Wrist fusion + 2 months

A temporary cast was worn for 2 months and now removed; my hand looks like this. Only a 5″ scar gives a hint of the serious titanium scaffolding that lies beneath….

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My hand feels pretty good at the moment. There is hardly any pain, just some minor nerve issues as it heals. I can easily make a fist, stretch the fingers as per normal, although the thumb is not as flexible as the other hand, but any difference is minor. There is a faint numbness on the top of the hand still, but it decreases daily. Being able to now wake up of a morning without that incessant wrist pain is amazing. I’m not sure what my future limitations may be, but to alleviate that pain is totally worthwhile. The measured strength in my right (dominant) hand is 48kg. Measured at 2-months, my healing left is only 16kg. The surgeon expects it might get to about 32kg as a maximum down the track.

Top (and side) x-rays at 2-months are as follows:

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The surgeon was quite happy with the look and feeling of my hand; certainly no evidence of significant issues. At this stage I have permission to increase light weights for stressing the bones to aid in development and healing. Also, driving a manual car and riding a bike on flat roads/paths. If the bone fusion improves in another 2 months from now, the surgeon will be happy for me to mountain bike once more.

Current exercises for me to undertake over the next 2 months include a stress ball to squeeze, a 1.5kg dumbbell to use for side lifts, shoulder presses and bent over rows. It’s very light, but the emphasis at this stage is low weight/high reps. There is also the use of the gyroscopic ball I referenced in my previous physio exercises after the initial crash. All of this is to aid in the atrophy in my arm/hand, boost strength and co-ordination.

I should point out to readers of this that I really expected my hand to feel quite unusual. I have to say that even at this stage it really doesn’t. For people who may consider the need for such an operation; don’t read into the stories about how weird and painful it is. If you are in pain, this is a godsend and there’s very little you can’t do. Yes, there is always the risk of it not all going to plan but the success rate is very high.

Expect an update at the end of April 2016…..

Wrist fusion, day 0

During the October of 2015, two things came to my awareness that affected my (already compromised) wrist in significant ways. Firstly, the winter that had just passed, while milder than average, had afforded me serious grief in my wrist in a general sense. Secondly, the regular mountain biking I had been undertaking each weekend had been noticeably more painful during the 3 months prior. Because of these issues, and to get to the point; I decided at this time to opt for a full wrist fusion. Initially I planned for April 2016, but as riding was becoming so painful, there was no real point in delaying. I therefore brought the date forward to be asap, which turned out to be early December 2015.

I was due for surgery on the 5th December 2015, but my specialist wanted to see me the day prior. A current x-ray was requested for this day and it confirmed my aforementioned grief. The x-ray (see below) showed two things of note; (i) the scaphoid bone was of mixed quality and (ii) it was impinging directly on the radius. The constant contact between the bones with severe lack of protective cartilage (due to initial injury 19th May 2013) revealed a severe onset of arthritis at the joint. While nasty news, it at least confirmed the need for a full wrist fusion.

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A full wrist fusion (wrist arthrodesis) is a tried and true method that minimises pain by fixing the bones at the joint which by definition arrests all motion at the wrist joint. Thankfully it was my left hand which is not my dominant hand. Doctors perform the wrist fusion in  a variety of different ways. My specialist combined two techniques simultaneously:

  1. A proximal row carpectomy (PRC)
  2. Wrist fusion using a standard 9-screw plate with a 10 degree upright bend at the hand to the arm.

A PRC can actually be done it’s own right with no fusion. But the two combined methods have shown to be very successful. In a PRC, the scaphoid, lunate and triquetral bones which are based at the radius/ulna are removed, ground to a paste and used a graft/filler to complete the wrist fusion. This shortens the wrist by 1-2cm but importantly, does not require an ancillary bone graft (say from the hip) which can end up causing more grief than the original injury. Of course this will always be a personal choice, but my proximal bones were compromised anyway and it seemed a clever way to do it. As an aside I know a few friends with horror tales of bone grafts and I didn’t want to add to an already nasty injury in the interests keeping myself together; physically and psychologically.

Fast forward to the next day and I was loaded up with a lovely afternoon cocktail from the anaesthetist Daniel. The supposed 2 hour operation actually took 5 hours in reality. I awoke to a vague discussion with my specialist and got a “yes, it went well” and also a very tired and concerned girlfriend. I had been given a full arm block so I was not in pain for a good few hours after surgery and then it wore off…

When the pain was starting to get outrageous I started using the bedside ‘press-me-for-morphine’ joystick. Not sure why but it actually didn’t really help. I would give the pain an 8 (out of 10) on this first day. By way of contrast, 30 minutes after my initial crash in 2013, the pain was absolutely 10 (out of 10). The first three days were 8 out of 10 pain-wise and I took a cocktail of Endone, Panadeine Forte, Panadol Osteo and Neurofen. After the 4th day, my pain dropped to 7 and then 6 by the end of a full week and I restricted my drugs to Panadol Osteo and Neurofen.

