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Wrist Fusion
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By Christopher Wong
Dec 26, 2009

Happy Holidays Mt. Project Community!

Curious to know if anyone out there has had experience with fusing their wrist. I ask as if this is a simple, everyday procedure even though I know it's not.

I have had pain in my right wrist for the past 7 yrs or so, and as of late the most recent orthopedic surgeons I've visited have said that I most likely sustained a fracture in my wrist which has lead to arthritis (due to the wearing of cartilage between two of the bones which causes friction of the bones=very limited range of motion + pain).

Unfortunately my only options are to tolerate the pain and eventually have to operate or operate soon and have youth on my side (25 yrs old) to aid in recovery.

The operation has an 85% success rate and I've been told I can't have 100% pain relief but it will help. Struggling to make a solid decision. Basically I'm interested in hearing others stories related to surgery. It would be excellent if someone out their has had their wrist fused before and continues as an avid climber.

Thanks!


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By Chad Thomson
Dec 26, 2009

Hi Chris,

I'm sorry to hear about your wrist problem! Reading your post brought back a lot of bad memories. My wrist is not completely fused but I only have about a 35-40% range of motion. I had surgery on my wrist in July of 2002 for Kienbock's Disease (avascular necrosis of the Lunate). The surgery went well and I was healing quite well until I tried to climb too soon and cracked the lunate bone in half. At that point they put a cast on my arm for another 8 weeks. I laid off of climbing for 7 months and then cracked the lunate bone again the first day I tried to climb. At that point the Doctor told me to do whatever I wanted and let him know when the pain got too bad so he could fuse my wrist. So I did what most climber's would do and went CLIMBING!!!! Well, I went back to see the Doc about 7 months later because the pain was to much to handle. He looked at the X-rays and told me that the bone was completely healed. I continued to have pain for a while but it eventually dissipated. I definitely get shut down on a few moves that require an undercling or gastoncling above my head on steep routes. I climb better now that I did before surgery and believe that the lack of mobility hinders my climbing very little.

My advice would be to do your homework! Have you seen multiple doctors to get another opinion? Are they hand specialists? Have you had an MRI?

Your story and symptom sound eerily similar to how my wrist problem started. I was 27 when I first started having issues with my wrist but didn't find out what the true cause of the pain was for 2 years. I am now 37 and my climbing is still improving year after year. I can tell you that the surgery and rehab is no picnic but in the long run it should help out with the pain. Let me know if you have anymore questions.

Sorry if the pictures are too much detail but its about what you can expect. The X-Fix was on for 12 weeks.

5 days after surgery for Kienbock's Disease
5 days after surgery for Kienbock's Disease


5 days after surgery.  External fixator instead of cast.  casts will pack out and you can move your wrist.
5 days after surgery. External fixator instead of cast. casts will pack out and you can move your wrist.


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By Christopher Wong
Dec 27, 2009

Appreciate the post Chad! Wow, those pictures made me think of the "Saw" movies. Yikes.

I have seen multiple doctors--the last two in California are orthopedic surgeons that specialize in the hand. The first one was more reserved with his suggestion to fuse the wrist whereas the 2nd said it was really up to me (in terms of how much I can tolerate the pain).

When I lived in Madrid, Spain ('06-'07) I met with several hand specialists one who actually said that I had kienbock's disease. They also mentioned fusing the wrist.

I definitely understand that this will be no walk in the park and your pictures clearly illustrate this. I'm now even more hesitant about surgery after hearing what you went through.

I've honestly lost track of the multiple x-rays and MRIs I've had done. However, before operating they would perform a CAT scan to get a better idea of everything that's going on in there.

Thanks again, and I'll definitely keep you in the loop on how this all goes--I'm waiting for the doctor to send me a complete report of my visit so that I can think this through.

-Chris


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By Chad Thomson
Dec 27, 2009

Hi Chris,

Sound like you have done you homework. I often wondered if any other climbers are dealing with Kienbock's Disease. I just want to clear up a few things. The surgery that I had was to revascularize the lunate bone with a bone graft from my left hip and blood vessel from my hand. The bone graft out of the hip was the most painful part of surgery. If that surgery didn't work the next step was to fuse my wrist. My doctor was also reserved about the full wrist fusion and thought it be better to try and revascularize the bone first. It sounds like you've been dealing with this for a while and may be in the later stages where a wrist fusion my be the only option. I got very lucky with having the bone heal while I was climbing on it.

