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Hand/wrist surgery experiences and or opinions
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By MojoMonkey
Oct 22, 2013
Just over a month ago I hurt my wrist climbing. I scared myself on a climb, clamped down to hang on while I got some gear in, heard a pop in my right wrist, then pain. My wrist doesn't hurt much now (mainly bending backwards, like if I were doing a pushup). An MRI last week shows:
1. Tear of the ulnar styloid attachment of the peripheral TFCC
2. Mild subluxation of the extensor carpi ulnaris tendon at the ulnar groove, consistent with extrinsic ulnar ligament tear
3. Mild tenosynovitis of the 2nd and 3rd extensor compartments
4. Arthographic findings suggesting a tear of the scaphoid trapezial ligament at the radial side of the wrist

My orthopedic doc suggests speaking with a wrist specialist / surgeon next.

Anybody out there have a similar injury? What was the outcome? Any recommendations on what to find out when I meet the next doctor?

And on that note - anybody have any good recommendations for hand specialists around the King of Prussia, PA area?

Or generally, is this pretty routine and getting back to 100% (I hope?) should be a normal procedure for any decent specialist? I wondered if a doctor with some familiarity with climbers would be a plus, or I should just go with anyone my ortho recommends that has convenient locations?

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By Chad Volk
From Boulder, CO
Oct 22, 2013
Here's another wrist injury thread that might answer some of your questions: Wrist Injury

While it doesn't deal with your same injury, you might find it helpful.

Definitely see a wrist specialist!

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By Aerili
From Salt Lake City, UT
Oct 22, 2013
Get down from there! <br /> <br />May 2013 <br />Photo by Duc
I've had a central TFCC tear and accompanying surgery (since conservative treatment failed). Your tear is more complicated since it's peripheral, plus you have a lot of other sprains and damage I did not. It is imperative you speak with a hand and wrist surgeon. Maybe even two.

Also look into buying a wrist widget brace in the meantime. They may try long-arm casting you later.

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By MojoMonkey
Oct 23, 2013
Aerili wrote:
I've had a central TFCC tear and accompanying surgery (since conservative treatment failed). Your tear is more complicated since it's peripheral, plus you have a lot of other sprains and damage I did not. It is imperative you speak with a hand and wrist surgeon. Maybe even two. Also look into buying a wrist widget brace in the meantime. They may try long-arm casting you later.


I've been wearing this some, but not religiously. Mainly at night so I don't roll on it oddly. I can't type/mouse with it well so I've been taking it off at work. Maybe I should be more diligent?

It really hasn't hurt me too much. I can feel the tendon move out of place sometimes, which is extra creepy now that I know what is going on. I haven't climbed since but have been biking a lot in the meantime, since it didn't really hurt (sometimes discomfort while shifting). I was wrapping my hand/wrist with a neoprene wrap for support. I initially asked the ortho about cycling when climbing was out and she seemed to be fine with me using pain as a guide and not to overdo it. Overdo is relative, though.

Cycling really does put any sharp stresses on it, though I am supporting some weight with it the whole ride... Bad idea?

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By JSH
Administrator
Oct 23, 2013
JSH @ home <br /> <br />photo courtesy of Gabe Ostriker
Here's another TFCC thread ...

I had the surgery. It's bombproof, even now. Rest of me, not so much, but the wrist is doing great.

Call the Philadelphia Orchestra and ask their personnel manager who they recommend for hand/wrist surgeons.

I'd guess that you're OK (road) cycling using pain as guide. Doubt you can tear it up much worse, and the surgery should provide a comprehensive fix. Best wishes!

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By MojoMonkey
Oct 23, 2013
JSH wrote:
Here's another TFCC thread ... I had the surgery. It's bombproof, even now. Rest of me, not so much, but the wrist is doing great. Call the Philadelphia Orchestra and ask their personnel manager who they recommend for hand/wrist surgeons. I'd guess that you're OK (road) cycling using pain as guide. Doubt you can tear it up much worse, and the surgery should provide a comprehensive fix. Best wishes!


