painful but range mostly is not affected.
Elbow replacement is a surgery that mainly aims at replacing ulnotrochlear joint.
Is it a treatment for dislocation of radial head!
Probably not.
It does not seem to justified treatment to sacrifice and replace ulnotrochlear joint when it is not affected.
I am yet to come across this concept.
Please let me know if you have a reference. I would like t have a look.
You might be benefited by a procedure that aims at stopping proximal migration of radius bone [which is common after radial head excision in about 15-20% of patients and which is cause for your wrist deformity.]
Your deformity needs to be taken care of now, not later.
Discuss your options with your doctor.
I hope that helps.
Hi Dr. Singh,
I’m Kristen’s father, and a chiropractor. She lives about 2 hours away, so I don’t have her MRI or x-rays available. I’d like to ask this question:
How arthritic would the ulnotrochlear joint need to be before needing replacement?
In Kristen’s case, that joint is arthritic, but I’m not sure to what degree. I do know that excising the radial head reduced pressure at the elbow and provided some measure of relief, but the pain in her wrist due to the dislocation is considerable, and the pain in the elbow is increasing as well.
A previous orthopedic surgeon wanted to do a radial head replacement, but that will only return the pressure on the joint, and it’s deteriorated further in the approximately five years since the excision. Is there another alternative? And, even with a full replacement, would the problem at the wrist persist?
Thank you for your opinion.
Kevin Adam
Hi Kevin,
When there is excision of radial head, the radius bone shifts proximally in about 15-20% of patients. This would cause deformity in the wrist as well because proximal migration of the radius affects distal radio ulnar joint as well.
Though I have not seen any image of the wrist of Kristen but I deduce from available information that this is the cause of wrist pain and deformity.
Correct me if I am wrong.
Usually, radial head dislocation is not known to cause arthritis of ulnotrochlear joint. I wonder when you say so.
Okay! Let me have a look. Could you arrange emailing of scanned xrays of elbow[anteroposterior and lateral views] and wrist [anteroposterior and lateral views].
Just to answer your questions. Yes! there are options available but you would need to think them over hether to exercise the choice or not.
Anyway! let me have a look first before I comment.
Because elbow replacement is not going to address the problem of migration of radius, I do not think it would affect wrist problem.
I hope I have kept it simple.
Kevin,
I have got the xrays but I have not yet scrutinized them. I am away for one or two days. I would answer back soon.
Sorry to keep you waiting.
I have a congenital dislocation of the left elbow. It was discovered when I was 7 years old when I ran my bike up a curb and it jarred. I was unable to straighten my arm at that time, but regained full movement with physical therapy. My orthepedic doctor at that time was going to perform surgery to fix the dislocation, but decided not to because my range of motion could be lost. So it was not fixed. I am now 25. While I was growing up, I occasionally had problems with my elbow, and one summer my wrist was very painful because the elbow joint was effecting the wrist joint. That passed also. I haven’t had problems with my elbow for a long time unless the weather changed and it hurt for a day or so. However, since November 2008, I have been experiencing more pain and stiffness in my elbow. I notice the pain the most when I am sleeping and it wakes me up. I did have xrays of it again back in November, but was told there is nothing that can be done because there is no new injury to it. I have been taking over the counter pain medications, and that seems to help with the pain. I have also just started wearing an elbow support again to see if that helps. It just seems to be getting worse each day. I am coping and continue to have a fulfilling life. I also play the trumpet. Hopefully my continuing pain and stiffness will not prevent me from playing.
Hi, some advice would be great. I have a 16yr old daughter who has congenital dislocation of the radial head. She had surgery in 1997 which was unsuccessful.
She does have a mild intellectual disability also.
She swims at a national level and as her arm slowly gets worse with age Im wondering if anyone knows if this condition would allow her MD classification to change?
She does have severe bowing in both arms however only the left dislocates at will.
Many thanks.
Denise,
I need to know following.
What was the surgery done?
What is MD classification?
Is the dislocation bilateral?
I have a 15 year old son who was diagnosed with congenital radial head dislocation 2 years ago. He was a hockey player so there was an assumption he must have injured it playing – although I was insistent that this was new for Bryan – looked like he had a second elbow. So the MD thought it was just a dislocation per se, so opened up the arm in hopes of getting it back in place and found this abnormality and closed it back up, diagnosing it was congenital radial head dislocation. He was stunned at what he found and kept saying this would be in the medical books. I believe it was new for him.
He was then referred to second surgeon who apparently specializes in such. This MD says this is something normal and sees all the time.
We have been seeing him since then. Bryan has 45 degree mobility, has intermittent pain in wrist and elbow but not requring regular pain medications. He truly looks like he has a second elbow. This is his predominent hand. On our last visit in January the MD suggested Bryan has surgery next month to shave off the bone sticking out which should eleviate the pain. He also says he sees these things all the time.
I cannot settle my mind with this procedure. I know my son doesn’t like the look of his double elbow and the lack of full rotation and mild to moderate pain, but it just doesn’t seem like the thing to do. What would your professional opinion be? He says now is the time for surgery bec. his growth plates have quit growing, but it seems premature. I know I’m not a doctor, I want the best for my son, but is this really the right thing to do? Are there truly MD’s who specialize in such here in GA? How will this affect him as an adult and ability to use that arm? Thank you in advance for your time and help!
