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The Surgeon’s Explanation

December 9, 2013

So after sending the report via e-mail to Dr. Steve McCabe, he called me yesterday to discuss my wrist. He mentioned that the MRI is a procedure that they normally do not use in the clinical care because it is provides way to much information. However, he did say that he would look at the MRI CD when he receives it this week to see about the 0.8 cm bone fragment at the base of my thumb. He said it may be a cause of pain.

 

More importantly we discussed my wrist, fingers and he provided me with some additional insight. He again explained to me how severe an PRC is and that removing the three bones is quite a shock to the wrist and is not a cure but rather a procedure to help me function as best that I can considering the damage I had to my Lunate bone. He did mention that if this does not work that fusion is the next step which would eliminate any pain. I do not have sufficient pain to warrant a fusion at the moment.  I told him that I noticed my wrist swelling a bit and getting sore when I do something that either shocks or vibrates my wrist such as when I ride my Vespa on bumping roads, cutting carrots, working with tools or using the snow blower, electric shovel and so on. He explained that this will be the case for the rest of my life and that I have to choose what I do with my wrist by taking into consideration the pain or swelling associated with the specific actions. He mentioned that I should never use a chain saw as an example. This is abundantly clear to me now. So chain saw is at one end of the spectrum and I have to decide on a balance equilibrium for the future. I now use my left hand for many things such as using the mouse, tools, eating, lifting, pushing and so on. I

Is a PRC a bummer? Absa-F$# $%-Lutley!

 

He reviewed with me how I should proceed when I over exert myself. So below are some notes that may be helpful:

 

  1. Avoid if possible activities that shock or vibrate the wrist.
  2. If you perform an activity that stains the wrist (such as riding the Vespa on Bumpy Roads),  ice the wrist immediately then at night in bed use hot compress or heat.
  3. Always wear the brace to bed to protect and rest the wrist.
  4. If the wrist is sore, wear the brace for a couple of days and take 400 mg of Advil every 4-5 hours to reduce the inflammation.
  5. Continue performing gentle stretching exercises.
  6. I personally have starting taking hot baths instead of showers in the morning because I find that stretching in the hot bath takes away the morning stiffness.

 

Dr. Steve McCabe expressed that he was pleased with my progress and range of movement on my fingers during the last visit. My next visit is February or sooner depending on how he feels about that 0.8 cm bone fragment. Personally, I think that I can feel that fragment at the base of my thumb that pushes into a nerve or something that causes  inflammation when I squeeze something. Perhaps it is just a nerve or tendon.

 

The saga will continue…

7 Comments
  1. Mark permalink

    I’m currently 6.5 months post-surgery. I’m pretty happy with how things turned out. I still have some discomfort on the back and palm side of the wrist when I rotate my hand back (away from the palm). But that discomfort seems to be getting more muted as the months go by. I don’t feel like I’m restricted in any way, but I have to pay attention to the angles when using my left hand. I don’t seem to be thinking as much about my left hand. Early on, I was always thinking about it. The fingers don’t get as stiff in the morning as then did 3 months ago (or I’ve just gotten used to it…maybe a little bit of both). I don’t really do any specific exercises with my PRC hand. Mostly because I’m lazy. Maybe some of the discomfort I feel now would disappear sooner if I followed some kind of exercise plan. In a couple months I’ll start swinging a golf club regularly. Then I’ll have a better feel for what kind of progress my wrist has made.

  2. Blake Childress permalink

    I too have had the PRC procedure and could not be more pleased with the results. It has now been almost a year to the day and there is nothing that I cannot do with the right wrist that I could not do before. There is no pain to speak of. Occasionally some minor stiffness on the outside if the wrist but that is the only discomfort.

    It took nearly 10 weeks for all of the swelling to subside. At that point I went back into the gym. I am 62 years old and work out at least 3 to 4 times per week. It has taken 6 months to work my way back to curling 25 lbs in each hand. I have to keep the wrist in the vitical position rather than the horizontal but there is absolutely no pain.

    The only discomfort I have is the motion of swinging a hammer. Even the motion of swinging my golf clubs has not been an issue. My doctors advice, just use it. The left wrist is scheduled for early next year as it too is just worn out.

  3. nancy permalink

    Hope it’s not necessary, but total wrist replacement is better than fusion. Retains partial motion. Had it done in 2012

  4. Mark permalink

    Interesting. I get that a PRC is a ‘salvage’ operation. I get that people react differently to the operation. However, at least in the eyes of the technician who analyzed the MRI, there were some abnormalities (the possible bone fragment and the tendon signal) that warranted further investigation. Maybe these abnormalities amount to something significant. Maybe not. What would frustrate me about this is the doctor trying to immediately rationalize all that away into being a part of the variability of having a PRC. In my opinion, the doctor should have more of a ‘let’s take a closer look at the data and see it means’ approach. I admit that all I have to go by is the summary you provided and maybe I read it with the wrong perspective. I’m kind of spring loaded toward frowning on people that rationalize an issue away without properly looking at the details (data) that pertain to the issue.

    On the one hand (pardon the pun), I think it is encouraging that the MRI found some things that deserve a closer look (I hate taking my car to the mechanic and having him say that they can’t find anything wrong when it is obvious that it is not working correctly). However, it is all a moot point if nothing can be done about those abnormalities. Since I have an engineering background, I feel that there should be a proper explanation for everything.

    Good luck. Hopefully if there is a bone fragment left in your wrist, you can have it removed and it results in noticeable improvement in your wrist/hand. I’m kind of curious about what the explanation might be in regards the return signal on that one tendon.

    As far as vibrations, my hand therapist said that early on vibrations (like those associated with lawn mowers, for example) will cause discomfort in the wrist. But he also said over time it will get better. About 6 weeks ago, I did use a chain saw to cut up some limbs that had fallen after a wind storm. I was surprised by how little my wrist bothered me. Since my left wrist is the PRC wrist, I was a little concerned about the chain saw kicking back unexpectedly.

    I rarely wear my wrist brace. I did wear it the other day when I was doing some hiking. One of my fears is that I will trip and fall and put my left arm out to brace my fall and muck up my wrist. My other big fear is being eaten by a shark.

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