My ordeal was all due to not listening to my doctor and trying to climb way before I should have been. Overall I was out of climbing for about 2 years. It may have been less if I would have listened to my doctor. A regular broken bone may only take 6-8 week to heal but a surgery like this may take over a year to completely heal. From what I've been told about a wrist fusion is that they will put a steel plate in the back of your wrist and fuse your carpal bones together. After about a year they may remove the steel plate from your hand.

Good luck in whatever you decide to do! Let me know if you want any more info. I'm glad to help!

Chad


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By Christopher Wong
Dec 29, 2009

Again, appreciate the response Chad! Although I do wish I had alternatives, it seems like most of the doctors agree that either operating to fuse my wrist or just dealing with the pain for now are the way to go. It bothers me though there there is only an 85% success rate of the operation and for that I need clarification from the doctor on exactly what that means.

Hoping that additional climbers that have gone through a similar situation will post on this thread as well. It would be nice to hear additional stories although yours has given me good insight.

We'll be in touch,
Chris


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By cheryl w.
From boulder
Jan 14, 2010
jtree lead

hey Chris...my right wrist was fused 15 years ago. i broke my scaphoid when i was two years old, it never healed & because most of the bone never received blood supply the bone died. i had it partially fused (by one of the world's best hand surgeons) and it was still terribly painful. He ended up giving me a full fusion. i am grateful that i am no longer in pain. As for climbing...i had never climbed before the surgery & then i started ice climbing. i felt like edward scissor hands with ice tools in my hands! i then progressed...or rather adapted to rock. i guess what i want you to know is that you don't have to live in pain & you don't have to worry about your climbing...you'll adapt. i sure did. best of luck.


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By Christopher Wong
Jan 16, 2010

Thanks for your story Cheryl! My PCP has referred me to UCSF medical center, so hopefully insurance will approve a visit to one of their orthopedic surgeons. Since they are also in academia, perhaps there is hope on the cartilage replacement front. Operation is probably inevitable but want to be well informed on my decision before I go under the knife. Glad to hear you are still climbing!

-Chris


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By christie
From SEattle, WA
Feb 28, 2011
pigeon spire, bugs <br />

hi! i was just diagnosed with kienbock's and was horrified to hear my doc say no, you may never climb again. reading this post is heartening. any advice from those of you who recovered? what about surgery vs not? how do i find a good doc?

any advice appreciated and most of all thanks for the posting & the hope!

btw, i was diagnosed via mri. xray didn't point to it, tho they didn't suspect this at the time so i'm not sure you couldn't see it.

im a 37 year old female and can't imagine life without climbing.

christie


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By Christopher Wong
Mar 2, 2011

Glad to see that Christie revived this post! Since my last post I saw an orthopedic surgeon at UCSF medical center in March '10. I managed to get one visit covered through my insurance and chose the doctor because of her supposed research on cartilage regeneration. Unfortunately her focus had shifted (and they just hadn't updated her bio).

Regardless, she was willing and able to examine the whole collection of x-rays and films that I brought in, spanning a couple years back from the time I spent living in Spain. This was one thing doctors from my normal network did not give the time of day (treating my x-rays from Madrid as if they were from a third-world country).

I mustered the courage to ask her whether or not there was a fix for my situation. She said "Unfortunately there will likely not be a fix in your lifetime." At the same time she did not discourage me from climbing, but instead said that it was amazing how my body is coping with it and how it is naturally starting to fuse on it's own (since there is little to no cartilage left between the lunate which leaves it bone on bone).

Pain comes and goes, but in the past year or so, I would say I do not have the excruciating pain as I did 5 years back. That being said, I have grown to know the limits of my wrist and know that unfortunately I can't place a ton of trust in it when on the rocks. This might be part of the barrier I have to over come when considering leading outdoors (more of a mental barrier than anything!).


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By Mark Cushman
From Cumming, GA
Mar 2, 2011
Profiley Styley

Man, after seeing those pics and reading your stories, I gotta say:

You guys are all awesome.

Best of luck, Christopher! Thanks for sharing!


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By Christopher Wong
Mar 2, 2011

Chad's pics looked like a scene from Saw!

Glad to share, hope we might find others with a similar situation and maybe someone can find a cure.

Thanks, Mark!


