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Old 12-29-2011, 08:39 PM   #1
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Bilateral Basal Joint & Carpal Tunnel Surgery

I need Basal Joint and Carpal Tunnel surgery on both hands. I had nerve conduction studies for the carpal tunnel and x-rays on the basal joints. Osteoarthritis has caused such severe damage the orthopedic hand surgeon I saw is referring me to another surgeon in the practice who has dealt with this situation. He said the other surgeon may be able to do LTRI and the carpal tunnel release at the same time. I have been reading a lot of articles that say doing the surgeries at the same time is preferable. They do one hand at a time. It would mean only 2 surgeries instead of 4. Has anyone on this board had both surgeries at once? How was recovery? I've already been told I could not expect to regain full use of either hand but the pain would be gone.
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Old 12-30-2011, 07:53 PM   #2
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Re: going through the basal joint surgery process - at least, my story

I just re-read every post in this thread! I posted earlier about having LTRI and carpal tunnel surgery bilateraly. Since my last post, I have switched ortho doctors. The first doctor planned on doing 4 separate surgeries starting with the carpal tunnel and planned on having them finished by summer. I had nerve conduction studies showing carpal tunnel, but he diagnosed both basal thumb joints thru manipulation and didn't even take an x-ray. Needless to say, I started getting nervous, thinking he was being too ambitious. I also thought he was neglectful for not x-raying my thumbs. I decided to get a second opinion, and several acquaintances of my husband recommended another orthopedic group of doctors in a neighboring town. I called the recommended ortho group. They had me send all the test results, paperwork, etc and said they would call after one of their doctors reviewed it.
They called me back in a couple of days to schedule an appointment with one of their doctors. I had my appointment with their hand ortho yesterday. He read the nerve conduction study and agreed that I did indeed need carpal tunnel surgery. He asked for the x-rays, and when I told him the other doctor never took any he sent me to their x-ray lab immediately. The x-rays showed I had severe osteoarthritis damage in both hands. At that point, he said I needed LTRI and carpal tunnel surgery. He explained a little about the LTRI, but told me since the arthritis was so bad he was referring me to another doctor in their practice who was more familiar with severe arthritis. He seemed to think LTRI and carpal tunnel could be done at the same time, but the other surgeon would have the final say on that. I am set up with an appointment with the new doctor. I do have a few questions before I see him. The hand surgeon told me I would not regain all the movement I've lost, because of the damage, but they could take care of the pain and give me more movement than I have now. He explained harvesting the tendon and threading it through the drill hole and using part of it for cushioning. He didn't mention anything about screws or k wires (info I picked up after reading articles on LTRI). Did anybody on the board have temporary screws or wire holding the surgery in place? What type of anethesia did you all have, and did you have to spend the night in the hospital? I know I will hear all this from the next surgeon I see, but that is 2 weeks away and I want to know NOW! I don't want to stay in the hospital and I don't want to be put completely under. Thinking about having screws removed or wires removed in an office setting with no sedation at all gives me the creeps. Any heads up you can give would be most appreciated. I did learn on my own that getting a second opinion when you don't trust a doctor is an okay thing to do. I was really at ease with the doctor and techs and office personnel with this new group. When I left the first ortho's office I felt like a cow on a conveyor belt! I also read up on doing carpal tunnel and LTRI at the same time and that is the preferred way to do it.....keeps the surgery down to 2 instead of 4.
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Old 12-31-2011, 06:24 AM   #3
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Re: going through the basal joint surgery process - at least, my story

