Experiences with Ulnar Shortening Osteotomy

Hey everybody,

I have wrist pains in both hands since 4 month. After getting some wrong diagnostics (tendovaginitis) I went to Prof. Schöffl in Bamberg (in Germany he is really famous around climbers ;-) ) and got the diagnosis that my ulna is too long. Now I am getting a surgery in April in which my ulna will be shorten. I am really afraid as this would be my first surgery at all (I never had a broken arm or similar stuff) and looking around the web I am only finding horror stories. :-( He is sure, if everything goes fine, I will be able to go climbing again (and work as a software developer).
Has anyone (good) experience with this kind of surgery. Anything that could decrease my panic? ;-)

BTW: I'm 36, climbing since 3 years 3-4 times a week.

Thanks!!

Jasmin

Hey Bruno,

thanks for your comment. Unfortunately I don't have the feeling that I have a choice. I can't go climbing since 4 month, because of the pain. And it does not seem to get better

Do you also have a TFCC injury(ies)? This is common with ulnar impaction syndrome. If so, you should consider starting with just surgery for the TFCC debridement/repair (whichever you need) and see how it turns out before going more radical with osteotomy. 

Is he saying you need shortening on both wrists? I would for sure start with your non-dominant hand first and see how that turns out before committing to both....of course.

I know you've seen several doctors already, but if you got this diagnosis and treatment option, I would recommend you still get another opinion if possible from another hand surgeon first. Find someone who sees other overhead athletes if you can't get another climbing knowledgeable doc - like gymnasts, tennis players, etc.  

Hey Aerili,

thanks for your answer!

Yes, I guess I have TFCC (had to google it to get the right translation ;-) ). He told me we could try that, but he would expect that it comes back and I trust him as I had similar symptoms (not so heavy and only for about a month) a year ago, also on both hands. That time they vanished after a while. But that is telling me, that it will probably come back when I don't remove the source of it.

In the moment we are only concentrating on my right hand as this is the one with the most pain and unfortunately my dominant hand. :-( But since 4 month I already do the most stuff with left. I'm glad that I am able to use both hands in nearly the same way (except writing ;-) ). A few days before the surgery we will do a MRI from the left hand to decide if this one is even worser, but to be honest I would prefer to start with my right hand, as otherwise I have the left hand broken because of the surgery and I could not use the right hand because of the pain. :-/

I went already to another hand surgeon. This one told me it will vanish after a while and I should stop climbing forever as this will cause the pain to come back. :-/ Okay, this was before I know my ulna is too long, but I am tired of hearing stuff like this! :-(

It seems that here nobody has good experience, but also nobody with bad experiences. ;-)

THX,
Jasmin

I can’t comment on your specific issue but I’ve had many orthopedic surgeries including one osteotomy. My best outcomes have been when my pain in the first few days was managed properly combined with completing an excellent physical therapy program. Finish your PT even if you feel fine and your pain is gone. Good luck!

Jasmin, do you have positive ulnar variance even when your hands are not under load? In other words, is your ulna too long even when your hand is at rest? (It is normal for the ulna to move "up" some distance toward the hand when gripping, esp palm down, like in climbing, so that isn't used to determine variance.)
https://www.wristwidget.com/blogs/blog-archive/ulnar-variance-important-things-you-should-know

It's possible that your doctor is correct - performing only a TFCC surgery may do nothing for you long term. (That is assuming you have a TFCC tear?) But I do assume you have been diagnosed with ulnar impaction syndrome, yes? This can be the cause of or be related to other problems, like the TFCC tears and DRUJ instability (distal radio-ulnar joint instability). It is important to know. 

I went through TFCC debridement in the past and also have DRUJ instability in both wrists (still - it will never go away due to my shitty connective tissue and the way I'm built). I had to see 3 different hand surgeons to come to a decision because I received opposing points of view, and I was very impaired in my affected wrist for a very long time. One surgeon told me to quit climbing forever also, as I have ligamentous laxity and he felt that my ulna would continue punching the TFCC once I returned to climbing due to this laxity. This was not a good answer for me.... I was not ready to accept it.

