Latest news

I keep seeing some improvement regularly. Above are the latest pictures. The top one shows my hand extended as far as I can get it at this point. So you can see I am not back to normal yet. I also still don’t have full strength. I sometimes can and sometimes can’t open a new milk bottle etc. But I am still gaining on it.

Still gaining on it

I am at 16 weeks now and still gaining every day. The Dr. says that the tendons should be as strong as they are going to get. They cannot be damaged from normal usage now. I am still gaining strength and mobility. I still have a long way to go before I'm back to what used to be normal. The scars are healing quite nicely and are not very noticable. I will post more pictures when I can.

Graduation day!

I had an appointment with the Dr. yesterday. He said no more splint. I have been wearing it at night. He said, no more therapy. He said, you don’t need to come back and see me, but if you can stand it, I’d love to see how you are doing in 3 months. The therapist said I was probably the only person who ever actually did the exercises they told me to do. They were quite impressed with my progress. I don’t have to continue exercises however I do feel my hand/wrist getting stiff and do the exercises occasionally to loosen up. I can type with all 10 fingers. I played guitar in church and even finger picked. It is still a bit awkward but I’m gaining on it. I’ve been driving for over a week now and it just gets easier. The strength is not back yet. I still can’t lift more than a couple of pounds but they said that is the last to get back. They said just live normally and all of that will come back. The Dr. said that the place where he sewed the tendons together are not quite at full strength yet but will be in another month.

It has been a long haul. Carol has been the ultimate trooper, driving me everywhere, doing everything for me and taking care of me. Now she can relax a bit.

Almost there

I have been without splint now for a couple of weeks. I only wear it at night. I have gained a lot of use back. I am typing with all 10 fingers although it is still a bit awkward. I can use my right hand for a lot of things I haven’t been able to do for some time. I can write. I can use fork and spoon. I can do light cutting (with a knife). And best of all, I can drive. I am going to start playing guitar again tomorrow at church. My therapists say that they are amazed at how well I am doing. I tell them they’ve given me so many exercises to do that it takes me 30 minutes out of every hour to complete them. I am pretty good at doing them too. They said, maybe 4 more weeks of therapy. A man came into the Hand Clinic (where I go for therapy) the other day who had had tendon transfers in his wrist as well. He still had the big splint and bandage on. I think he had had his surgery within the past week. He had been bitten by a shark! We talked a bit. I told him, “Do the work!”

We have started to work on strength training and I am gaining quite a bit every day.

Gaining on it!

I am only wearing the splint at nights now. With therapy and hourly excercises, we are working the hand and arm. Though I still have a long way to go, I have gained a lot of mobility back. I don't have dexterity yet but I think that will come along. We have started working on gaining strength back now. I can do a bit more each day. I still can't drive yet but I think it won't be long.

I'm gaining on it.

I have been doing therapy. I am gaining a lot of mobility in this arm. I still cannot do much with it but have more mobility than I have had in a long time. Exercises all involve stretching tendons & moving the hand and wrist. I am 3 weeks into therapy and the Dr. said 8-12 weeks of therapy. The pictures above show the exercises I am working on. Once an hour, I do a series of exercises. I have been using the new connections and the therapist exclaimed about what a great job Dr. M. did. Streightening out my fingers and thumb is the motion I had lost and you can see in the pictures how that works. You can also see how the splint has been cut down to allow more movement.

Healing

Yesterday we went to the hand clinic where I will have therapy when the time comes and they removed the big cast like bandage and created a splint. The best part is I can take it off and wash my hand and arm and put lotion on. In two more weeks I should start therapy to learn how to use my hand and fingers again. I'm getting there!

You can see the splint that was created for me and the incisions on the back and underside of the wrist.

Stitches are out

The stitches are all out; 11 in the top incision, 15 in the incision on the back of my wrist and 11 in the incision on the inside of my wrist. That combined with the first surgery at 17 stitches that makes a grand total of 54. I have a slightly smaller bandage and splint on and am scheduled for my first therapy session on April 20. That is a lot sooner than I expected.

I go back to work tomorrow but am still not driving so Carol gets to play chauffeur.

Top incision

There is not much pain any more. You can see where the scar from the first surgery was longer and how it healed. There are at least two more incisions under the bandage. All stitches will be removed on Wednesday and the bandage replaced, possibly by a cast, which will stay on for 4 more weeks. The visible incision has 11 stitches (first surgery was 17). I don’t know about the others. Don’t know how many incisions or stitches. I will send more pictures after the next DRs visit.

1 week after 2nd suryery

The top white bandage will come off tomorrow and it will go unbandaged most of the time. He cut along the same scar on top but it was not as long. About 1 inch shorter than last time. The arm is a little achy at times and when that happens I prop it up on pillows. I will go back to the Dr next week and he will remove both bandages and remove the stitches. Then he will put on either a cast or splint like I have now and it will stay on for 4 weeks. Then to occupational therapy for 8-12 weeks. My fingers are a touch freer now but I can only bend the outer 2 knuckles. I can not use them for anything yet. I am not supposed to lift with them and they hurt a bit even with light pressure. I signed my signature with my left hand yesterday…not pretty!