Quote:
Originally Posted by gingertea View Post
I just re-read every post in this thread! I posted earlier about having LTRI and carpal tunnel surgery bilateraly. Since my last post, I have switched ortho doctors. The first doctor planned on doing 4 separate surgeries starting with the carpal tunnel and planned on having them finished by summer. I had nerve conduction studies showing carpal tunnel, but he diagnosed both basal thumb joints thru manipulation and didn't even take an x-ray. Needless to say, I started getting nervous, thinking he was being too ambitious. I also thought he was neglectful for not x-raying my thumbs. I decided to get a second opinion, and several acquaintances of my husband recommended another orthopedic group of doctors in a neighboring town. I called the recommended ortho group. They had me send all the test results, paperwork, etc and said they would call after one of their doctors reviewed it.
They called me back in a couple of days to schedule an appointment with one of their doctors. I had my appointment with their hand ortho yesterday. He read the nerve conduction study and agreed that I did indeed need carpal tunnel surgery. He asked for the x-rays, and when I told him the other doctor never took any he sent me to their x-ray lab immediately. The x-rays showed I had severe osteoarthritis damage in both hands. At that point, he said I needed LTRI and carpal tunnel surgery. He explained a little about the LTRI, but told me since the arthritis was so bad he was referring me to another doctor in their practice who was more familiar with severe arthritis. He seemed to think LTRI and carpal tunnel could be done at the same time, but the other surgeon would have the final say on that. I am set up with an appointment with the new doctor. I do have a few questions before I see him. The hand surgeon told me I would not regain all the movement I've lost, because of the damage, but they could take care of the pain and give me more movement than I have now. He explained harvesting the tendon and threading it through the drill hole and using part of it for cushioning. He didn't mention anything about screws or k wires (info I picked up after reading articles on LTRI). Did anybody on the board have temporary screws or wire holding the surgery in place? What type of anethesia did you all have, and did you have to spend the night in the hospital? I know I will hear all this from the next surgeon I see, but that is 2 weeks away and I want to know NOW! I don't want to stay in the hospital and I don't want to be put completely under. Thinking about having screws removed or wires removed in an office setting with no sedation at all gives me the creeps. Any heads up you can give would be most appreciated. I did learn on my own that getting a second opinion when you don't trust a doctor is an okay thing to do. I was really at ease with the doctor and techs and office personnel with this new group. When I left the first ortho's office I felt like a cow on a conveyor belt! I also read up on doing carpal tunnel and LTRI at the same time and that is the preferred way to do it.....keeps the surgery down to 2 instead of 4.
Hi Gingertea,

Good that you got yourself a 2nd opinion.

I did not have any drilling, screws or wires.

I had anethesia which is administered by ones weight at the time of the operation.

I stayed overnight in hospital as my surgeon advised me to so he could give me a cocktail of painkillers which included a low does of morphine. I have no regrets about that.

If I was in your shoes, I would want anethesia as there will be quite a bit of pain involved in this operation. If you are worried about the anethesia you need to discuss it with your surgeon.

I remember reading here on this thread quite a few posts about drilling & screws & wires.

Sorry I cant be of more help to you & wish you good luck.

Let us know how you are doing & what you have decided.

Haydena.

 
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Old 12-31-2011, 07:38 AM   #4
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Re: going through the basal joint surgery process - at least, my story

Hi Ginger Tea: I am 5 weeks out from basal joint/tendon transfer surgery on my dominant hand. Like Haydena, I had general anesthesia, stayed one night in the hospital for pain management, and had no screws or wires, just a non removable splint which was just taken off earlier this week. I think that you really should consider staying in the hospital overnight. I was highly sensitive to the pain medication they gave me, Dollitid instead of morphine because I developed a rash from the morphine, and I was extremely ill from the anesthesia. If I had not been on the hospital IV I would have become dehydrated from the vomiting and that is dangerous. In my case, I stopped vomiting as soon as I stopped using the pain pump and really never experienced a great deal of pain. I took extra strength Tylenol capsules for a few days after the surgery, and very rarely after that. Now I only have tenderness around the incision spot, and have ordered Arnica cream per Haydena's advice (my surgeon confirmed it's usefulness). Even though my thumb is still swollen and stiff, I can tell you that there is no more of that grinding sharp pain that I suffered through for 2 years prior to surgery. I am optimistic for a complete recovery although I know that it will take months to develop strength there. My other thumb is just as bad, but I'm going to beg my surgeon for one more cortisone injection and pray that I can hold off on having that surgery until next year at this time. I'm lucky to be a unionized employee and will be able to take 3-4 months off again at that time. Don't be afraid of this surgery! It is so worth it! The only thing I wish that I had done differently was to have already had that supply of Arnica cream on hand, like Haydena had recommended, as it is not available in the drugstore here and I have to wait at least 4 days now to have it shipped to me. If your surgeon is going to use a wire or screws, I'd find a different hand specialist. People who have had the K-wire say that it was very uncomfortable. Best of luck to you.

Last edited by ADKLADY; 01-01-2012 at 12:51 PM.

 
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Old 01-02-2012, 11:18 AM   #5
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Re: going through the basal joint surgery process - at least, my story

Just to clarify....the doctor didn't say anything to me about screws or wires. That is just information I picked up from reading posts on this board!