Julie,
At maturity of skeletal growth, excision of the radial head is one of the prescribed treatment for alleviation of pain. I think you are talking about that procedure.
But this surgery does not cause any gain in the movement.
One of the possible side effects of this procedure is proximal migration of the radius [Please go through the comments before this and I have explained the process in detail.]
However, this does not happen in all the cases and it cannot be said that it would happen/not happen in a particular case, but there are certain factors that make it more likely.
This proximal migration also causes wrist deformity.
I personally feel that surgery should be delayed as the pain is not very frequent. A little life style modification and avoidance of painful activities would help.
You can discuss it with your doctor
Thank you so much Dr. Singh!
I too have been leaning towards delaying the surgery bec. of the possible side effects and his pain was not severe, Thank you for your professional opinion. Are you taking new clients?
My son quit hockey because the MD had told him if he had an injury on it, it could cause significant complications. Is this really true? He has since become a skateboarder – don’t know which is really more of a risk – but he wants an active lifestyle.
Dr. Singh, what are other procedure possibilities to gain range of motion (is PT helpful)?
Will he eventually not be able to use this arm and will this continue to get worse?
He has been diagnosed with closed anterior dislocation of elbow – radial head and closed medial disclocation of radial head.
Thank you so much for your time and patience! Julie : )
Hello,
My son last year, at the age of 7 was diagnosed with congenital dislocation of the radial head. My child’s ortho had suggested to evaluate him every 6 months. His condition HAS not disabled him from being active. He skateboards, is a drummer (pretty good for his age!) and loves to draw. He is going back to visit his ortho this June. My question is, what is the likelihood that it can worsen. I know the doctor advised me to ask him if he has any pain or discomfort but he has had none. Is it possible for this defect to just look abnormal yet not limit his range of motion? He will be turning 8 years old in a few months and I know his doctor mentioned that his condition will have to be checked annually till he is 18 years old.
Any help you can provide would be helfpul. Do you have any written publications or pamphlets regarding this condition? W e have many family and friends who would like to know more.
THANKS
Sandi
Julie,
You are welcome Julie.
Because of abnormal anatomy, the symptoms might worsen but it does not happen in every case. Every individual is different in regards to pain perception and pain threshold.
Most of the individuals are able to maintain an active life style within the constraints they have.
Physiotherapy would not gain fresh ROM but it helps to maintain muscle strength.
Good Luck and take care.
Sandra Ortiz,
I wish I could answer your questions as yes or no. But I cannot. No body can.
This conditions have been found to get worse with time. How much worse one would become cannot be predicted. But that does not mean that your child would definitely and absolutely get worse. There is a possibility the may not. But the chances are less.
Because, the radial head is not where it should be, there would be changes in the head and tissues around it. Therefore things would not be perfectly normal.
There are two things as you mentioned. Appearance of the elbow and symptoms because of the problem.
The symptoms are not purely governed by the disease itself. Personal attitude and tolerance also shape them. Therefore, they vary from individual to individual. Secondly, the severity of the disease also varies from individual to individual.
You may find the literature on this condition in pubmed.com.
I hope that helps.
Hi, My name is Jessica and I have a 3 year old daughter named Aubany.
At age 2 I noticed her right arm was much shorter (about a inch) than her left. I took her in to our PCM (Primary care manager) (We are Military). He doctor took X-rays and was completely blown away, I don’t know if this is a very rare case or what. We are stationed in Okinawa Japan and they sent the X-Rays directly to Hawaii to a specialist for children. We received word her Radial head is deformed and her Ulna i believe is bowed. This has caused it to be shorter. My daughter can only turn her hand as if to pick something up, she cannot place her palm twords the other one. She also cannot turn her arm as if to even shake someone’s hand or talk on the phone. congenital dislocation of the radial head is what one doctor said it was and it is from birth, that she formed it even in the womb. At 3 years old she is loosing motion in her arm and cannot participate in many things due to the fact “my husband and I, as well as the doctors” are afraid it is going to break or get worse.
What is your advice and suggestions for me to take now? I want to help my daughter have a wonderful life. It kills me to watch her try and use scissors or write because she struggles to be like others and move her arm. I have an appointment with her Doctor coming up and would like to take some good suggestions and knowledge of this with me.
If anyone can help me with what i can do to help my daughter please let me know. I think out of all the post my daughter is the youngest so far. “To have it known already she has this condition”
Thank you so much
From a very concerned mother.
Jessica
Dr Arun Pal Singh Reply:
June 4th, 2009 at 2:00 am
@Jessica Kirby,
As your child is young, reduction of dislocation can be tried. She would need to undergo surgery for that. Generally, this condition is discovered late and the procedure cannot be done on older children, there is not enough data on outcome of surgery.
You should talk to your specialist or find a doctor who deals with congenital dislocation of elbow on frequent basis.
You can discuss it with your doctor and decide if surgery is right for your child.
