Hand Trapeziectomy and ulnar shortening osteotomy

[EmEm]

I have written here previously of ongoing hand problems. In 2016 I had a left total wrist fusion and recovered well, adapting to a wrist that no longer bends but does rotate. I knew at the time that I also had arthritis in other areas of the same hand but have managed nearly 4 years before accepting the inevitable surgery - a trapeziectomy with ligament reconstruction and also ulnar shortening (taking 4mm out) to stop that bone clipping the radius.

It was my first experience of a nerve block where the anaesthetist used ultrasound to find the nerves to the hand which he injected. I woke up to a completely pain free hand which gradually came back to life over the next 24 hours by which time I had sufficient oral pain relief to keep me comfortable. I'm in a very large partial plaster cast with lots of padding on top. After 2 weeks I will have a custom made splint which I will wear for at least a month.

I'm grateful that I was able to have both procedures done at the same time so only one recovery.

 

[Jaycey]

@EmEm Welcome back to BoneSmart! Sorry you had to have more surgery. But it sure sounds like you took the right approach. Getting it all done in one op is a great idea.

How long was the surgery? Is your pain still well managed?

If you give me your exact surgery date I'll pop the information in your signature for you.

 

[EmEm]

Hi @Jaycey, the surgery took 2.5 hours and was meant to be a day case. By the time I came round in the recovery room the decision had been made to keep me overnight. It's now one week on and the pain is managed with just paracetamol. I had OraMorph in the hospital and was sent home with that and dihydrocodeine.

I can definitely recommend buying a shower sleeve (Limbo). I kept mine from the fusion surgery. The only issue I have had is getting clothes over my huge plaster!

I updated my signature - one surgery per year for the last 4 years!

 

[Jaycey]

Sounds like you are doing really well @EmEm ! Good suggestion about the shower sleeve. Please keep us updated. Others considering this surgery will find your input helpful.

 

[helenium]

Thanks for posting about this @EmEm. The first hand surgeon I consulted wanted to do a trapeziectomy along with my carpal tunnel decompression. I went with the second opinion and chickened out of the trapeziectomy! Now that I'm on crutches again I'm beginning to regret that decision. It's so reassuring to hear that your recovery is going so well.

The only issue I have had is getting clothes over my huge plaster!

We'd make a great pair, I still can't get my trousers over my swollen leg!
Very best wishes for the rest of your recovery.

 

[EmEm]

@helenium we could have shared the pyjamas because I had to buy men's shirts to get a cuff big enough. They came from that well-known high street cheap clothes store but I really like them although my husband thinks he might acquire one of them!

A quick update on my hand, the bruising I can see beyond the plaster cast is impressive - dark purple knuckles and elbow. I have made use of my gel ice packs (from hip replacement) because inside the plaster gets very warm. As the back of my hand/arm only has padding and bandage I can feel the benefit. I was advised to elevate my arm as much as possible and have the large foam sling from the hospital hooked up to a floor lamp and could fit the ice pack inside.

I'm self-employed and having to work a few hours this week but with lots of breaks.

 

[Jaycey]

I had to giggle - it's amazing how inventive we can get when you need to. Your elevation technique sounds great! Icing and elevation are bound to ease any swelling.

Very early to be back working. I do hope you can take it easy!

 

[EmEm]

2 week update: I had the plaster cast removed yesterday and the two wounds are healing nicely. There had been a lot of bruising which is now fading. I then had an x-ray and went to physio for a hand therapist to make a splint.

It was an interesting process, firstly she drew a template and cut that out to try on my hand, then cut the shape out of thermoplastic material that went into a water bath to soften. The therapist then tried that on my wrist and spent some time adjusting it. She then added velcro straps and let me try taking it off and putting it on again. It is so much lighter and slimmer than the plaster which makes everything so much easier. I'm able to remove it to wash my hands but have to shower and sleep with it on for the next 2 weeks. The plastic shower sleeve will continue to be useful!

