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Hand surgery LRTI (ligament reconstruction/tendon interposition)

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Posted 3/4/2017 7:28 AM (GMT 0)
Hello fellow hand surgery recoverers (or anticipators). I'm starting a new thread to trade recovery experiences and progress. I'm anticipating surgery in mid-March and (living alone) am trying to work out the logistics for me and my three cats. The plan is to cook casseroles etc in advance, have my meds filled and ready to start postop, borrow an ice machine from a friend, and lay in for the siege. My car is a 5-speed, so driving's out until the splint comes off at two weeks..

Has anyone done this solo? Honestly I don't want people around when I'm feeling lousy. I'm planning to have it done using a Biers' block (regional anesthesia, not an axillary block) and prefer to avoid any sedation. The surgeon tells me that most people who have this done manage with little or minimal pain medication, although the rehab is long

Any feedback about what worked for you? Thanks...

Barbara/San Francisco
Posted 3/31/2017 2:52 AM (GMT 0)
Hi Barbara. Did you have the surgery? I had mine done on my left thumb on 2/28. The splint was removed a week later, everything was checked and determined to be ok. They removed the stitches and put a fiberglass hard cast on immediately. I will have the hard cast removed on 4/12 and they will remove the two pins. On 4/13, I start the rehab.

How is your progress?

Bryant (Horseheads, NY)
Posted 3/31/2017 3:46 AM (GMT 0)
That is great news, Bryant. So your immediate post op recovery was not difficult? I'm glad to hear this after reading so many horror stories. I'm wondering if they are exaggerated? or had questionable surgical technique?

I had my left thumb surgery on Mar 16 and had the sutures removed 10 days later. 'Was in a soft splint till I could see the hand therapist (2 days). She made me a custom fiberglas splint and started me on gentle exercises. I'll see her twice a week for 4 weeks, then return to see the surgeon for follow up. (I would not recommend that this surgery be done by anyone other than a board-certified hand surgeon).

Immediate post op was not too bad. I managed on tylenol and codeine for a few days and then went to advil. I'd set up my place with food and supplies so that helped.

I asked my surgeon about using pins (K wires). He doesn't use them; 'says they can provide an opening for infection. I wanted to stay awake for the surgery but chickened out after a couple minutes of the pneumatic tourniquet. That really hurt. But I went home an hour or two after waking up from versed and whatever else I had. Not a big deal.

Good luck, and keep me posted!
Best,
Barbara/San Francisco
Posted 3/31/2017 2:13 PM (GMT 0)
Glad you both are doing ok. smile
I got my fiberglass cast removed this past Monday and a molded plastic splint put on then. It's a bit uncomfortable but my incision is still temperamental right now.
I started therapy by doing exercises at home/work. I have a desk job and its hard NOT to want to type and write too much.
I see the doctor again on the 24th.
Its a long recovery process. sad
Posted 4/1/2017 12:38 AM (GMT 0)
hi Cannoka - Alas, it is a long recovery. when did you have your surgery? Are you having trouble typing with the splint on? Did you have a full circular cast on at first? (Mine was a split splint with a ton of ace wrap holding it on - it was great to get that thing off). Being a stubborn cuss, I never stopped using the hand and moving the fingers. My doc says "don't overdo the exercise; go slowly."

I'll upload some photos of my hand as of today (two weeks + 1 day post op). I had the splint made on Wednesday and took it off today to have a look at a "hot" spot. Sure enough, there's a [very small] beginning blister at the base of my thumb, so I'll put some mole skin on to protect it. 'Also have some numbness along the radial nerve distribution (inner aspect of the thumb) from instrumentation during surgery. No doubt that will fade as the swelling goes down. But no pain.

Best,
Barbara/San Francisco

PS - have been trying to upload photos, no luck. Using Safari - any suggestions ?

Post Edited (cavedivingwoman) : 3/31/2017 10:09:57 PM (GMT-6)

Posted 4/6/2017 3:45 PM (GMT 0)
Barbara,
I had my surgery March 2. I was in the half splint with the ACE bandaging as well. I wore that until the 13th then had a fiberglass cast put on. I wore that until the 27th. It was removed and I was fitted with this annoying custom removable splint. I only wore it for a week when I went back yesterday to have my doctor check my incision as I thought the splint was irritating it, even with wearing one of those socks. He said the incision looked good but took me back over to the therapist to have them put foam padding inside the splint where it was causing pressure on my incision. He said I will still have pain until everything heals. Can't come soon enough.
I try not to type too much with my bad hand. Writing is still a work in progress. My thumb lets me know when its had enough.
I am concerned I will not have the range of motion I had before everything went south. My thumb just seems tighter and more rigid than before.