But if no treatment option is considered, you would need to modify few activities. your doctor would tell you all the precautions you need to take.
Your child can still have a wonderful life. But you would need to work on few things.
May God bless you in your efforts.
Hi Jessica,
Dr. Singh can address your medical questions, but perhaps I can offer some suggestions as to how to manage your daughter’s problem. My daughter is the child discussed near the top of this forum, under the name “PJ.” Fortunately, our girls only have this problem in one elbow. My daughter can still use her right hand for some tasks, but she is becoming accustomed to using both hands or her left hand for many activities. It doesn’t help the pain of course, but a person can get along with one hand. I suggest that you start encouraging your daughter to use her left hand whenever possible.
When she is ready to learn how to use a computer, there are single-handed keyboards for the right or left hand – Frogpad is supposed to be one of the easier-to-use options, but other configurations are available: http://www.frogpad.com/
Further down the line, there is a website run by a “handwriting repair” specialist, Kate Gladstone, who developed ergonomic handwriting techniques (left and right) because of her own neurological problems. She uses a modified form of italic instead of cursive since cursive writing is difficult and italic is both easier and more legible.There is a link to a section for lefties at the bottom of the homepage that might come in handy if your daughter has trouble learning to write. My teenager found the website and one of the books that she recommends to be quite helpful: http://www.handwritingthatworks.com/ The book “Handwriting Without Tears” is another book that might be worth looking at. (You should be able to find it at your library before you buy.)
We’ve found that left-handed scissors and desks can be hard to locate at school (never mind left-handed art materials or instruments). In addition, my daughter needs support for her right hand because of pain so those left-handed single arm desks aren’t adequate. It helps to talk to the people at school *before* the school year begins to make sure that your daughter gets any accommodations that she might need. This includes preschool.
Schools are generally cooperative if you’re pleasant and if you have a letter from her doctor stating that she has such-and-such a disability and needs x, y, and z to do her work, but if necessary, your daughter can get an ADA Section 504 plan that will legally require the school to provide any educational equipment that she might need. If you want more information, I suggest the Wrightslaw website: http://www.wrightslaw.com/ It gets into detailed points of law and is perhaps a bit intimidating, but you can find the basic information you need for something this simple. You can also get an IEP if your daughter needs help from a teacher to learn how to write comfortably and clearly.
Ask your daughter’s doctor about occupational therapy in addition to physical therapy. If she needs it, OT will teach her techniques for doing things with her left hand only. She might be too young, I don’t know. In any case, it’s amazing how well my teenager has been able to find workarounds for doing right-handed tasks, and I bet that a child as young as 3 will have much more success.
I hope that your daughter is young enough to have a successful elbow reduction; either way, I wish you both the very best.
PJ
Dr Arun Pal Singh Reply:
June 4th, 2009 at 4:08 am
@PJ,
Those are very good practical tips PJ. I know people would find them useful.
Thanks for sharing these.
Hi Jessica,
I talked above about my dislocation of the right arm and the problems my surgery has caused me. I have a congenital dislocation in both arms, as does my aunt and my 2 year old daughter was just diagnosed. Currently, my daughter has quite a bit of mobility but it does get harder as she ages. My aunt recently had an elbow replacement at 40 years old and it was life-changing for her. Before that she could do very little with her arms. With that said she and I have led very full lives and can give you some help. With computers, as she gets older, get her a program that types what you speak. This is all my aunt and I have used in order to be able to type with more than just our pinkies. Also, find a mouse that uses a ball instead of the movement to move the cursor. She can use that no matter how little rotation she has, just switch the sides of the buttons to whichever works better. Also, we tried a lot of handmade pencil holders to get the design right for us but I would experiment a little in your spare time with different sleeves of varying widths over a pencil to see what she can hold. It makes a huge difference.
I know its incredibly difficult to watch your daughter struggle but you will also be in awe of how she will be able to make the world work for her. Please feel free to email me anytime: Elvis4ever_83 [at]hotmail [dot]com, since we all know how important a support group is for such rare problems. All the best.
Kristen
I was born not being able to straighten my arms and I am now 24 and depending on the days and how i use my arms…they hurt bad…some days I can’t go with out ibprofen..i went to the Scottish Rite hospital for children back in 88 and they diagnosed me with bilateral congenital dislocation radial heads. I don’t quite know what that means…and my parents can’t tell me anything about it to help. I just want to know how i got this problem and what i can do to help with pain and a possible fix… thanks
Dr Arun Pal Singh Reply:
July 18th, 2009 at 3:12 am
@Jamie,
Please go through the article to know more about the problem. The exact cause of the problem is not known yet and is often discovered late.
If you have painful elbows, you should visit a doctor who can tell you if you would be benefit by a surgical procedure.
But the mainstay of your treatment still would be life style modification.