Other surgeons felt I would be able to climb again, but at what level they couldn't say. I tried all kinds of conservative treatment, but after 9 months of little improvement, I knew surgery would help me. Anyhow, this is why I recommend still getting another opinion - especially now that you know you have positive ulnar variance. This would be a good reason to also ask a second doctor, with full knowledge of your anatomical root cause, if TFCC surgery as a first step is a worthy idea - because it's an incremental and less radical step of treatment. You can see what happens before committing to an osteotomy. (Again, that's totally assuming you do in fact have TFCC injury - you should become clear on that.) If you do a TFCC-only surgery, and it doesn't work, then you know you are a good candidate to consider the osteotomy. You must get the information on exactly what is wrong in your wrist as a result of your positive ulnar variance.

Do you know which procedure they recommend for your problem? Ulnar shortening osteotomy? Or arthroscopic wafer technique? You should also be very clear on which one is recommended AND WHY.

I understand your terror. I had also read many horror stories of TFCC injuries online, and some published papers which showed long term successes to be a lower percentage than I would have liked. But I chose a good surgeon and my outcome was very good (in my opinion). I still deal with wrist issues from time to time; I have had to give up some types of climbing completely (no bouldering, I must be selective on sport and trad climbing route types to climb, I avoid using hard slopers, I avoid grades above 5.11- generally, as well as I avoid a lot of training exercises which are hard on the wrists). Aside from that, I made a very good recovery and am able to climb at a higher level than the surgeons would probably have predicted.

I found a few studies that show fairly high positive results for ulnar shortening and wafer procedures:
 
"Baek and colleagues investigated long-term results of USO in 36 patients, with excellent clinical outcomes in pain, range of motion, and function greater than five years postoperatively, even within 16% who demonstrated radiographic arthritic changes of the DRUJ. More recently, a retrospective case series of 33 patients following USO were assessed at average follow-up of 10 years, with 88% reporting satisfied to very satisfied with the procedure, accounting for 30% of patients who required hardware removal."  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262812/#b19-88869-1_chiro_58_4_401

The above article has lots of good references, including the following:
https://www.ncbi.nlm.nih.gov/pubmed/15067279
https://www.ncbi.nlm.nih.gov/pubmed/18984356
https://www.ncbi.nlm.nih.gov/pubmed/17906587/
https://www.ncbi.nlm.nih.gov/pubmed/22883875/

Hey Aerili,

my ulna is definitely too long even in rest. This leads to symptoms also when I do typing on a keyboard which is bad when you work as a software developer :-/

My surgery will be a Ulnar shortening osteotomy and arthroscopic. One for removing the cause and the other for removing the symptoms. My doctor is really sure that this is the right choice to have a painless work and sport life again. He told me that it is worser to fall down a rock and break your arm than having this surgery.

Thanks a lot for all your articles, I will study them ;-)

BR Jasmin

Ok, then, good luck. If you want to read a published article but you can't access the full article without paying for it, you should try contacting the author directly. An author will usually always be happy to send you their studies at no charge. 

Thanks Aerili!

Perhaps when my surgery is done and I'm able to type again I will let you guys know how it worked out. Perhaps someone in the future will be happy for my experiences.

Hi Jasmine,
I am happy that I found this forum. I have a 15yo daughter with wrist pain and one bone longer. The surgeon said she probably wouldn’t have had problems except that she is a diver and practiced several hours 6-7 days a week. She loves the tower but can’t compete because of the impact. She had some imaging and will see the MD in the next week. I suspect she has a TFCC tear. This situation is so heartbreaking for her because she is talented and loves the sport. Has anyone tried stem cells or protein rich plasma treatment? It’s very expensive and not covered by insurance. We saw a wrist surgeon and he mentioned the shortening procedure but after reading about it I think she is too young. 