Kathi
Posted 4/6/2017 9:00 PM (GMT 0)
Hi Kathi - I'm really sorry that you're still having pain a month out. It's discouraging, I know. My hand therapist is amazed that I'm comfortable and says that most people are not at this point (3 weeks). So unfortunately what you're experiencing is "normal" or expected.

Here is where you need to be assertive. Ask your hand therapist to fashion you a new splint that fits, not just patch it up. It takes just a few minutes. If it's just chafing over the hot spot you could try a patch of moleskin (such as is used for blisters). That helped me. But if the splint is too tight, that won't help. Personally I'd rattle her cage (nicely but firmly) but that's my style. I worked as a critical care RN for years and understand the system. If you settle for "just OK," no one else will advocate for you.

Hang in there, and see if you can work with your therapist. Are you using a heating pad for relief? For work, you might check into a microwaveable pack. Everyone is different but heat was the only thing that really helped my (pre surgical) pain, which was considerable. It also increases local circulation and encourages healing. Heat it up!

Keep me posted, OK? Good luck.
Barbara
Posted 4/6/2017 9:20 PM (GMT 0)
an update for me: Three weeks post op today and pain free (non dominant hand). The incisions closed cleanly and smoothly. There's some anesthesia (numbness) on the inside of my thumb, which is common and will fade.
The hand therapist says all I can do at this point is apply a hot pack and incision massage (along with flexing and extending the thumb and fingers). I can do that anywhere so I'm saving up visits for when exercise can start.

The only soreness I've had was after a hike last weekend when I let the arms hang down (swelling). Some advil and rest fixed that right up, but I'll support it with a sling next time.

I work as a medical journalist and have not had a problem typing. I emailed my surgeon asking his blessing to swim laps, do limited gym workouts, and yoga. I'd also like to try some light chores without the splint and within reason (no weight loading on the joint). We have the first decent ski season in 10 years here in CA but I missed it. My real sport is scuba diving, especially in underwater caves. I'm hoping to be diving again in a couple of months (probably limited and having help with tanks). Just putting my gear on (especially thick neoprene gloves for our cold Pacific waters) has been wretched for a few years, so I'm looking forward to some pain-free dives!

Please keep me posted as to what you're doing. Bryant, how are things with you?

Barbara
Posted 4/26/2017 9:29 PM (GMT 0)
I have been a dental hygienist for 33 years. I had carpal tunnel surgery a long time ago. Some years ago I started having pain in my basall joint. I went to my hand specialist who informed me I had developed arthritis, due to breaking my thumb a long, long time ago. She said one day I would have to have reconstruction surgery. She also said she didn't want to do it til the pain was unbearable, because she couldn't guarantee I would be able to do dental hygiene anymore. Meanwhile, it has progressively gotten worse, with other joints in my hands developing arthritis. I now have a mucous cyst on my left hand middle finger, and am having surgery to remove it next month. I guess my main concern is what will I do if I can't do dental hygiene anymore, and if not, could I qualify for disability. Especially considering it is in both hands. The pain in my thumb is considerably worse and even everyday functions are affected.
Posted 4/26/2017 10:14 PM (GMT 0)
Hello, Dentalgal, and welcome!

Do you know exactly what surgery you'll be having? Is it the LRTI? If you're having bone on bone pain, you might be surprised how much relief you will get from having that "shock absorber" in place once again. Or is it only the mucous cyst you'll have removed?

After many discussions with my hand surgeon, other surgeon friends, and the hand therapist, I've concluded that the surgeon's skill and experience determine results, in addition to proper aftercare. Is your surgeon a board-certified hand surgeon? How many of these procedures has she done? What results can she anticipate for you? Do you have a picture in your mind of exactly what the procedure is? What can you expect for the first few days postop? When does the immediate postop pain resolve? How long will yo be splinted? Will you have pins (K-wires)? When can you start therapy? And so on.

Have you called your disability office to see what benefits you qualify for?

Let us know.
Best,
Barbara
Posted 4/26/2017 10:22 PM (GMT 0)
Hey cavedivingwoman! I will be having the bone removed and tendon transplanted in its place. But the mucous cyst is a new development in my left (non dominant) hand. Only having the cyst removed. It has ruptured once, and my Dr doesn't want to take a chance on infection in the joint. My Dr wants to put off the thumb surgery as long as possible, but I have a feeling it won't be too far in the future.

