This blog begins my new category for Upper Extremity Surgery and Rehabilitation including the following subjects:
- My Volar(palm side) ganglion wrist surgical resection
- Ulnar sided wrist pain aka TFCC—The triangular fibrocartilage complex (TFCC) is a cartilage structure located on the small finger side of the wrist that, cushions and supports the small carpal bones in the wrist. The TFCC keeps the forearm bones (radius and ulna) stable when the hand grasps or the forearm rotates.
- Left shoulder impingement syndrome with intraarticular partial thickness rotator cuff tear and degenerative labral tear: My arthroscopic subacromial decompression(SAD) surgery with arthroscopic intraarticular debridement
Chronologically, this blog begins in 2010 well before my Sacroiliac (SI) Joint Surgery and the launching of my website in 2013. Even though I had been suffering with SI joint problems, low back pain along with the bio-mechanical walking deficits and ongoing shin pain aka fibular pain, I also was suffering in my left arm and wrist too. The real beginning to all of my medical journey as posted thus far on this website had its roots in pursuing orthopedic surgical intervention starting with my left wrist first and progressing from there. Simultaneously, I had started care also for my TMD/TMJ jaw/head pain also in 2010 that will also be written about in near future.
History: The pain in my left wrist was on the ulnar side (pinky finger) of my wrist as my hand would deviate towards this side when picking up a pot or pan. The pain was right in front or distal to the head of the ulnar bone. I had diminished grip strength and a dull ache all the time. I did feel some nerve pain on the volar (palm) side of the wrist near the lump of the ganglion cyst.
I cannot remember any direct trauma and I would say that I had more of an accumulated effect from years of sporting activities. Growing up I had one wrist sprain that I can remember; however, falling onto my arms/wrists was a normal part of my days as a competitive roller skater back in the 60’s and 70’s as I grew up. Then I’ve had years of horse back riding and many times I would have to give the horse the side of my hand slap. Looking back this was not good either. The other contributing traumas were too whiplashes back when I was around the age of 32. My first whiplash was having my neck bent backwards by a tree branch on a trail ride; and then 2 days later on same weekend, I was thrown from a horse and landed on base of my neck between my shoulder blades in a field. I spent the decade of my 30’s always trying to maintain my neck and keep tightness and pain down mostly through chiropractic and massage care. As I write now, I can see some connections to the condition of my neck muscular wise and my body posture working against me regarding my shoulder and forearms. But back then, I had no clue of any correlations.
December 28th, 2010— my diagnostic journey began with seeing a wrist and hand specialist at Northwest Orthopedics in Spokane, WA and he ordered an MRI of my Left wrist along with a NCV/EMG nerve test of my left arm as posted in these links MRI Lf Wrist 12-28-10
My left wrist MRI was negative except for the ganglion cyst. However, the hand specialist took an extra close look at the TFCC region of my wrist(as described above) on the MRI images. He was convinced that my pain was associated with some possible unseen tears and didn’t think the cyst had anything too much to do with my pain.
December 28th, 2010 —Left Arm NCV-EMG 12-28-10 pg 1 Left Arm NCV-EMG 12-28-10 pg 2 Left Arm NCV-EMG 12-28-10 pg 3
I was told that the nerve test was negative to Cubital Tunnel Syndrome which is defined as: a condition that involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. The ulnar nerve runs in a groove on the inner side of the elbow. My test was also negative to any other nerve dysfunction that could have come from my neck due to the prior whiplashes. So it was all good news.
After much discussion, I decided that I wanted the cyst removed and to go from there in sorting out the left wrist. I was basing my decision on having a prior right handed dorsal ganglion cyst that was removed while in my 20’s. That removal did reduce pain as the pressure of the cyst was giving me some nerve feelings in my hand. And to this day, I haven’t had any other problem on the top of my right hand near where that ganglion was.
January 10th, 2011 — Northwest Orthopedics(NWOS) surgical center, left wrist ganglion resection surgery performed as discussed in my surgical record:Left wrist surgery 1-10-2011
I wore a post op bulky splint for 10 days and then the stitches were removed and I started physical therapy while wearing an OTC wrist splint. I seemed to recover just fine; but as I progressed my exercises, I still had some pain in the TFCC. A few months after the surgery, I had my very first cortisone injection into the side of my wrist in front of the ulna head. Oh my goodness, when the numbness of the injection wore off, I felt the worst intense pain ever. Far worse than my post surgical pain and I was so glad I had a left over pain pill to take. My hand literally throbbed to move it even with my splint on. I thought no wonders I was against cortisone injections if they make you feel this bad. The main reason in hindsight is the tiny space that the volume of fluid is going into. Larger joints don’t feel this bad. Over the next few months my wrist seemed to be better and I did look back with thankfulness for the injection.