Thank you…when I was younger I was very active in sports…except baseball -hitting the ball with the bat was very painful for me…My freshman year of school I fell and hit my left elbow on a metal chair…which is now dislocated on top of having crooked arms..the doctors didn’t want to touch it so for 10 years now it has been dislocated…they never hurt me or at least I never noticed it until this year…when my daughter was born, not 3 hours after she was born we checked her arms…which are fine…and I am glad she will not have to go thru any of this. Somedays I will be driving my car and a sharp pains goes thru my arm. I wish there was more that doctors could tell us…but thanks for your help…
Is this condition the same thing as radioulnar synostosis?
Dr Arun Pal Singh Reply:
July 19th, 2009 at 1:12 pm
@Jamie,
No! They are different entities. Congenital radioulnar synostosis means that upper end of radius and ulna are fused whereas in dislocation the radial head gets out of its socket where it articulates with upper end of ulna.
In the end both cause loss of movements of the forearm, former more severe than later but later is often more painful.
I live in Oklahoma and was born with this in both elbows. My doctor told us when I was not even ten that when I was old enough he would let me make the decision to try cutting off the head of the radius in an effort to give me some more motion. The summer after turning 18 we tried it, the results didn’t really help with motion but stopped popping and catching and reduced the pain to a degree. Then in 1995 in an effort to once again reduce pain they went back into the left arm and took more of the radius off, once again working on the reduction of pain. Just like some above discussion earlier in life was that some day I would be a candidate for a replacement in both elbows. During those years I spent time thinking how neat it would be to be able to see my palms finally or reach things easily like others because I am tired of having a limited reach as my arms are far from straight. Then at 44 I put my doctor on the spot asking for either a fusion of my left elbow or replace it. He tells me that due to the weakness of the bones and a lack of a real joint I am not a candidate for both and the only thing to do is just deal with the pain the best I can while splinting the elbow left arm. Now the right arm is showing the same signs that the left one did prior to the first surgery back in 1985 and we are at a loss of what to do next. I found this while searching the net for a place to get a molded plastic splint for my right arm so that I don’t have to deal with fiberglass that doesn’t like when I am out side in the Oklahoma heat swetting.
However, for those parents of young ones out there. Though I have been in pain and had arthritus since about age 12, I may not have been able to get into the military when a kid but have made great achievements as a student and an adult. While a child I wanted to be athletic but the doctors and parents didn’t agree. So, I took on music and accomplished more than most ever dream of. Then after getting married and becoming a parent I have built rooms on my house, played golf while wearing my brace, coached my son who has great arms in football, hockey and wrestling taking him all the way to being a state participant. I have been taken out of gainful employment, but still work part time and am still coaching in a semi-pro football league. Until I was given maximum restrictions at 43 regarding the use of my elbows they never slowed me down as I just found other ways of making things happen.
Don’t tell me something can’t be done, you better be ready to stand and watch.
Tommy -
I am 39. I have this condition as well in both elbows. I have found the older I get the more my wrists are turning inward because of “daily living” and “daily use” of my hands – like pouring a gallon of milk, etc. Driving is even an issue, etc. – turning the steering wheel. Like you, it didn’t stop me – I adjusted around the condition. However, within the last couple years, I have been unable to. Would you share more details of what you cannot do now and when? It is hard to get a lot of information on this and especially hard to meet people that share this – I would greatly appreciate this.
Lori
P.S. I have been a stay-at-home Mom for 21 years, so work has not been an issue for me – I am fortunate and can totally work around this; however, with my children getting older – I wanted to get back into the work force and I am finding it hard to determine “what” I can do. I can’t lift a heavy load. I can’t type a long time or type sitting at a desk. I can’t hold a phone for a long period of time. I can’t write with a pen, etc. Can’t, can’t, can’t. I am finding myself actually being more fragile with my arms, so that they “last” longer! hehe I look forward to your response! Thanks!
My injury happened when I was about 12 years old I was throwing a football and all of a sudden I felt this intense pain and pop in my elbow it like locked up on me and I did not have any flexibiltty in it. Now im 18 years old and my arm still pops everytime i try to extend it its a big weakness, but it something I just have to deal with I went to my doctor and he said this injury is rare and the only thing he can do is get the radial head excised when could have its risk like immobilty of the arm it really sucks and I dont understand why it happened or what to do
Dr Arun Pal Singh Reply:
October 9th, 2009 at 1:54 pm
@Mitch Kleiderman,
I do not think this is the right place for this comment. It should either be under fractures otr elbow injuries.
Anyway please mention your diagnosis and if possible send an image of your xray by email.
I have congenital dislocation of the radial head on both arms. It was first discovered when I was 5, and my grandparents noticed that I never straightened out my arms. My right arms could not move past about 90 degrees (a perfect right angle), and my left arm could move a little bit farther. We had x-rays done to confirm, and at the time the doctor stated that there was nothing to be done until my joints were fully developed. I lived my life like a normal child, and I attempted gymnastics, dance, sports, etc. to my best ability. Of course there were times that upset me, because I was never good at gymnastics because no one knew how to help me with certain moves that you need straight arms for, and dance I loved, but knew I always looked a little off. Sports were always fun I did track for 4 years, soccer when I was little and my elbows never seemed to hinder me from that. Cheerleading was hard for me, when I was little I always wanted to be a cheerleader, so when I got to the try outs for High school, and talked to the coach about my arms, she was more or less snobby about it and told me not to waste my time trying out. Even though I was very flexible from dance, she didn’t even want to take the time to see what I could and could not do.