Good thread to read, thanks! Sounds like I am in a pretty similar condition as you were. I also have previously broken my wrist (3 of the bones in there, not sure which, about 13 years ago in a kickball game...)

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By Aerili
From Salt Lake City, UT
Oct 23, 2013
Get down from there! <br /> <br />May 2013 <br />Photo by Duc
MojoMonkey wrote:
I've been wearing this some, but not religiously. Mainly at night so I don't roll on it oddly. I can't type/mouse with it well so I've been taking it off at work. Maybe I should be more diligent?


Again, look up the Wrist Widget. It is different and should be worn in the daytime. See a doc sooner than later. With peripheral tears, time matters iirc.

You are lucky you don't have much pain. I had crazy pain for months, so bad I really couldn't use that arm for almost anything. Totally handicapped.

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By MojoMonkey
Oct 23, 2013
Aerili wrote:
Again, look up the Wrist Widget. It is different and should be worn in the daytime. See a doc sooner than later. With peripheral tears, time matters iirc. You are lucky you don't have much pain. I had crazy pain for months, so bad I really couldn't use that arm for almost anything. Totally handicapped.


Oops, I didn't realize "wrist widget" was a brand / name in your first post.

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By MojoMonkey
Oct 28, 2013
Guess I'll keep this updated as I go in case someone else is ever in a similar condition.

Met with another Dr this morning. Two actually - I believe one was apprenticing the one I had an appointment with. Seemed to be good news. Both seemed surprise at my lack of pain through a number of tests, given the MRI report results posted above. Aside from the pain I feel bending my wrist back and applying pressure, as in a push up, there was really only one other test that produced notable pain.

From a few rounds of tests and going back to the MRIs, their opinion was that the TFCC tear was not as bad as the report concluded, that MRIs aren't perfect at diagnosing tears - sometimes they appear worse than they are, sometimes better. He felt that the main concern was a ligament between my scaphoid and lunate bones. He also felt that I was healing well and that more time and immobilization to let scar tissue develop would be the best course.

He didn't like the brace I was wearing (linked above) because it allowed thumb movement. I was fit for a new molded plastic brace that immobilizes my thumb. He wants me to wear it as much as possible and come back in 4-6 weeks to review. I was allowed to continue cycling as long as it didn't hurt, but still refrain from climbing until at least my next appointment.

Sounds like he expects a good recovery with conservative measures. If things are not improved by my next visit, his next tactic is going in (at 4 different points) with a small camera to see what tears there may be. He mentioned the possibility of scraping to clean up areas, and possible application of heat to tighten up ligament(s).

Sounds like good news to me at this point - though I'd be curious whether those with relevant medical knowledge think this sounds like an appropriate approach. I am still considering getting a second opinion. (I contacted a climber and hand/wrist specialist a friend recommended but have not heard back - I may try again).

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By jeff lebowski
Oct 28, 2013
There was a post about scapho-lunate disassociation just a few weeks ago. You might read that post & contact the author if you want to compare notes. I had a scapho-lunate ligament sprain a few years ago and healed fine with conservative treatment. Although I ended up wearing a brace full time for 3 months and during activity for another 4 months. I didn't attempt any climbing until I could lift a gallon of milk without pain. I was very conservative with my rehab because according to the literature the surgical options are really not that great. I would definitely not agree to the thermal shrinking procedure without doing some serious research first. There's a good reason it's no longer done on the acl.

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By JSH
Administrator
Oct 29, 2013
JSH @ home <br /> <br />photo courtesy of Gabe Ostriker
I think with such a recent injury (I know, it feels like forever, but still) it makes a lot of sense to immobilize and be conservative. Surgery almost always involves some sort of compromise, scar tissue, possible worse outcome, etc. I only had surgery after 6 or 8 months or so; it's not something to jump to do, for sure.

Keep us posted!

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By matt snyder
Oct 29, 2013
check your PM.