As I continued to progress my arm strengthening, it became obvious that I was getting more shoulder pain doing exercises with my left arm/wrist. I saw another doctor at NWOS who specialized in shoulder arthroscopy. After his initial exam and no findings on x-rays of my shoulders, he ordered and MRI.
May 25th, 2011 — my left shoulder MRI report MRI Lf Shoulder 5-25-11
When I had my follow up appointment, he came into the room and suggested that I get a Subacromial Decompression (SAD) surgery to eliminate the bone spur pressing into the bursa and rotator cuff muscles in order to be proactive in preventing further rotator cuff injury. At this point the MRI was not showing any rotator cuff tears that needed to be repaired. He could see on the MRI that the bone was pressing into the muscle in a neutral position, let alone lifting and using the arm. He said he experienced the SAD surgery himself and described it as the least complicated post op protocol for shoulder surgeries.
July 7th, 2011 –NWOS surgical center again welcomed me for my left shoulder surgery. My surgeon did find more pathology than originally seen on the MRI such as the degenerative superior labral tear. Here is a link to describe a labral tear. Here are the pages of the surgical report:Left Shoulder Surgery 7-7-2011, 2 pages
The surgery went fine. I had bought my own comfortable sling, an older version of this link: the Don Joy UltraSling. It was my personal opinion that the attachable waist pillow was an excellent thing to have even though not required for my surgery. It felt better to have my arm abducted away from my body and the sling secured to the pillow to give added support and take the weight of my hanging arm off of my neck. Since the surgeon did not do any repairs and only debridement, I was allowed to move my arm after 24 hours. Every day I did my instructed arm exercises and the surgeon was really pleased with me at my 10 day post op appointment. He said to discontinue reliance on the sling; but that I could use it as needed to rest the shoulder. Being the summer months, I took full advantage of my backyard pool as part of my physical therapy exercising.
However to this day, I regret the Brachial Plexus regional nerve block to control pain from the surgery that was given to me against my better judgement. I just was not well researched back then and the anesthesiologist talked me into it while in pre-op before surgery. I was also having general anesthesia too. The nerve block injection was given somewhere between base of neck and shoulder. Even though I was assured everything had gone fine during the procedure, I wasn’t convinced of that in the weeks that followed after the surgery. Post op, I had immediate awareness of a lump where the block had been given as my hand went right to this spot of neck pain. In non-medical terms, it paralyzed my entire left arm and shoulder girdle and my arm felt like a dead limb that would have fallen to the ground if it had not been put into a sling. Yet I had sensations in my hand even though touching it, I could not feel anything. I was awake all night after my surgery begging God to bring back my feelings into my entire arm. I’d rather feel pain from surgery than having a dead feeling arm. It did wear off within 24 hours and still I only needed pain meds for 2 days.I felt like my entire shoulder girdle had been pulled off of my body. It was evidenced by pronounced scapular tilting/winging effect.
I am pictured above at 3 weeks and I was able to go most of the day without my sling and I only used the sling to rest my shoulder. I was pictured out in the woods of our family camping trip. I was swimming in the lake. I just was practical and careful not to over do it. By this time I had done several weeks of physical therapy too.
Over the next weeks, I would have shooting nerve pain up the side of my neck to behind my left ear. I never felt too much pain at the arthroscopic surgical incisions themselves. No one could explain this nerve pain too me. I never had nerve pain ever in my neck even with the prior whiplashes. I actually had an appointment about 8 weeks after the surgery to meet with the anesthesiologists to share my concerns regarding the nerve block and protocols. Apologies were given to me for what I perceived as the block being pushed upon me as though I didn’t have a choice to reject it. I regretted my decision to let them give it to me because I did not have peace at the time, but I couldn’t defend my reason as to why I didn’t want it. I gave into the fear of the pain that they said I would have without it instead of staying in faith. It goes back to being a victim to medical professional pressure due to lack of knowledge on my part. I really did learn a valuable lesson from that experience. Every surgery since then, I have never had any nerve blocks and I’ve done just fine with general anesthesia. After the fact, here is just one research paper on the subject: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099233/
Also at about 8 weeks or so since the surgery, I did have fluoroscopic guidance for needle placement of a cortisone shot into the joint capsule to free up any acquired adhesive capsulitis preventing me from getting full ROM in my physical therapy. After the injection, I got my full ROM and I have had it ever since. My shoulder surgeon then sent me for some Intramuscular Stimulation Therapy (IMS) aka Dry Needling into my shoulder girdle. After a series of 6 appointments my muscle spasms seemed to calm down and I wasn’t getting anymore shooting nerve symptoms up my neck and till this day I have not felt that kind of nerve pain since. I thank God it resolved, but scary none the less while I was going through it.