The following three images show my hand after surgery, mid and end of week. The puffing reduced midweek, but the bruising increased.

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Hand injury, week 98+

Stitches out at last, but one more day covered up until I can get hand wet again.

Looks a sorry sight, but rest assured it feels a lot worse than that 😉

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There’s small but noticeable raised bump where the bones have re-positioned themselves. It may decrease in a size due to decreasing swelling, but I think this will be a “feature” of my wrist now.

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From here, it’s a case of stretching and encouraging safe mobility ranges. I need to work on a lot of hand and wrist strengthening too. Back to low weight dumbbells!

Hand injury, week 97+

Summer is over and doesn’t my hand feel it. The cooler months ramp up pain levels, particularly where Canberra winters are concerned. To keep it as pain free as I can, I do important things and recommend them highly:

1. Health supplements

i. Glucosamine with Chondroitin

The combination of the two is very important as studies has shown that glucosamine (only) is marginally better than placebo.  The combination above has shown to offer relief.

Adult dosage: 2 tablets per day

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ii. Fish oil

Used for many ailments, but in the case of joint health the dosage required is greatest. Studies has shown that 2.7g of Omega-3 is optimal for joint health where arthritis is concerned.

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Adult dosage: Box suggests “5 tablets, TWICE per day” (for joint health). Actually 9 total tablets will give 2.7g, which is what I am doing.

2. Wax bath

Fantastic temporary relief for a sore hand on a cold day. Well worth the money. Feels particularly helpful after a bike ride.

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Hand injury, week 96+

I opted to have the screw removed from scaphoid as I was noticing acute pain in that specific area. I had the operation on the 27th March 2015, and unwisely, elected to have it out with local anesthetic, not general anesthetic. Being awake for this ideal was not optimal, but we were unfortunately pressed for time for a appointment and having general anesthetic would have made this impossible. It’s hard to unsee something like this and I cringe occasionally at flashbacks. As readers if this blog will know, my wrist’s flexion is poor. Yet to get access to the scaphoid my wrist needed serious flexion to obtain access. So, pumped up with a (surprisingly painful) load of local anesthetic, the doc made his first cut…. A serious amount of cutting followed and wrist manipulations that caused a lot of bone cracking, nerve twinges and me wandering what the hell I was doing awake for this. Locating the exact position of the screw required in-situ x-rays. Took some time, but it was found. An electric screwdriver was used to extract it and I felt the torque it had on the bone as it pressed against the others. Acutrak-2-Family_0 Charming experience. Another 10 minutes and I was stitched up and released into the world outside the hospital. Was told it wouldn’t hurt too much afterwards. Well, that was a one-way joke. Loaded up on Endone only to feel nauseous and pathetic pain-targeting. I switched to Panadeine Forte (current) and am hoping pain subsides soon. Anticipate a follow up to this in 10 days time or so when the stitches are removed.

Hand injury, week 87+

This update represent a 12 month follow-up from my previous appointment back in Jan 2014.

The good news is that my scaphoid is no worse than before, and possibly marginally improved if anything. A bit of lesser bad news was that the capitate bone had displaced itself and possibly was becoming arthritic at the point of contact with the scaphoid/lunate. But in the scheme of things, this is minor.

The more significant bad news is that the the distance between the carpal bones that I damaged and the radius has halved. In the CT Scan image you can see how close the scaphoid is to the radius. Actually, the screw is making contact with the radius. There are two interpretations of this:

  1. The cartilage at the wrist joint would have undergone trauma and some time would have been required for it to settle down. Now if it had settled down prior to the image captured 12 months ago then the halving of this distance should be taken as a negative. This means that the area is progressing towards arthritis; but how soon is anyone’s guess.
  2. However if the cartilage had not settled down prior to the image captured 12 months ago then the normal distance was not measured at the time. If so, this is more positive news. That is the measured distance today may be closer to normal and it is not accelerating to arthritis.

Only time will tell which is the case.

My hands extension/flexion is currently something like 30%/50%. If these measures decrease significantly to say 10% each, OR, pain increases dramatically at the joint then I will need a full wrist fusion.

So all up, a bit of mixed news.

I can manage up to a 3hr mtb ride and then it’s time for a rest for the rest of the day. My hand also feels way better in Summer than Winter. Might have to retire in Vietnam….

My solution is to enjoy each day and ride as often (and safely) as I can as if it’s my last chance.

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