Throughout my life, I hated to wear t-shirts to school because of the way my elbows looked, and people would make the worst comments to me. The boney look of my elbows is very prominent especially because I am small boned to begin with. When I was 17 years old I decided to have reconstructive surgery on my elbows. After researching doctors, I found one in my area who was amazing. When my parents and I set up an initial visit with him and he explained what he could do. He said that the surgeries would be done one at a time, beginning with which ever elbow I wanted, and he stated that my elbows would never be fully fixed and I would never be able to fully straighten out my arms. Then he proceeded to explain how the procedure would be done on my right elbow, the worst one. There was extra skin, webbing, that would be graphed downs, and a new muscle and tendons would be created, and the protruding bone would be shaved down. He even explained the looks of the scars. The webbing on my right arm prevented my arm from straightening out further. On my right arm I would have a lightning bolt looking scar where the webbed skin was and just a straight line on the exterior part of the elbow where the bone would be shaved. He said that I would gain a further ability to straighten my arm on the right side, but the left side I would not because the skin had formed properly and the surgery done to the left would just be to make the joint not look so protruding.
My first initial reacting was disappointed because I had always wanted straight arms. That December I had my surgery on my right arm. It was a long rough process of physical therapy and recovery. I did physical therapy to help straighten out my arm, and I even gained motion my wrist that I have never had before. In addition to the physical therapy, I did scar therapy to help prevent redness or scar tissue build up, which would have hindered some movement. After 2 months of healing, I decided that I would not do my left arms, since the surgery would mostly be cosmetic anyways. But getting my elbow operated on was the best decision I have ever made. My confidence sky rocketed.
My parents were nervous about people asking me about my scars and how I would feel, but I don’t mind at all. I am very proud of it. Plus I think it is very cool to have a lightning bolt scar, or as some may say “Harry Potter” scar. I gained about 20 degrees in motion in my arms and I can twist my wrist with more ease.
Now I am 23 and no one really notices my scars and I am not afraid to show them off. I will never have straight arms, and of course I missed out on certain things and was never “perfect” at certain things, but I tried it all and I had great support. The only concerns I have for the future is arthritis, which to doctor said that I have a greater chance of getting.
My parents are not sure if I got this condition from genetics or a car accident my mom was in when she was pregnant with me. She thinks she remembers my great grandfather never straightening out his arms.
Hello:
I am 23 years old, and have known that I have congenital radial head dislocation in my right elbow. I believe it stops there, my left elbow is seemingly fine, but growing up I had severe pain in both knees. About five years ago, I dislocated my right shoulder as well; I came to find out that it was more prone to dislocation (which now pops out of the socket constantly, and I can’t afford arthroscopic shoulder surgery without insurance) because of the angles at which I have to move my arm to compensate for the inability to pronate or suppinate.
I have never let this condition affect my life; in fact, most people never notice it unless I tell them. I am an avid weight lifter, although I have to approach it very differently from most. Instead of lifting as much weight as I can, I do body-weight exercised like pull-ups and dips. I am in great shape and have exercised regularly for years, although working with my legs usually brings excruciating pain in my knees. So I don’t work out my legs very much anymore.
I have pain in my wrist and, of course, elbow and shoulder. I fear that eventually the pain will get worse and worse, but the stories here have made me feel a lot better about my future. I was always concerned that I would basically lose the use of my hand; while I suppose that it is still possible, it helps knowing that most people who have this are able to live life normally.
For those of you with children, the last thing you should do is discourage a fun, normal life. Let them play sports, let them do everyday activities, but make sure they know that they have to do these things in their own way. You can’t let it stop you, but you have to always be aware and conscious of the situation. if you fall down, know that you can’t catch yourself with that arm. I have broken my right wrist twice, once on a bicycle and once playing football; both times it healed, but I feel like the condition weakens the bones and makes them prone to fracture. Let your kids enjoy their lives, just do so conscientiously.
For the doctors on here: is the fact that I lift weights (not power-lifting mind you, within reason) making my bones and joints stronger or weaker? Will this hurt me or benefit me in the long run? I have always read that exercise makes your bones stronger, but I would assume that applies to normal bones. Any advice would be great!
Dr Arun Pal Singh Reply:
October 21st, 2009 at 2:59 pm
@Devin,
Your body would guide you what you can and cannot do.
You can exercise.
I am not aware of any data against it. It always helps to keep yourself fit.
I threw my arms up over my head to signal a touch down.my left arm felt like it hyper-extended,and caused severe pain and a loss of strength and range of motion.now it seems like my shoulder is not right anymore,as if it ‘s out of alignment.i had theraphy and my elbow is still crooked.one doctor told me it wasn’t too bad and i should live with it.i really would like to have my elbow straight (if possible) and maybe more of my strength back. Please advise me to whom i should see.
Thank you
Dr Arun Pal Singh Reply:
November 21st, 2009 at 3:06 pm
@mike,
I think you need to see an orthopedic surgeon.