My patient to patient advice: As far as I am concerned and also through the advice of my acupuncturist and Natural Doctors, nerve blocks should be avoided if possible. It is risky in creating complications to the nerves. I know it can be wonderful pain control especially for those that don’t due general anesthesia very well. I just suggest a patient do complete research on the subject of nerve blocks and decide for themselves if they want to subject themselves to it. Just because it may be routine in the surgical centers, each patient has the right to decide for themselves what they will or will not accept for their body. Not everyone has days of uncontrollable horrible post op pain to risk a possible secondary problem besides the surgery itself in getting a nerve block.
This brings me chronologically to my prior blogs written regarding my ankle, fibular pain etc. as spelled out in this beginning blog for the Fibular Pain category on my website. I did continue to heal fully from my shoulder surgery and I really didn’t think much more about it as my focus shifted to my lower left leg problems going on simultaneously.
Regarding my left wrist, I researched the subject of TFCC and basically continued to do intermittent splinting when I felt any pain flare ups. Since the MRI was supposedly negative to it, I didn’t give it a second thought. As far as I was concerned, the cortisone injection had done what it was suppose to do and I was better for it along with getting the cyst out of my wrist. Here is the best website I have found for definitive conservative help for TFCC-ulnar sided wrist pain. www.wristwidget.com
Here is also a page explaining TFCC in more detail: https://www.wristwidget.com/pages/how-do-i-know
So for the next 2 years, life went on as I dealt with my two peripheral nerve surgeries in 2012, then onto my SI surgery , proximal tibiofibular surgery, and ending with HyProCure Surgery in 2013. During those years, I had no choice but to use crutches extensively along with wheelchairs for my lower extremity surgeries. Looking back, crutch walking is not a positive thing for shoulders, elbows or wrists; but at the time, I needed them to accomplish the leg surgeries. The subject of my left wrist and adding in the left elbow gets woven back into the story in the fall of the year 2013.
Today as I sit here and write my blogs, the subject of my shoulder girdle and neck have now come full circle and they will be a part of my ongoing diagnostic process to sort out the remaining issues of my left arm and wrist. It is always important to work from proximal to distal(from closet to trunk of body to end of extremity). I would be remiss if I didn’t say that I do have concern for the situation around my shoulder. And yes I am researching very much so at this point to have viable questions to ask my doctors and therapists at my ongoing appointments. Could it be thoracic outlet syndrome, long thoracic nerve issues affecting serratus anterior/scapula, humeral head instability issues, rotator cuff issues, further degeneration of spinal segments impinging upon nerve roots that make up the Brachial Plexus (click on photo to enlarge), a left over injury from the prior nerve block of the Brachial Plexus, or the shoulder AC joint itself [The AC (acromioclavicular) joint is a joint in the shoulder where the collar- bone (clavicle) meets the shoulder blade (scapula). The specific part of the scapula adjacent to the clavicle is called the acromion, hence the name AC joint]. If nothing serious then, just simple imbalances in muscles? All I know is certain positions of my shoulder/arm flare up muscles and nerves in my upper and lower arm. I feel like the entire arm has been compromised and my poor wrist gets the brunt of it all besides its own direct problems. Yet I see moments of great hope that an answer is coming.
Besides my injuries along the way of my life, I still go back to the component of Medical-Malalignment being a root to how my body has functioned with its muscles pattern built accordingly unbeknown to me until these later years of life now looking back to piece the puzzle of my dysfunctions together. Every day I work on keeping my body re-orientated and I do feel the positive results as proven in my walking gait and lack of pain in my entire back minus the area of concern around left shoulder and arm/wrist issues. Here is a link to information on long thoracic nerve and winging scapula as written up by the Neuroplax Clinic that specializes in Peripheral Nerve Surgeries of all types. An excellent website to read on peripheral nerve issues. Even though this medical journey is exhausting, my brain does enjoy staying sharp with new learning. I live a life of learning anatomy. Many patients have said to me that I should go get some medical degree. No thank you, living the journey itself is my degree!!!
So stay tuned for my next blog in the ongoing wrist and elbow/shoulder saga picking up from the year 2013 and the subsequent left elbow surgery I had on 2/16/16. For those readers that may have missed my recent spiritual journey blog, here is a link. That blog does show me having some enjoyment in life. As always, I’m available to support and listen to patients that contact me on my website or see my Facebook page.
