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mojomonkey


Oct 22, 2013, 9:40 AM
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Hand/wrist surgery experiences and or opinions
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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?


(This post was edited by mojomonkey on Oct 22, 2013, 9:41 AM)


marc801


Oct 22, 2013, 2:04 PM
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Re: [mojomonkey] Hand/wrist surgery experiences and or opinions [In reply to]
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mojomonkey wrote:
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?

I'd suggest that getting a really good physical therapist who knows what they're doing is actually far more important, as is religiously sticking with whatever recovery protocol and exercises they give you. That will account for easily 75% of your eventual outcome.


gblauer
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Oct 22, 2013, 4:02 PM
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Re: [mojomonkey] Hand/wrist surgery experiences and or opinions [In reply to]
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Sorry to hear that Doug.

As you know it's taken Mitch 4 surgeries and more than 2 years to get back to climbing.

Dr. Jeff Arliss in Kingston NY is a hand specialist AND a climber. You should bring your MRI results to him for an opinion. Jeff did not do the surgery because it was too far away from Philly.

Mitch went to Dr. Jack Abboudi (for the second, successful surgery). We really liked Dr. Abboudi. He was very clear about expectations, empathetic and did a great job.

Good luck...Bet you won't be doing proctoscope again anytime soon!


mojomonkey


Oct 23, 2013, 6:43 AM
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Thanks for the tip Marc - hadn't thought about PT yet.

Gail, Mitch has sent me some good info. It would be nice to talk to a climber doctor (I recognized the name from some photos on MP) but since I am not climbing I don't think I'll be at the Gunks any time soon :(

I'm seeing the Dr my ortho recommended on Monday just to get an initial review, and am considering at least getting a 2nd opinion from Mitch's doc.

As for Proctoscope - I would like to go back and do it some day. I just scared myself and an adrenaline fueled grip is apparently enough to tear ligaments (but did buy me time to get gear in!).


(This post was edited by mojomonkey on Oct 23, 2013, 6:57 AM)


gblauer
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Oct 23, 2013, 7:35 AM
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Re: [mojomonkey] Hand/wrist surgery experiences and or opinions [In reply to]
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Doug, It's worth taking the day off and running up to see Jeff. Or, find out if you can email your records and get an opinion.


mojomonkey


Oct 28, 2013, 7:48 AM
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Re: [mojomonkey] Hand/wrist surgery experiences and or opinions [In reply to]
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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 (just used one I had from prior broken wrist) 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 the Dr Gail mentioned last week but have not heard back - may try again)


kane_schutzman


Oct 28, 2013, 8:42 AM
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Re: [mojomonkey] Hand/wrist surgery experiences and or opinions [In reply to]
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First, wish you the best.

I've had a wrist injury which resulted in proximal row carpectomy. Doctors told me I wouldn't be able to climb again. One year after I was back, not as strong but maybe because it's scary to stress a new wrist. Two years after, climbing is around 90%. The 10% accounts for specific moves which may be more difficult due to loss of motion, etc. We both had/having different different injuries, bottom line, don't accept what they say about the outcome.


(This post was edited by kane_schutzman on Oct 28, 2013, 8:44 AM)


DJS


Nov 15, 2013, 12:40 PM
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Re: [mojomonkey] Hand/wrist surgery experiences and or opinions [In reply to]
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I've actually injured the TFCC in both wrists while climbing (separated by ~6 years), and treated them differently. The first time, I went for the suggested surgery, and the recovery was long, painful, and incomplete to the point where I avoid underclinging with my left hand as much as possible. The next time (right wrist this time), I treated myself with a long recovery period filled with mild exercise and swimming, LOTS of swimming. The low impact exercise of swimming I believe led to a much healthier wrist in the right wrist versus the left. The proper course of treatment of course depends on your exact injury, and the severity of it, but my experience was that the surgery quite possibly made things worse. I haven't heard many success stories about TFCC surgery either, making me think my experience isn't an isolated case.

Edit: It may be a long road to recovery, but I wanted to get the point across that it is possible. It took a while, but I was able to get my climbing back to V6/5.12b/c levels with dedication and care (until another injury, oi). I hope you can do the same.


(This post was edited by DJS on Nov 15, 2013, 12:42 PM)


mojomonkey


Nov 26, 2013, 9:02 AM
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Re: [DJS] Hand/wrist surgery experiences and or opinions [In reply to]
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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 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.


mojomonkey


Jan 15, 2014, 9:30 AM
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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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