Post Edited (Dentalgal) : 4/26/2017 4:25:27 PM (GMT-6)

Posted 4/26/2017 10:27 PM (GMT 0)
Dentalgal, I don't know anything about the mucous cyst. But all I can say about the LRTI is that I wish I'd had it done two years ago. I read too many horror stories on the internet describing extended pain and disability. My surgeon assured me that I'd have minimal postop pain. It helps that I've known him for a long time and that his reputation in SF is unsurpassed. He was right. 'Just some moderate discomfort/pain for a few days post op, then steady improvement.

When do you have your LRTI? Is the cyst surgery superficial only?

Barbara
Posted 4/26/2017 11:59 PM (GMT 0)
@cavedivingwoman Yes my surgeon is a board certified hand surgeon. All she does is hands. She did my carpal tunnel release also. My sister works for her, and she is great. We haven't gotten to specifics yet other than the basic stuff, like she told me she would take that bone out, splice the tendon and put it in that place, she is worried I won't be able to clean teeth anymore afterward. So we will see. I am gonna be long into the disability stuff so I can have my ducks in a row. I'll keep us posted! The cyst is coming from the arthritis in the distal joint in my left middle finger. It is filed with fluid from the joint. She will take the cyst out, sack and all, which is the only way to keep it from coming back. It's not a big surgery, but necessary to keep the joint from getting infected

Post Edited (Dentalgal) : 4/26/2017 6:24:22 PM (GMT-6)

Posted 4/27/2017 4:40 AM (GMT 0)
Ouch @Dentalgal.It hurts just to read this! I am curious as to why she does not anticipate a full recovery - the surgery has a high success rate. It's >98% I think. But it sounds as if you have a lot of pre-existing arthritis and inflammation going on. At this point it sounds like you're pretty much impeded already by the pain and limited mobility. Does your surgeon believe that surgery could make things worse?

'Just finished up a round of exercises (started the real rehab on Tuesday). Now the hand aches. Heat helps more than anything sad But it's as important as the surgery to achieve a good result). But ouch.
Posted 4/27/2017 11:30 AM (GMT 0)
She anticipates total pain relief and recovery as far as daily function goes. Im a dental hygienist and when I am cleaning someones teeth all the pressure and force is on my thumb. She's just not sure how much strength I will have because of that. But I already have lost alot of strength, so Im thinking it won't be long before I have to have to go ahead with surgery. I hope everything goes well with your rehab!
Posted 4/28/2017 5:38 AM (GMT 0)
It sound like you have little to lose. Regaining strength is one of rehab's purposes. The problem is that it takes time especially after splinting.

I can see where the pressure would be mostly on your thumb when scaling, scraping, etc. 'Sounds like it's time for serious consideration. Maybe start PT before surgery to minimize muscle/strength loss?
Posted 5/3/2017 8:54 PM (GMT 0)
How is everyone doing?
Barbara, how is your therapy and recovery?
I am near the end of my 4 weeks of therapy. I still have a very sensitive area near the incision site but my range of motion is much better. I have been working a little on my dreamcatchers but after about 45 min of weaving my hand says enough.
My doc said to wean myself off of the splint and I don't have to sleep with it on anymore! But, I still need to wear it when gardening, etc.
I only hope my left thumb never has the same issue the right one did. I am not one to be idle, even if it's recovering from surgery.
Everyone have a great weekend! smile
Posted 5/3/2017 9:03 PM (GMT 0)
Hi Kathi - That is great news! It sounds like you are coming out the other side of the wormhole. I'm still in the middle - just starting therapy with some pain...lots of ibuprofen and heat for me. I wear the splint occasionally but it's off most of the time. I have a cave diving trip scheduled for the first week in June. The diving part is easy but getting in and out of the water with 100# of tanks is not. I will also need my buddy to run the guidelines for the team. But I'll be happy just to get in the water. If I can't lift tanks, I'll just paddle around the river with my snorkel and enjoy the company!

So glad you are doing well. How's everyone else? Dentalgal, are you hanging in?

Best,
Barbara
Posted 5/8/2017 5:33 PM (GMT 0)
Hi Barbara,

I'm so happy that you are doing well.