Dear Dr. Singh my son Zachary suffered excessive traction at time of birth. As a result of this he suffered a broken left humerus, two head hematomas, and Erb’s Palsy or another name Brachial plexus to his right arm. He has undergone 3 surgeries for the plexus injury, a Neve graft, a Mod Quad and just recently a Triangle Tilt at age 8. The other two were done at 5 mos. and 15 mos.After this most recent surgery almost 6 mos. ago he experienced an uncomfortable popping in his right elbow and visited a local orthopaedic specialist who diagnosed him with Congenital radial head dislocation. To this i have many questions,how do they know for sure that it is congenital and not traumatic due to the traction at birth and other injuries suffered. Also could it be a result of the brachial plexus he had a dislocated shoulder due to the plexus doesnt it stand to reason that the radial could stem from it to.could the injury have happened at birth, could it stem from brachial plexus or is it something he was born with?We have so many questions. Could you please shed some light on this injury for us!
Dr Arun Pal Singh Reply:
May 21st, 2010 at 8:13 am
@Amy Mccarter,
I do not think it can be differentiated but usually the traction at time of birth is usually not through the elbow.
However regardless of the cause the course of problem would remain similar.
Because the associated injuries make it a complex issue, please discuss with your treating doctor about future actions as he would be able to take into account the complete status of limb.
I am 46 years old and live in Australia, I have conjenital dislocation of both arms. I was diagnosed at the age of five and unfortunately my condition has only worsened. Reading all the comments here has been uplifting because I have never been able to find anyone with my condition. I have found that over the years the pain has increased and I now have osteo arthritis in the elbow joints. My hand muscles did not develop properly and I find that they are weakening. Opening jars, driving, etc. is just getting harder. I have raised three sons and would like to return to the workforce but take medication on a daily basis. All of them are codeine based, have tried oxycontin and such but they make me feel terrible and don’t really dull the pain. Sleeping is hard so i’m always tired and worried when my arms won’t work anymore. Some days are great and I think I can forget about it but just doing one thing like swimming or picking groceries up or driving a distance put me back to reality for several days. Yes modifying your lifestyle helps but how far do you modify? My doctors have told me I’m too young for a joint replacement and that they are rarely successful anyway. But some days the pain is so bad I can.t stand it anymore. Quality of life is the issue here and I just can’t find a doctor willing to do anything except give me painkillers.
I have gone over my x-rays and think that if you have more information that it may help in your answer. The x-ray report says that i have a dislocation of the radiohumeral joints. the radius is dislocated posteriorly. Deformity of the radial head and neck bilateraly. Subluxation of the ulnohumeral joint with deformity of the articular surface and degeneraive change bilateraly.
In the wrists there is congenital carpal fusion. fusion of the lunate and partial fusion of the scaphoid and trapezium.
Whew. Hope that helps in your advice to me. Regards, Ann.
Dr Arun Pal Singh Reply:
July 16th, 2010 at 8:23 am
@ann verbakel,
You should see an elbow surgeon or an orthopedic surgeon with preference for elbow. You have degenerated elbow joint and though have not examined you physically, the only option I can think is replacement.
Yes! There are issues involved in this surgery but you would need to discuss that with the one who is doing it frequently.
Ann V. – I would love to email you personally. I am 40 now and find myself in your exact position – we are twins! I look forward to hearing from you! Contact me at alkutch5[at]yahoo [dot] com if you would like to start up a dialogue. Lori
hi
ive had elbow replacement 5 weeks ago after a nasty fall that crushed my elbow. Ive been coping well with excercises suggested by the pt. However I seem to have no strength in the hand and this makes changing gears and driving difficult. How long before I am able to push and change gears?
Dr Arun Pal Singh Reply:
July 28th, 2010 at 5:09 pm
@janey singh,
It would take some time before you regain your strength and control. There is no definite answer though. The time varies with individuals.
You may talk with your doctor about it.
Hi Dr. Singh-
I was astounded to find this site. Thank you for providing this for those of us that suffer, often in silence, with something that most people don’t understand. It’s great to find people who know what I am going through!!
I am nearly 40 and I have congenital radial head dislocations in both elbows. It was discovered when I was around 8 and crashed my bike. The Dr. in my small home town had no idea what was wrong with my elbows and referred me to another Dr. That Dr. also didn’t know, but said that if I didn’t have it corrected by the time I was 18, my hands would be deformed. That scared me so badly, that I never really complained about the constant pain I endured while playing baseball, swimming, or lifting weights, and when I did, I was told to “suck it up…(you) just have “crooked” elbows…so what?”
When I was around 32, after much trouble with my wrists, shoulders, elbows, fingers, etc., I was finally able to see a specialist, who not only named it for me, but showed me that the 2 long bones are actually fused together in both elbows, and there is an extra bit at the end of each. I have limited mobility, as I can not put my palms out flat and my right elbow pops when quickly straightened. I have constant pain, frequent numbness in my pinkie and ring fingers, and tasks such as typing on a lap top, quickly become excruciating. People often think me lazy, because I don’t jump up to unload groceries, or move furniture and I am tired of people telling me to get over it. No one understand what it feels like!! I once had a cortisone shot in my left elbow, that helped for a while, but as I age, the pain gets worse and worse.