Hey Willow,
I'm sorry to hear about your daughter. I can't tell you something about alternatives. I had my surgery 2 month ago. So far so good. Still a bit pain and I am not allowed to climb in the moment, so I can't tell if it was successfully. After scanning the left arm the doctor told me, that this is not such bad than the right one and he would suggest physio for it. So I have to see if this will do the job.

BR Jasmin 

Hey there guys ... I’m also having ulnar shortening surgery this coming Tuesday ( a week from today ) and I am TERRIFIED! I keep trying to find research on it but all I’m finding is how a lot of people regret doing it. Unfortunately I really don’t have any other options. I have what’s called Madelungs deformity. Which is a birth defect. There’s not a lot of studies on it due to it not being a very common issue. Any advice would be appreciated. 

Willow C wrote: Hi Jasmine,
I am happy that I found this forum. I have a 15yo daughter with wrist pain and one bone longer. The surgeon said she probably wouldn’t have had problems except that she is a diver and practiced several hours 6-7 days a week. She loves the tower but can’t compete because of the impact. She had some imaging and will see the MD in the next week. I suspect she has a TFCC tear. This situation is so heartbreaking for her because she is talented and loves the sport. Has anyone tried stem cells or protein rich plasma treatment? It’s very expensive and not covered by insurance. We saw a wrist surgeon and he mentioned the shortening procedure but after reading about it I think she is too young. 

Hi Willow, I’m sorry to hear about your daughter’s pain with the TFCC tear and ulnar length issue. I have an ulna that is too long and had a TFCC issue myself and I can attest, the pain is quite alarming for something that looks “fine”, generally speaking, to the naked eye. 

To heal, I used the Wrist Widget brace for day to day stuff and early in my return to climbing, and it was quite helpful for relieving the pain. Then I did a series of neural control training drills to build up the function, mobility, control, tolerance, and strength, of my wrist and forearm muscles. 

I’m pleased to say that things are healed now and I can do the things I love pain-free. Consider this a strong recommendation for using non-invasive routes to make big headway - even if surgery is eventually done, it pays to have the tissues and joints as solid as possible ahead of time. Best wishes!

Kate Galliett wrote:

Hi Willow, I’m sorry to hear about your daughter’s pain with the TFCC tear and ulnar length issue. I have an ulna that is too long and had a TFCC issue myself and I can attest, the pain is quite alarming for something that looks “fine”, generally speaking, to the naked eye. 

To heal, I used the Wrist Widget brace for day to day stuff and early in my return to climbing, and it was quite helpful for relieving the pain. Then I did a series of neural control training drills to build up the function, mobility, control, tolerance, and strength, of my wrist and forearm muscles. 

I’m pleased to say that things are healed now and I can do the things I love pain-free. Consider this a strong recommendation for using non-invasive routes to make big headway - even if surgery is eventually done, it pays to have the tissues and joints as solid as possible ahead of time. Best wishes!

Hey Kate!
Can you describe a few of your exercises? I had a surgery on my right arm, but I am trying to avoid this on the left arm which is not so damaged.
Thanks,
Jasmin

Diane Steinke wrote: Hey there guys ... I’m also having ulnar shortening surgery this coming Tuesday ( a week from today ) and I am TERRIFIED! I keep trying to find research on it but all I’m finding is how a lot of people regret doing it. Unfortunately I really don’t have any other options. I have what’s called Madelungs deformity. Which is a birth defect. There’s not a lot of studies on it due to it not being a very common issue. Any advice would be appreciated. 

Hey Diane,
I had my surgery on the right arm in April and I don't regret it at all. I still have some issues with it, but my doctor said in July this is okay for the next 3 months. I am already climbing and bouldering 3 times the week again and I am getting stronger and stronger each week. I am still not there where I was last year, but not far away from it. :-D I wish you all the best. Chin up!! ;-)
BR Jasmin

Jasmin Roeper wrote: Hey Kate!
Can you describe a few of your exercises? I had a surgery on my right arm, but I am trying to avoid this on the left arm which is not so damaged.
Thanks,
Jasmin

Hi Jasmin! 