I see a new surgeon on Jan. 13. The hand surgeon I saw said my arthritis was so bad he wasn't the best one to do the surgery. I am seeing another doctor in the practice who is more familiar with my problem.

If I was a patient person, I would wait until I discuss the surgery with him. But being the curious type, I've been reading everything on LRTI I can find.
I will be ready to challenge him if he mentions screws or wires!!!

I need carpal tunnel surgery too, and according to the articles I've read they should be done at the same time. If you need ct and lrti neither surgery would be successful if they don't do them both. I've been trying to find someone on the board who has had them done at the same time.

Thanks for all your info, if you have anything else you think I should know I'd be glad to hear it!
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Old 01-02-2012, 12:07 PM   #6
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Re: going through the basal joint surgery process - at least, my story

Quote:
Originally Posted by gingertea View Post
Just to clarify....the doctor didn't say anything to me about screws or wires. That is just information I picked up from reading posts on this board!

I see a new surgeon on Jan. 13. The hand surgeon I saw said my arthritis was so bad he wasn't the best one to do the surgery. I am seeing another doctor in the practice who is more familiar with my problem.

If I was a patient person, I would wait until I discuss the surgery with him. But being the curious type, I've been reading everything on LRTI I can find.
I will be ready to challenge him if he mentions screws or wires!!!

I need carpal tunnel surgery too, and according to the articles I've read they should be done at the same time. If you need ct and lrti neither surgery would be successful if they don't do them both. I've been trying to find someone on the board who has had them done at the same time.

Thanks for all your info, if you have anything else you think I should know I'd be glad to hear it!
HI Ginger Tea,

I do understand your curious mind but I think you should wait until you see your doctor to ask him all the questions you are concerned about. Once you have that information by all means share with us.

Its always better to hear straight from the horse's mouth !!

I don't know anything about screws & wires except they are kind of old fashioned.Nor do I know much about CT.

I hope you wont take offence to me telling you the above. Hang in there & wait to hear what the surgeon tells you. You are under no obligation to have your operations done by him & you are free to search your area for other hand surgeons.

Let us know please what the outcome of your next appointment is.
Good luck.
Haydena.

Last edited by Haydena; 01-02-2012 at 12:10 PM.

 
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Old 01-02-2012, 05:15 PM   #7
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Re: going through the basal joint surgery process - at least, my story

Good advice, Haydena!

I started with another ortho group, so this is my 2nd opinion doctor. The first doctor I saw glanced at the nerve conduction studies I had for CP. He said they were abnormal. He manipulated my thumbs and confirmed arthritis, but never even took an x-ray. He wanted to do 4 surgeries. He made me so uncomfortable, I knew I needed to get out of there.
I really liked the new surgeon I saw. He actually looked through the reports and made notes on them and spent a lot of time checking out my thumbs. The next thing he did was send me for x-rays. After he saw the damage, he referred me to another surgeon more experienced with arthritis. I really liked the doctor I saw and my gut feeling was I could trust him.
I looked up the new surgeon and saw he has very high ratings from his patients, so I'm hopeful that he'll be the right doctor! I'm just anxious to find out what he plans as far as surgery goes. I've read too may different posts about the same surgery. I know I'm getting ahead of myself.....I need to quit reading every post and just re-read the paperwork about LRTI that was given to me by the doctor. It's written by the American Academy of Orthopaedic Surgeons. It's very straightforward and mentions nothing out of the ordinary like I've read in these posts about screws and wires. Guess I will just stop looking for trouble! I will let you know what the next surgeon tells me. Thanks again!
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Old 01-03-2012, 11:09 AM   #8
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Re: going through the basal joint surgery process - at least, my story

Quote:
Originally Posted by gingertea View Post
Good advice, Haydena!

I started with another ortho group, so this is my 2nd opinion doctor. The first doctor I saw glanced at the nerve conduction studies I had for CP. He said they were abnormal. He manipulated my thumbs and confirmed arthritis, but never even took an x-ray. He wanted to do 4 surgeries. He made me so uncomfortable, I knew I needed to get out of there.
I really liked the new surgeon I saw. He actually looked through the reports and made notes on them and spent a lot of time checking out my thumbs. The next thing he did was send me for x-rays. After he saw the damage, he referred me to another surgeon more experienced with arthritis. I really liked the doctor I saw and my gut feeling was I could trust him.
I looked up the new surgeon and saw he has very high ratings from his patients, so I'm hopeful that he'll be the right doctor! I'm just anxious to find out what he plans as far as surgery goes. I've read too may different posts about the same surgery. I know I'm getting ahead of myself.....I need to quit reading every post and just re-read the paperwork about LRTI that was given to me by the doctor. It's written by the American Academy of Orthopaedic Surgeons. It's very straightforward and mentions nothing out of the ordinary like I've read in these posts about screws and wires. Guess I will just stop looking for trouble! I will let you know what the next surgeon tells me. Thanks again!
Hi Gingertea,

You are being sensible by not reading everything you can on the internet about your future operation as it can drive you crazy. There is just so much on the internet which can make your mind spin!!