I started rehab on April 13 (surgery was 2/28) and have been going once per week since then. The therapist said that once per week was enough as long as I kept up with my "homework" of doing my own therapy between visits. As of May 3rd, he said that I was in the "top 5%" of recoveries and added, "just don't mess it up". However, he said that I am beyond causing injury that might require repair. It is still generally sore, but the bones where the pins were attached are feeling almost right and I did not have any infection from the pins, but it was certainly a possibility.

Also, in my case, the therapist did not construct any of my casts. The initial splint was done while I was coming out of surgery (I don't remember it) and a week later the hard fiberglass cast was done by a Physicians Assistant who I had been working with throughout this. The actual surgery was done by a Board Certified Orthopedic surgeon who has been doing this for a very long time. He and the PA work closely together with each patient.

This Wednesday, I will have another visit with the therapist and he will take measurements and file his report with the PA in time for my visit to the PA on Thursday.

I have been gradually bearing more weight and stress on the thumb and hand and I notice strength improvements every day. There is some stiffness and soreness, but I expected a long recovery. Also, I am 67, so I am sure that my age has an impact on my healing speed.

I have a lot of yard work and vegetable gardening coming up, so I need to be ready!

All the best to you on your trip!

Bryant
Posted 5/9/2017 1:57 AM (GMT 0)
Has anyone received ssd for osteoarthritis and bilateral pulley release surgeries
I have other issues and bursitis.
Posted 5/24/2017 3:09 AM (GMT 0)
Hi everyone, I just had my right dominant thumb/hand surgery this morning (5/23/17). So far I am having very little swelling in my fingers, I can't see my thumb from the bandages. My pain is minimal in my fingers but my thumb is a little achy. Finger movement is good. But if I put pressure on my fingers or move my arm just so I get an excurciating muscle spasm in my fore arm where they took the tendon. Has anyone else experienced this? I didn't expect muscle spasms! They are very painful but they don't last too long.
I hope everyone else is healing nicely. If anyone has any advice or tips for me feel free to reply.

Thanks
Kathy
Posted 5/27/2017 7:58 PM (GMT 0)
Hi Kathy,

For reference, I am starting my 13th week of recovery from LRTI surgery on my left (non-dominant) thumb. I have found that there are a few different techniques used for this surgery. In my case, my entire tendon was not used as it was "split" so that part of the tendon was used and the other part remains in place. I experienced some soreness in my arm, but no spasms as you describe. I had three small incisions in my arm to facilitate the pulling of the tendon. However, everyone is different and people have varying sensations of pain and ways of describing pain. I used hydrocodone (Vicodin or Norco) to reduce the impact of pain. If you don't have any problem with short term use of a narcotic, a prescription for that that may help you. Otherwise, depending on your medical history, Advil or Tylenol may be helpful to you. Also, be sure that you are not showing signs of infection, e.g. fever, discolored discharge from the wound, bad smells, etc. It is expected that you will experience some pain up front, but it will taper off. Did the surgeon install pins to stabilize the thumb for the next several weeks? If so, that adds a little more pain into the mix as well as another way for infection to get started.

In any case, contact the doctor's office if you have questions or concerns and follow their instructions. If needed, they can see you, remove the cast, inspect the wound, then replace the cast. This is something that is fairly common for them to do.

Let me know if you have any other questions. I am not a medical professional, but have had had many personal surgical experiences and worked with others who have had similar surgeries, so I only speak from my experiences. Always speak with your doctor for medical advice.

All the best to you.

Bryant
Posted 7/15/2017 12:41 AM (GMT 0)
Hello, 'just an update to report excellent recovery/function at about 15 weeks post LRTI. I haven't gotten any updates from this thread for at least a month, so hoping that everyone is doing well.

My own recovery has been trouble-free from the get-go, which I'll attribute to my surgeon's excellent abilities and skills, my hand therapist's careful rehab, and my parents' good genes. In summary, I had a few days of moderate and manageable discomfort with rapid decrease in swelling from day 4 or 5. Even a few days post op, I felt much better than the chronic ugliness before surgery; any healing discomfort pales in comparison to what came before. All I can say is choose your surgeon well; you want to go with someone who has done many hundreds of these procedures with excellent results. Early post op it's important to keep the hand elevated, move your fingers, and be sure any bandaging doesn't constrict good blood supply. I was able to drive by day 4ish or as soon as I was off meds. I will finish up PT next week and see the surgeon for final sign off. All has gone beautifully. I no longer dread having the dominant hand done and may opt to do it sooner than later.

'Wishing everyone good healing and best of recoveries. 'Signing off for now but if I can help anyone with questions, please get in touch.
Barbara
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