I saw the surgeon who was very pleased with the wounds and with the x-ray. He also showed me the pre-op x-ray so that I could compare before and after. The trapezium had ragged edges hence the pain pre-op. I return to physio tomorrow to have the splint checked to make sure it's not rubbing anywhere. The plan is for another physio appointment in about 3 weeks and then see the surgeon at the beginning of January by which time I should be free of the splint.

 

[Jaycey]

@EmEm thanks for the detailed update. That new splint sounds amazing. Technology has certainly moved forward.

Did you happen to get a copy of your x-ray. It would be fascinating to see the before and after.

 

[EmEm]

I have had 2 physio appointments now, the first to check the splint which did need modifying.

Last Friday I started the exercises. I tried them in the clinic with the hand therapist who then emailed me the set as a video 'exercise prescription'. Great idea as a reminder of what I am trying to achieve. Some are relatively easy but some are still painful.

I can now take the splint off to shower but must wear it night and day for another 3 weeks. I can also take it off if I am sitting still, for example watching the television. The two scars are healing well and are very neat. The trapeziectomy scar is about 5cm and the ulnar scar about 10cm!

 

[Jaycey]

Sounds like you are making real progress @EmEm ! Keep up the good work. You are one brave lady going through all this!

 

[EmEm]

Six week update.
I saw the hand therapist on Friday to monitor how I was getting on after the trapeziectomy. I explained the splint was uncomfortable and that for the past five days I had only been wearing it at night and outside. She promptly took the splint from me and put it in the rubbish bin! Apparently I had weaned myself off the splint and no longer needed it. I still need to do the exercises for my thumb but we are both pleased with how much I can move it.

Next step is driving which I have been cleared to do but want to try it somewhere quiet before I do a longer journey. After my wrist fusion in 2016 I drove round an empty supermarket car park but now, in the run up to Christmas, they are never empty!

The osteotomy scar has healed well but it's difficult to tell whether that procedure has improved the pain on that side of my wrist because it still aches. Early days because this is equivalent to recovering from a broken bone.

 

[Jaycey]

Wow - great progress @EmEm ! Maybe a practice drive on Christmas day? Thanks for the update!

 

[Jamie]

Thanks for providing your updates, @EmEm. I hope things continue to improve for you and I'll look forward to another report in February or even sooner if you would like to post before your appointment.

 

[EmEm]

@Jaycey, @Jamie thank you for your kind comments and continued support.

I saw the surgeon yesterday, 9 weeks since surgery, and had an x-ray to check my progress. We are both pleased by my recovery and the range of movement and dexterity I have regained since the trapeziectomy. I acknowledged the encouragement of the hand therapist who set realistic goals, as vital in my recovery and the surgeon congratulated me on the effort I have put in!

The osteotomy has healed well and the surgeon is hopeful that has put an end to the pain in that area. He mentioned that the plate may cause irritation in the future because it is near to a tendon and eventually may have to be removed. This was mentioned pre-surgery and is not worth worrying about now.

The surgeon would normally see patients for a six month review but we both felt it was unnecessary and he discharged me from his care on the understanding I could get in touch if I had any concerns in the future.

After joint surgery in 2016, 17, 18 and 19, I hope for a better year!

 

[Jaycey]

@EmEm Another great update - well done! Yes, here's hoping 2020 doesn't include any more surgery! Time to get back to living again.

 

[Jamie]

Congratulations on this good news. I agree you've had quite enough surgery for a while. I hope you are now able to just enjoy all those repaired joints in peace.

 

[EmEm]

A quick update of my progress following the trapeziectomy and ulnar shortening osteotomy 6 months ago. I noticed @Grammyof2 is having the same thumb surgery and reading my thread might help.

The surgery has been very successful and I can mark my progress by how much gardening I have done this year. It's not my dominant hand but having a thumb that is almost completely pain free makes most gardening tasks possible. All the additional time I have had since the UK lockdown started has meant being outside every day.

The osteotomy has also made a big difference. I do have a restriction on how much I can carry with that hand but can still manage a watering can!

 

[Grammyof2]

And here I am, reading about your surgery adventures! Your recovery and the hard work you put in to make it happen are inspiring.

 

[Jamie]

Thanks, EmEm!! Updates are always good to help others. Glad you're doing well and continuing to improve.