The Scaphoid's Connected to the Lunate...Or It Should Be

[dmarley]

I am highly medicated, so I am typing for my own little self.

I consulted the surgeon today. He was a nice, funny, confident and eloquent person who gave me Lortab. I like him. :) Although the MRI results weren't terribly conclusive about whether or not I had a torn ligament, further x-rays showed that I have a tilted scaphoid bone. Misalignment of that bone usually *is* the result of a torn ligament, specifically the Scapholunate ligament. Given the length of my (non) recovery, the kind of pain I'm in, and the site of the pain, the clues do seem to point to a torn ligament. (To use the surgeon's analogy, if it looks like dog poo, and smells like dog poo...:))

There are a couple of things I can do about this. One, I can start physical therapy and try to get back some range of motion and flexibility and see if it heals. The good thing about the PT option is that time isn't a big issue for this particular injury. If I opt for surgery, I can do it a few weeks from now and it won't make a difference. In fact, even if I do choose surgery, I'll need to do PT for two or three weeks to get as much flexibility as I can pre-surgery, so that's a pretty easy non-choice.

The bad news about PT is that it's already been two months and things have not improved. Moderate delay isn't going to mess me up any further, but at this point the surgeon isn't sure how much more improvement I can expect. The other bad news about the "no surgery" option is that un-repaired wrist injuries have a nasty habit of triggering arthritis down the road. It's by no means a hundred percent, and the surgeon was very scrupulous about saying that he *wasn't* saying "OMG you'll get arthritis if you don't have surgery!" But there does seem to be a correlation between these kinds of injuries and arthritis later in life if the ligaments aren't fixed properly.

The other negative in the PT-only column is that, frankly, the pain is getting to me. I've been in near-constant pain for two months. That, and the frustration of not being able to do anything with my dominant hand is really starting to interfere with my overall enjoyment of my life. Granted, the surgery will hurt, and the recovery will hurt, but both the surgeon and the physical therapist told me that the post-surgery pain will very quickly be a whole lot less than what I'm going through now. (I believe them, because right now *brushing my teeth* hurts like hell. Really, it's a good thing I couldn't type, because I would have been doing nothing but whining. :))

Anyway, the surgery. The surgery he discussed involves putting (temporary) pins in my wrist to align the tilted bone, then trying to repair the ligament. If the ligament can't be repaired, then he can pull some other tissue down from the joint capsule and attach it to the bones to replace the ligament's function. Recovery time from the surgery will be 8-12 weeks (when they'll take the pins out), and getting back full strength and flexibility will take from six months to a year.

The unmitigated bad news: Either way, it's likely that I'm going to lose, permanently, a certain degree of my range of motion in my wrist. I also consulted a physical therapist today, and he didn't quite grasp my dismay at my pathetic 83 degrees of motion until he measured my uninjured wrist and realized that I was used to 160 degrees. Once he realized where I was coming from, he reassured me that even 83 degrees isn't far from what most people need for doing, well, most things, and I shouldn't have any troubles knitting or typing even if I can't flex my wrist as much. Most of the stuff I really love doing involves finger dexterity more than wrist-flapping, but I won't lie that losing some of my much-treasured hand function is a blow, even if it's something that I'll probably be able to work around fairly easily.

To sum up for those who wish to skip the icky medical details under the cut: I'm going to do physical therapy for two or three weeks, then I will probably choose to have surgery to try to repair/replace the damaged ligament. Surgery recovery might take 8-12 weeks, then it might take as long as a year to recover completely. I'll probably lose some flexibility in my wrist, but the doctors say that I *shall* knit again. :)

PS--The pictures I've linked to come from a helpful and informative article called Ligament Injuries of the Wrist.

Comments

[ladypredator.livejournal.com]

Sounds like one of my emergency medicine lectures. Hopefully the PT will help. I had problems with a tendon in my foot and it helped, though I never got very good at the picking-up-marbles-with-your-toes exercise. Hope you feel better!