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By atlclimbingdoc
From Boise, ID
Mar 2, 2011

Hey Chris,
After reading the thread, I am still not really sure what exactly you have going on in your wrist, i.e, where is the arthritis, and what joints are you considering having fused? If doesn't sound like you have Keinbocks - perhaps you have an old scaphoid fracture that didn't heal, and now you have arthritis between your scaphoid and lunate bones? There are lots of bones and joints in the wrist area, so a fusion can mean lots of different things. Fusion of your main wrist joint, while it may relieve pain, may cause limitations for you in climbing. Fusion of some of the smaller joints may not be much of a limitation for you in climbing. If you have significant arthritis that has developed in a joint, there is no such thing as cartilage regeneration that will restore things. Pretty much any hand specialist will be able to give you the relevant options, but they may not have much introspective into climbing activities, and thus how you would do with a fusion in that regard. Also, even with some arthritis, you may be able to climb without too much pain as you indicated - since alot of climbing involves pulling instead of compression on the wrist. You may find more issues with putting alot of weight on the wrist in mantling moves.


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By Jim Gloeckler
From Denver, Colo.
Mar 2, 2011

Most Doctors do not know how climbers think. When they say that you might not or will not climb again, they are completely unaware that it inspires said climber to somehow prove them wrong. Once a climber...always a climber...for the most part. I think that is a good thing. :)


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By Christopher Wong
Mar 9, 2011

Hi Todd-

Thanks for your insight. You are definitely correct about being able to climb without too much pain (the pulling vs. compression). I saw that you are a Orthopedic Surgeon.

Instead of posting my results from UCSF online, I'll send you a PM.

Thanks,
Chris


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By Chad Thomson
Oct 17, 2012

Hi Christie, It has been a long time since I have looked at this post. Sorry to hear that you have Kienbock's. I was diagnosed via MRI also. How is your wrist? Did you have surgery?

I would have to say that having surgery was a good decision for me. I am climbing better now than I did before surgery and before I had a wrist injury. I definitely had a few years where the wrist hurt but the pain is gone and I'm still improving as a climber.

Hope all is well!
Chad


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By christie
From SEattle, WA
Oct 19, 2012
pigeon spire, bugs <br />

Hello and thanks for checking in. So after 3 MRIs suggested my bone was getting worse, my doctor, still not convinced I had KB's, decided to do a scoping surgery to check things out. Turns out I didn't have it. I probably had a number of things wrong, including: bad bad tendonitis, a cyst on my ulnar, and a bruised lunate - with cartiledge that was pealing away from the bone, making the MRIs look strange. but the bone was and is fine.

I'm actually doing really well, though it took about 1.5-2 years to recover from all of it. Now I can type and I can climb and I'm feeling really very lucky. It was a really hard time, though, especially when the doctor told me I might never climb again.

THanks for checking in and hope you heal well, can climb and enjoy life to its fullest!!
Christie :)


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By Christopher Wong
Oct 21, 2012

Chad and Christie, great to see this thread come back to life! And great, that folks seem to be doing better with their respective recoveries! Time sure passes by quickly, no? Because of a job change in the past year, I have not been climbing as of late (a big lifestyle change!!!) because I am not close to a climbing gym. Intentions to get back into it as soon as I'm able...

On the wrist front, I went for a follow up visit to UCSF with the doctor that I saw two years ago. She commented that my body has coped with the issue and is basically auto-fusing. I have definitely felt much less pain than in years past. Whereas, my wrist would be in pain a few times a month (about 2 years ago), I currently only have pain about every few months and it seems to go away quicker.

Ran into an acupuncturist and he says my wrist doesn't have to be that way. Not sure what to think as in the very beginning I did go to acupuncture with no results.

Take care, all!

-Chris


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By Chad Thomson
Oct 22, 2012

Chris and Christie, I'm glad to hear that you both are doing well.

Take care!
Chad


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By canadakid
Nov 5, 2012

I've had the same thing for a while now. My wrist clicks. It sounds like the joints are grinding or something. If I keep it tensor end. Then it's fine. Otherwise it hurts a lot. I find my self icing all the time. Which is a nuisance.

My wife bought me a compression wrap, which is a huge help, pick one up. They are great. I copied the link of where she got it from www.kingbrand.com/Wrist_Injury_Treatment.php?REF=Boris1011

Hope it helps! Good luck and happy climbing!


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