The specialist told me that I could have the excess bit excised and that should alleviate the numbness (apparently, the nerve goes right between the bones) and possible give me back some mobility. Unfortunately, I no longer have the insurance to cover that specialist and my last Dr. told me it would be considered a “cosmetic” procedure.
I have lived with pain my whole life, but again, as I grow older, it’s affecting my shoulders, and wrists as well. I don’t want to get addicted to pain killers…but there is only so much I can take.
To any parent out there with a child with this condition, please consider getting it fixed if you can. It’s great that some people can learn to live with it and adapt to it, but I missed out on my chance to get it corrected as a child, due to fear, and now I live with the pain.
Thank you again to my fellow “crooked elbow” people..it’s great to know I’m not alone.
Hi Dr Singh
i came across this site as i was carrying out research, my brother was born with both his elbows bent, he couldnt straighten them out, they are shaped more or less like a boomer rang. he is in his twenties now but as a child he was taken for surgery but doctors said he was too young. later on in his teens he did some physio-therapy.
his hands are shorter than normal and quite bent, he experiences pains especially when he tries to lift heavy objects. x rays show that his hinge joint cannot straighten. please can you give me a medical term for his condition and treatment, i want to pay for any medical treatment he can get but i was too young to know the full diagnosis when the doctors made it back then. thank you
Dr Arun Pal Singh Reply:
August 13th, 2010 at 3:54 pm
@hauwa,
There could be many possibilities which would result in bent elbows.
I think you should get him examined and get diagnosed.
My son was diagnosed w/ congenital radial head dislocation at the age of 8 when he fell off of a trampoline and was thought to have broken the elbow, but was told the prominence was not due to the fall, but was congenital so he was sent to a pediatric orthopedic specialist. He was followed by him every two years to xray and look at how the elbow had changed over the time. No surgery until he was “finished growing”. He played football one year in 8th grade and had so much pain in the wrist of the same arm that it was not worth the pain, so he quit and never played again. He had surgery at the age of 15 finally and the appearance is so much better as the bone was sticking out about 3 inches by this time, however that arm is significantly shorter than the other arm now, quite a lot of bone was cut off. He has been very happy w/ this surgery even though he only regained a very small amount of rotation in the elbow. He is now 19 and is having more and more pain in the wrist to the point that he is unsure of what he can do as a career because of concerns of not being able to use it fully. Cosmetically, the elbow looks good, but he is having too much pain in the wrist that he can do nothing about. Does anyone have a similar story or a suggestion of what he can do to alleviate this pain?
Thank you for any comments.
Dr Arun Pal Singh Reply:
October 15th, 2010 at 4:01 pm
@T. Bumgart,
Most likely he has proximal migration of the radius bone. Did you discuss with your doctor?
He was released a few weeks after the procedure. The physician is 3 hours away from us so we have not seen him again. He told us he would have wrist pain from time to time. He saw a local orthopedic dr about the wrist pain before the surgery but when he saw his elbow he said the elbow is the problem not the wrist. So, we just worried about the elbow at that time. We had never read up on anything about the congenital radial head dislocation, so didn’t know what to expect in the future. Now that I have read up on it, the wrist pain is concerning for the future. Would surgery be something he would need possibly to help this? He had wrapped it before w/ activity but he doesn’t want to wrap his wrist on a constant basis. He also has a splint, which he doesn’t want to wear all the time either. He may have to. ? I will contact a local orthopedic if there is anything that can be done to alleviate the pain or is this just something he will not be able to do anything about?
Thank you for comments.
Dr Arun Pal Singh Reply:
October 29th, 2010 at 9:32 pm
@T. Bumgart,
He needs to be assessed if a procedure would help him. Splint and medications would help to certain extent but if the pain is affecting activities of daily living, it is worthwhile to consider a procedure if he is a suitable candidate for that.
Hi Dr. Singh,
I am so glad to have come across your forum! I think this might be the condition that I have in my left elbow (although mine doesn’t seem to be as severe as most people have described here).
Ten years ago, when I was 14 years old, I slipped down a steep path and fell hard on my elbows. I immediately began feeling a strange tingling sensation in my left elbow…but even more startling, I noticed that I couldn’t fully straighten my left arm! When I went to the orthopedics, my x-ray was disturbing…my left elbow joint was visibly deformed. The doctors said that I must have sustained a traumatic injury to the bone growth plates when I was very young. This seemed ridiculous, though…I mean, wouldn’t I have complained? My mom reasons that I was probably born with it, although we cannot find definite proof either way in any childhood photographs. The doctors said that I could undergo corrective surgery, but they did not recommend it. So we left it go.
Over the years, my elbow did not bother me at all. I felt only the slightest discomfort when I had to carry something very heavy in my left arm…and this would always disappear quickly. Most people did not notice my deformity, and I would only be reminded of it when I stretched my arms out in front of me or touched the bump of the radial head…or if I needed to face my left palm completely up (it pretty much gets there, but strain is involved). I didn’t even get any pain or discomfort from lifting heavy weights ever since I was 19.