I’ll do you one better...I have a video lesson I made for my movement students that demos the three main exercises I started with and used in the early days of healing myself. Happy to share it with you and anyone else in this thread who might find it helpful. When done with attention and focus, these drills are powerful, and they set things up nicely for more complex stuff in the future!

Wrist Exercises For Wrist Health, TFCC, Hand, And Forearm

As with anything movement related, only you can know what’s right for you so use your smarts about listening to your body. :) 

Kate Galliett wrote:

Hi Jasmin! 

I’ll do you one better...I have a video lesson I made for my movement students that demos the three main exercises I started with and used in the early days of healing myself. Happy to share it with you and anyone else in this thread who might find it helpful. When done with attention and focus, these drills are powerful, and they set things up nicely for more complex stuff in the future!

Wrist Exercises For Wrist Health, TFCC, Hand, And Forearm

As with anything movement related, only you can know what’s right for you so use your smarts about listening to your body. :) 

WOW!!! That so great! :-D Thanks a lot. I will start immediately to do the first two exercises when sitting at my desc in the office and the third one I will integrate in my every evening stretching exercises at home in front of the mirror.

I'm pretty sure the exercises are good for both arms, the one with the surgery and the other one with not much pain (in the moment).

THANKS!!

You’re welcome, Jasmin :) Have fun using the exercises!

To revive this thread a bit, here's my story of struggling with an injury for the last two years, up to the USO surgery:

Been struggling with a diagnosis surrounding my Ulnar Impaction Syndrome for the last two years or so. First diagnosis was something wrong with the TFCC, done by a physio. Months of osteopathy and physio to no avail, still hard to climb at my max - pain seeping into other aspects of my life (guitar, writing, etc.).

Pain would subside after rest, but would never get better (i.e. as soon as I came back to climbing, it would restart basically just as strong). Did an MRI and two x-rays after switching to an accredited sports doctor, diagnosed with Kienbock's disease.

Difficulty finding resources about this rare diagnosis. Eventually saw one of the only people who seemingly knew about it in my region, she was iffy on the Kienbocks diagnosis.

We sought yet another opinion. Booked an appointment with the orthopaedic surgeon who'd operated on my knee years prior. Being an orthopaedic surgeon, he obviously saw something about the bones/biomechanics of it all. His diagnosis was basically "it could be Kienbock's, but there are enough signs to show it's probably just pressure due to the ulna being slightly (2mm-ish) too long".

He recommended the Ulnar Shortening Osteotomy, saying that essentially, despite the somewhat uncertain diagnosis, it was bound to relieve the pressure put on my lunate, which was the cause of my pain. If it was Kienbock's, the same surgery would help slow it down and relieve the pain. If it was purely biomechanical, the surgery would essentially cure it. No expected reduction in long-term ROM or grip strength. Seemed like a win-win situation to me.

Got the surgery done last friday (five days ago). Regional anesthesia (shoulder-down), surgery itself took 45min, in and out of the hospital in 4 hours. No sedatives needed. No cast. 1000mg of acetaminophen every 6 hours until the pain subsides. Managed to sleep every night since on acetaminophen alone, pain was the worst on the day after, rapidly subsided by the second day after. I am now typing with my hand, and it's only been four days. Still no heavy lifting of any kind, and some motions hurt quite a bit. Expected recovery time 6-8 weeks, from which point physio will be picked up indefinitely.

I've read up on PRP and stem cell therapy, and to the best of my extent (using some of my limited knowledge from my ongoing bioengineering degree), it's hopeful at best. Not much real science, data or studies (which don't have a conflict of interest, I'm looking at you, Regenexx) to back it up. Sure, USO doesn't have that much research either, but it is quite straight-forward and logical of a surgery, so I trust my very knowledgeable surgeon with it.

I will be keeping you guys posted on this thread. If not, and you have questions about this operation, feel free to send me a message (can be done through my profile). I'd love to spread as much anecdotal information about my personal experience with this surgery as a climber as I can, to make it easier for anyone I'm my situation in the future.

Best of luck to everyone else dealing with lingering injuries out there - may we all see some hard sendies in our future.