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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Hand injury, week 23+

“USE  IT  OR  LOSE  IT!”   is the advice from doctors and physio.

My hand needs to undergo some normal “life” now, mild loads yes, but it has to start moving, moving, moving. In fact I have been told to wear a glove on my other hand to force the issue. For me this essentially boils down to including two things which would ordinarily bring me so much joy, currently make me cringe.

i. I was given the OK to drive again.

…scary stuff! Mine is a drivers car, with a 6-speed manual. My first attempt was 3 weeks ago when I tried to reverse out of the drive way. A mild lightning bolt of pain shot through my thumb and I turned off the ignition and I did some safer like watch “The fast and the furious” (with a cup of tea).   I awaited another 2 weeks and re-tried. Interestingly enough, this was after a few sessions of increased hand strength from further physio exercises,… and it showed.  Not only could I get out of the driveway, I was off down the road and did a smallish loop of the surrounds. The first drive did make my hand/wrist ache a bit. The rotations, mild as they were, were being re-learnt again and I guess it will take time. I’ve driven now 2 or 3 times since, and each time the pain is lessened. I really feel this is very much helping in an alternative physio sense.

ii.  on your bike!

..say what!  Yes, you heard it. But with limitations;Low-profile-wrist-7

  • padded gloves and brace..always,
  • full suspension mountain bike.
  • bike paths only, NO mountain biking!

Fair enough I thought, I couldn’t imagine mountain biking anyway, for some time. Cycling again, hmmm. OK, this will be hard to appreciate by readers, but even walking on the hard surfaced road that I had been doing initially made me feel sick. Seriously. I had bad flashbacks of my event back in May 2013. The hardness of road, the pain. I cringed as I just wrote that…..

To ride again was going to muster a lot of confidence. My first try a day or two ago was essentially fine. But I was very tentative and went slow. At times I felt it a bit upsetting/disturbing. The gloves I was using and position of the Ergon grips did make my hand ache somewhat. I’ve tried better padded gloves now and altered the angle of the Ergons to improve the brace contact and it’s much better. Two or three small rides since have lifted my confidence but I’m riding slowly with a very defense-minded attitude. 

On reflection, it’s probably the driving that hurts more than riding; during riding, the brace and fact the hand stays relatively flat is probably why.

Psychologically, I feel that the driving and riding in its limited forms has really lifted my confidence. I’m due to hit work again next week and this confidence-lift has helped me.

I’m still blessed/burdened by the time my physio exercises takes me each day. I’d estimate approximately 4-5 hours all up.  I am a bit concerned about fitting them into a working life as they are not to be ignored. I can expect some strange stares as I go through the motions at my desk; nothing to see here guys, just physio… nothing else lol.

Hand injury, 21st week

So I had an important appointment with the hand surgeon today, primarily to get a feel for the progress of the scaphoid bone.

An x-ray taken an hour before the appointment told him that the bone had healed somewhat more since my last x-ray (some months ago). Parts of the scaphoid in the x-ray that were white, were now black which indicates blood is progressing further into the bone; a really good sign. Importantly it still has healing time to go, so the benefits have even greater potential over the next few months. At my next appointment in 3 months time I will have a CT scan which will reveal the exact nature and extent of the blood flow in the bone. This will effectuate a period of 8 months since the accident which is a good period of time to assess a scaphoid bone.

Unfortunately I can only get a poor quality copy of the x-ray to show:

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So with this positive news, coupled with my increased mobility and hand strength, he expressed he was really quite surprised how well I was progressing. Also on hand at this appointment was the surgeon who had operated on me at the time of the accident. He was very happy to see me and was visually shocked at how well it was going as he’s never seen such a traumatic hand injury prior to me.

So all in all, I’m very happy and will continue my physio, cardio and eating well in earnest.