Dr. Culp did a phenomenal job on my broken unit.

www.handcenters.com/index.php/our-physicians/dr-4.html

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By Doug Lintz
From Kearney, NE
Oct 29, 2013
Destroyer of popcorn
Your list of findings from your MRI are similar to what I had several years ago, along with a non-displaced fracture of the distal ulna. I injured mine slipping off a strenuous mantle move.

I was referred to a wrist specialist who was ready to repair all the torn ligaments/complex with arthroscopic surgery. I asked him to delay the surgery a few weeks while I decided if it was worth it. In that time this particular doctor left the orthopedic group and moved back to the East Coast. Their other wrist surgeon suggested intense physical therapy for several months to see if surgery could be avoided. I strictly followed my PT regime and ended up not haveing the surgery. It's been several years now and I haven't had any issues with it. At this point I have about 95% strength and flexibility compared to pre-injury. I can live with that.

Good luck with whatever you choose to do.

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By MojoMonkey
Oct 30, 2013
matt snyder wrote:
check your PM.


If this is to me - I never received a message...

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By MojoMonkey
Nov 26, 2013
First, thanks to those chipping in with info and experiences.

I had a follow up yesterday after a month in the plastic brace that immobilized wrist and thumb. I wore it pretty regularly, as instructed - at night, and as much of the day as possible. I'd take it off for running and cycling, though I'd use a soft strap for some support while cycling. When I did take the brace off, my wrist seemed to hurt more in the specific positions that had been causing pain. I asked if that was expected from immobilization, and a good/bad/neutral sign. He said it was neutral, expected.

After a battery of testing/examination of my wrist, the thumb side didn't seem to hurt as much as his prodding/rotations last time. The area near the TFCC seemed on par pain-wise with last time.

There was also the MRI mention of mild subluxation of the extensor carpi ulnaris tendon. I asked about that and he checked it again, detecting the mentioned movement. However, he checked my other wrist and found the movement to be similar and that that may just be how I'm built and not an issue to worry about.

He felt that I was making progress and should be able to get back to my prior status without surgery. He recommended swapping the hard brace for a soft one. I should wear this one as much as convenient, and he also provided a wrist widget (Aerili wins!) for support when the larger brace was not feasible (suggested for typing at work).

He said he could go in with a scope and clean up as mentioned above (scraping and possibly heat to shrink), but didn't think there was any reason to at this point. He did want to try a steroid shot. Because there were the two main suspect areas (TFCC and scaphoid-lunate) he wanted to try the steroid in one of the two locations to see if that addressed the pain or not, possibly trying the other next follow up if it did not help. He was still leaning towards the scaphoid-lunate area as the bigger concern, but since I felt more pain near the TFCC he injected that location. During injection he said something to the effect that there was no bulging elsewhere from it to indicate the fluid leaking through, which was apparently good . I didn't think of it at the time to ask, but I'm not sure if good means "not torn" even if that hints that this area was not the prime issue. There was some discomfort in my wrist later that afternoon/evening, but nothing bad and really only worth noting when the brace was off.

I have a follow up in 6 weeks. I can work in activity using pain as a guide, though climbing is explicitly out. Darn.

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By MojoMonkey
Jan 15, 2014
I don't think the shot did anything for me. It was sore in that area for the next day (two?) but I didn't feel like there was a change in pain level. A few days later I slipped on my iced over driveway and landed using that wrist to break my fall. It bent back - the position that hurts most - and ached a few days after.

On to the good news. Just under two weeks ago I had my follow up visit. The doctor said I could stop using he brace (though use it if I felt I needed it or to ween down). He also gave me the thumbs up to ease back into climbing. I've climbed 3 times now, starting at a very easy level with only a few climbs. I haven't had any new pain on subsequent days, and feel like I am getting better range of motion with less discomfort.

I haven't tried yoga yet since bending my wrist at a 90 degree angle (like in a pushup position) still hurts and I'm not sure I'd make it through a class.

I'm supposed to continue increasing use of my wrist and check back in if things do not continue to improve or even get worse. Fairly positive.

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