After surgery

Here's the low-down on Lisa's surgery.we just got home about 30 minutes ago. Yes, it WAS a long day!

The surgery went well.the surgeon did what he planned to do: moved tendons & removed the "bad" section of that nerve. He didn't put a cast on it; it's more of a very thick bandage with a split under it to immobilize Lisa's wrist.

Lisa's body doesn't much care for the anesthesia.it was difficult for her to come out of it (the reason we got home so late) and she was (and still is) nauseous. They said that's mostly due to her having been sedated for almost 4 hours due to the length of the surgery.

She's resting comfortably in bed right now, and hopefully, will be able to eat a little broth so that she can take some pain medication. She's not in much pain right now.

Details

My next surgery is scheduled for Thursday, March 26. They will cut where they cut before and remove the bad section of nerve. Then they will cut two places on my wrist and move two tendons to work the fingers and thumb to replace the function I have lost with the extensor muscle. He said, I will be in a cast for 4 weeks then in a splint for 4 weeks. On week 9, I will start therapy 3 times a week for 8-12 weeks. By 6 months I should have as much motion and use as I will have. He said it will not be like it was but I will have the use of that hand.

Second diagnosis

Dr. M called today with a diagnosis. He said it is an intraneural perineruomia. It is a benign tumor. It is extremely rare. He said there is no indication that I am at any risk for this to happen to another nerve in my body. He said the chances of doing a nerve graft and having it work are slim. So he is going to remove that small section of the nerve then move tendons around to give me back the function the extensor muscles gave. He is taking that section of the nerve out for a couple of reasons; 1. that nerve will not work any more, 2. He would feel more comfortable removing it to ensure it has no way to spread up the arm and cause more trouble. I agree with him. I will feel better with it out as well. Surgery will take place on March 26.

Not what we expected

The first surgery took place on February 12. The hand surgeon, opened up the arm expecting to find a tumor inside the posterior interoseous nerve. Instead, he found a section of the nerve that was 4 to 5 times thicker than normal, hardened, and discolored. The nerve above this section was normal. The area below, as far as he could see, was abnormal. He could not graft a long enough piece of nerve to make it work so he took a section of the nerve for testing & closed up my arm. After this surgery, I completely lost all use of the extensor muscles. I could grip and still use my hand to some extent but could not extend my fingers. The preliminary pathology report said it was not cancer. We waited about a week for the next report which also told us what it was not but, once again got no diagnosis. Then a section of the nerve was sent to a neuropathology lab at the University of Pittsburgh where a Pathologist diagnosed it as an intraneural perineromia in the posterior interosseous nerve. This pathologist said, in his 20 year career, this was only the second time he had seen this.

What is it?

It is a small tumor inside a nerve in my right forearm. Dr. M, a hand surgeon is going to operate to remove it on February 12. It is to be outpatient surgery and should only take 2 hours sometime in the morning. He said I should be able to go back to work the following Monday. Best case scenario, they will be able to remove the tumor easily and I will start regaining the use I had lost within a week. Worst case scenario, it will be so intertwined with the fibers of the nerve, he will have to cut that portion of the nerve out and graft another section into that area. Obviously, that would take far longer to heal. He said it was highly unlikely that the tumor is cancerous as it is very slow growing but they would not know that for sure until they got results from the lab.

It will be nice to get my right hand back.

Discovery

Sometime during mid 2007, I started to notice that my right hand, my dominant hand, was losing some mobility. I could stretch the thumb on my left hand further than the thumb on my right hand. I watched over several months and noticed it was getting progressively worse. When it started getting somewhat awkward to pick up things, like a pencil, I decided I needed to talk to the doctor. In December of 2007 I spoke with my primary care physician who referred me to a neurologist.

The neurologist scheduled me for MRI's of the brain, neck, and brachial plexus nerve (a nerve that runs down the neck into the arm). He also scheduled me for an EMG, Electromyogram, a test that is used to record the electrical activity of muscles. They used a machine to send electrical pulses through certain muscles in my arm & test how well the muscles conducted the pulses. Yes, it felt like I was being shocked and was a bit uncomfortable. They also put needles in those same muscles to listen to the signals as they passed through my arm. (Also not a fun experience.) The MRI & EMG showed nothing abnormal. This doctor also sent me for occupational therapy, thinking that might help. After several weeks of OT, the hand was not getting better. In fact it was significantly worse.

So I got sent to another neurologist, this one at Jackson Memorial. A little over a year after I first asked a doctor about this problem, I walked into Jackson Memorial. This neurologist also did not recognize the symptoms so called in a colleague. His colleague asked some questions and said that it was the posterior interosseous nerve. This is the nerve that works the extensor muscles of the hand. He sent me for another MRI and, you guessed it, another EMG. Fortunately this time they found something.

Introduction

Over the past 2 years I have gone from noticing something wrong with my right arm to getting a diagnosis & through two operations. This is a blog to document what I have gone through.