That is…until recently. This summer, I upped my lifting regime, added new exercises, and increased barbell weight. About a month ago, I heard/felt crepitation in my left elbow while lifting. I immediately stopped, and over the course of a week, I got pain and crepitation that seems to match the symptoms of tendonitis (golfer’s and tennis elbow)…as well as pain in my wrist and forearm. The pain has mostly decreased, but the crepitation is the same. I’m treating it with rest and a hand-held ultrasound device. This injury brought my deformity to mind. I checked out my old x-rays and compared them to photos online. The closest thing that matches is congenital dislocation of the radial head.
I just graduated with my master’s degree, and I am looking for a job, so I do not have health insurance at the moment. So, I’m wondering if you would be willing to check out my x-rays for an informal diagnosis? (I plan on getting another x-ray once I get health insurance…and consultation with an orthopedic doctor face-to-face). Also, does tendonitis seem like a plausible injury due to improper weight-lifting form (because of the deformity)…and will the crepitation eventually disappear?
Thanks,
Jason
Dr Arun Pal Singh Reply:
November 11th, 2010 at 12:34 pm
@Jason,
Sure! I can have a look at the xrays.
There could be many reasons for pain aprt from tendoinits.
Improperly positioned joint is a stress on the surrounding tissue and any tissue could be responsible for the pain.
Hello Dr. Singh,
I am very glad that this forum exists!
My whole life I have had a dislocated elbow and was always looking forward to the day it would be fixed. When I was a baby I had surgery to try and fix my right arm but both surgeries were unsuccessful. From that point on I had been told that I will be able to fix it when I am done growing. I am now 20 years old and still have a dislocated elbow. I am losing flexibility in my arm, i’d say I can extend about 45 degrees which is uncomfortable and annoying to me. I have always played sports and can lift weights, I am pretty strong but I cannot build muscle well around my biceps and triceps because of my poor extension. I do not mean to sound bitter but it has been hard for me to realize that I may never actually have a normal looking right arm.
Is there any way the elbow joint can be completely removed and replaced with some sort of fake elbow or device? I understand that trying to fix my arm could decrease flexibility more and have other repercussions but I would be a much happier person with two good arms.
Thanks,
Will
Dr Arun Pal Singh Reply:
December 14th, 2010 at 7:38 pm
@Will,
I do not think replacement is justified in your case. Moreover the replacement does not address the joint in question rather it is the other joint which is replaced.
Im sixteen, and i have the dislocation in both arms, and we first noticed it when i was about ten. since then, i have lost a large amount of movement, and recently, my left arm has been having severe shooting. over the course of 2 weeks, it has gotten considerably worse. i was wondering if there was a nerve that can pinch in between the bones maybe, or if there is an explaination for that? i dont know if it matters, but i am right handed, and dont have these pains. thanks
Dr Arun Pal Singh Reply:
February 22nd, 2011 at 7:35 am
@daniel lower,
Please see a doctor and get a radiograph if it is possible.
Hi Dr. Singh,
After reading all these postings I decided that I need to see if you could help me and my daughter. She was diagnosed with congential dislocation of the left radiual head when she was about 8 months old. We started going to the Shriners Hospital at this point. She is now 15 years old and we are still left with more questions than answers! My daughter has full range of motion and her wrist was formed normal so we have just watched it over the years like the doctors said to do. She has had pain from time-to-time but nothing that has limited anything that she has wanted to do and the only thing we’ve found that she can’t do, so far, has been push ups. About 3 months ago she started fussing with more pain than normal in a year with her arm. She says it runs up to her shoulder everyday and during her band camp, when she played her clairnet more, it was really killing her.
My daughter wants to go to college at University of Tennessee or University of Vanderbilt because she wants to become a surgeon. For her to go to UT she may have to go on a band scholarship. She wanted to go to the Airforce Academy, but found out that chances are they would not take her because of her arm. The Shriners said they could not do anything to help her unless we chose to have surgery. I do not what to ruin my daughters dream of becoming a surgeon because I chose to make her have surgery on her arm. What are the other options for us to help make the pain stop for her? She is at the point now that her arm hurts her all the time not just when she puts weight on it. Please help!!!
Dr Arun Pal Singh Reply:
February 22nd, 2011 at 1:08 pm
@Tracie McCloud,
Things are quite complex in your case.
With congenital dislocation of radius our treatment options are limited.
Anti-inflammatory drugs, local measures like heat and physiotherapy are the first line of treatment.
A decrease in pain producing activity is wanted, especially those activities where pronation and supination activities are repeatedly done. These two movements are at proximal radioulnar joint, therefore they cause maximum stress on dislocated head.
In her age, surgery is an option and would reduce pain.
Surgery involves resection of the radial head and is indicated for pain.
Try reducing the activities that produce pain.
To get operated or not is the decision that has to be taken by you and your daughter. If nothing else works, it is the final available option.
Do discuss it with your treating doctor and understand the effect, limitations and other effects of surgery.
I hope that helps.