Wrist R Pinkie Extensor Rupture

[InkedMarie]

It looks good and glad you found a hand specialist physical therapist!
Marie

 

[mendogal]

Thank you @InkedMarie !

 

[mendogal]

7 weeks post op; 8 days after cast removal. You can see how inpaired my flexion is, both with straight and with curled fingers. My PT assures me this is normal.

Speaking of PT... On another member's thread not long ago I mentioned that many PTs in an institutional setting like med center clinic feel constrained from addressing issues even a little outside the written prescription.

My PT doesn't feel that way. She understands my thumb problem is due to prolonged abduction in the cast and provided ultrasound and massage to it.

We also figured out we crossed paths 35 years ago in San Francisco while I was a hospital discharge planning nurse and she was a brand new PT working the same units!

 

[djklaugh]

@mendogal What a fun discovery for you and your PT gal!

 

[Hip4life]

@mendogal Oh, how I feel for your thumb pain flare. No matter what the surgery, it always is impressive at the stiffness that ensues with immobilization. I am always thankful to find PTs who are comfortable with their practice and confident in their skills who can really help you with not only the specific problem but with the effects it has on the tissues around it. Keep on keeping on. It's gotta feel good to be at this point.

I discovered my new DIL has had the chance to work in an educational setting with a former respiratory therapist friend of mine. I retired and she became a paraprofessional with the school system. It was so good to reconnect to her. Definitely not in a way I would have imagined. Fun for you, too, I would imagine.

 

[mendogal]

Almost 9 weeks post op, 18 days out of the cast.
My flexion improves slowly but it's noticeable daily.

Extension at the big knuckles is great, including on the ring and pinkie fingers where tendon transfer was done.
Extension is lagging most severely at all the PIPs, less so the DIPs, due purely to the weeks of immobilization.

My thumb is responding to PT's work with ultrasound and two days on, a few days off at a time of kinesiotaping with topical diclofenac when untaped. Mostly the pain has gone from "severe" to "mild to moderate."

Functionally I can type a tiny bit on touchscreen pressure, not trying keyboard; on the desktop I can use a trackball for a few minutes. PT agrees this low-pressure exercise is appropriate. We're not working on strength til I see the OS October 6.

 

[Jamie]

This is such a great journal of your surgery and recovery. I so appreciate you taking time to provide all the little details that someone might want to know about this procedure. Thank you!

 

[benne68]

That looks like significant improvement from your last photo, Janet. Are you able to use the hand for ADLs at all?

 

[mendogal]

That looks like significant improvement from your last photo, Janet. Are you able to use the hand for ADLs at all?

I am very cautious in that, as it's not yet even 12 weeks from a bone and tendon surgery. My PT doesn't want me doing any strengthening yet. Our focus is range of motion.
So yes, without applying weight or pressure in holding things, rightie is definitely more active in very limited roles.
I can use the trackball on my desktop computer for a couple of minutes, pet my cats, type a sentence with my index finger.
I can increasingly steady things with my R hand rather than using the forearm or crook of elbow.
I can hold a pen and make gentle marks, but hesitate to apply pressure to actually write.
I'm still in single-hand friendly pullover dresses or soft stretchy pants (depending on the weather) but the R hand can assist with some very lightweight laundry folding (t-shirt or small hand towel), or getting socks on and off, and I'm working a bit on thumb-forefinger fine motor control (doing a little of the pill counting for MediSets).

 

[benne68]

It' wise to be cautious and it sounds like you are already doing quite a lot.

I'm glad you can pet the cats with both hands again -- bet they are too!

 

[mendogal]

Despite improvement overall especially with finger flexion, my thumb flare up remains an issue and at times pain at the distal radioulnar joint. My fingers are still swollen and it's unclear why.
So I have been using a little topical diclofenac and have started twice daily icing and elevating.
I will see the surgeon Monday. I already know he's likely to discount soft tissue concerns and I may need to see my local non-surgeon sports med doc.

 

[mendogal]

Ten weeks post op, four weeks out of the cast!
The distal ulna pain is gone, just a tad of ache at times, and on hand pronation/supination a tiny area of slight friction.
The finger flexion is slow but fairly steady. Extension at the big knuckles is good, extension at the proximal interphalanges (PIPs) lags but with a regular stretching regimen is improving.
The base of the thumb hurts but improved (pain 3-4/10 versus 7-8/10 two weeks ago).
I'm icing and elevating to reduce the swelling.
Saw the surgeon today. He's pleased and oks slow beginning of strengthening in PT. I'll see him again in six weeks.

 

[djklaugh]

@mendogal Excellent report! I am so glad this is healing well for you.

 

[mendogal]

Every time I stretch out on the guest bed to ice and elevate my hand (yes on a pillow on the Lounge Doctor) sweet Rufus crawls across my tummy and chest to keep me company.

 

[Jamie]

Aren't our pets just the best nurses ever. What a sweet baby you have. I'm glad to hear your progress. You've really done well.

 

[djklaugh]

And a very handsome purr-a-medic he is!

 

[mendogal]

11weeks post op and I can touch all fingers (ever so lightly) (and briefly) to my palm after some warm up and stretching. I am starting to use soft therapy putty a couple of times daily.

Functional gains include
Driving (need to turn the key in the ignition with leftie still!)
A little snipping with embroidery/cuticle scissors
Signing my name, adding a tip to credit card bill
More active use in dressing and undressing
More use at computer and phone
I was able to make a collage during my workshop at the homeless shelter last night!

OS wouldn't tell me how long to wait before a steroid shot in the thumb because "I could do it right here!" but "it's just a temporary measure." Well Doh! I am nowhere near ready for a thumb replacement and this acute flare was 100% due to the prolonged casting. I plan to follow up in a few weeks - well past 3 months post op - with my local non-surgeon sports med doc.

 

[Jamie]

Really good progress!

How functional is your thumb at this point?

 

[mendogal]

Really good progress!

How functional is your thumb at this point?

I agree!

The two most limiting factors are the overall weakness of the hand and the tendency of the entire base of the thumb to become quite painful with what it considers overuse.

Unfortunately using the hand putty with my other four fingers requires continual readjustment of the thumb to keep it happy. As I'm only doing 5 or 6 light slow reps with the putty, it's easy to let it rest.

I pushed the thumb a bit last night doing the collage and took topical and mild oral pain meds for pain up to about 4/10. Today with just light usage it's staying between a 1 - 3/10., no meds needed.

I actually hit quite a milestone this evening: using a very sharp paring knife to chunk a few softer veggies (I left carrots and celery for MDH to do; I'm not stupid!). The thumb IS the main limiting factor (the wrist develops an ache that I totally respect) and it stayed under a 2/10 baseline during and after.

My hope is that over the next two weeks the thumb quiets down on its own. It does LOVE the ultrasound treatments from PT.

 

[Jamie]

It looked like the muscles at the base of the thumb had atrophied a bit, which I suppose would explain the weakness. I think the putty is a great exercise and you’re wisely watching how much you use it at a time. I still do think you’re making great progress. Like all these procedures, I’m sure patience is the toughest part of the recovery.