Great that you get good vibes from your surgeon, trusting him is a very important step forward. Being able to ask him any question you want is also very good. Never forget, its your body & you are in charge!

You have'nt got too long to wait until your next appointment, so hang in there & I look forward to reading your follow-up post.

Take care.
Haydena.

 
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Old 01-05-2012, 07:23 AM   #9
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Re: going through the basal joint surgery process - at least, my story

I have a quick question....my doctor told me after they remove the trapezium bone they send it to pathology to be biopsied. Is that standard practice?
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Old 01-05-2012, 09:29 AM   #10
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Re: going through the basal joint surgery process - at least, my story

Quote:
Originally Posted by gingertea View Post
I have a quick question....my doctor told me after they remove the trapezium bone they send it to pathology to be biopsied. Is that standard practice?
Hi Gingertea,

I think your doctor is taking precautions by sending the trapezium bone to be biopsied.It makes sense to me.
If you are concerned about this I suggest you ask him.

Haydena.

 
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Old 01-06-2012, 06:39 AM   #11
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Re: going through the basal joint surgery process - at least, my story

Hi GingerTea: my surgeon didn't mention that he sent the bone in for a biopsy, but maybe it is standard procedure. When you find out the answer to that question, I'd be interested in the answer.

 
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Old 01-12-2012, 07:10 PM   #12
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Re: going through the basal joint surgery process - at least, my story

I hope the third time is the charm. I am seeing the 3rd surgeon (and the one that is supposed to do my surgery) tomorrow morning. Hopefully I can get some questions answered. First surgeon barely looked at nerve conduction report for Carpal Tunnel and didn't even take an x-ray for my osteoarthritis. Said he needed to do 4 separate surgeries. Found a new group of highly recommended orthopedic surgeons and had an appointment with their hand surgeon. He took x-rays of the osteoarthritis and looked at the nerve conduction studies. He said I needed the basal joint and the carpal tunnel surgery, but they would do the 2 together to save me 2 surgeries. After he saw the severity of my osteoarthritis on the x-rays, he wanted me to see another doctor in their practice with more experience in arthritis. Finally, I should get some information on what I can expect...and hopefully get an opinion on which hand to do first. My right hand crunches every time I try to write, but my left arm gets shooting pains then goes numb. I am right handed so I'm leaning on having the left done first, so I know what to expect when I get my dominant hand done.
I hope this doctor has all the answers!
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Old 01-13-2012, 04:16 AM   #13
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Re: going through the basal joint surgery process - at least, my story

Quote:
Originally Posted by gingertea View Post
I hope the third time is the charm. I am seeing the 3rd surgeon (and the one that is supposed to do my surgery) tomorrow morning. Hopefully I can get some questions answered. First surgeon barely looked at nerve conduction report for Carpal Tunnel and didn't even take an x-ray for my osteoarthritis. Said he needed to do 4 separate surgeries. Found a new group of highly recommended orthopedic surgeons and had an appointment with their hand surgeon. He took x-rays of the osteoarthritis and looked at the nerve conduction studies. He said I needed the basal joint and the carpal tunnel surgery, but they would do the 2 together to save me 2 surgeries. After he saw the severity of my osteoarthritis on the x-rays, he wanted me to see another doctor in their practice with more experience in arthritis. Finally, I should get some information on what I can expect...and hopefully get an opinion on which hand to do first. My right hand crunches every time I try to write, but my left arm gets shooting pains then goes numb. I am right handed so I'm leaning on having the left done first, so I know what to expect when I get my dominant hand done.
I hope this doctor has all the answers!
Hi Gingertea,

Sounds like you have found the right doctors for your hands. I hope you get the answers you are looking for.
Let us know the outcome of your appointment today & I wish you good luck.

Haydena.

 
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Old 01-13-2012, 05:31 PM   #14
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Re: Bilateral Basal Joint & Carpal Tunnel Surgery

gingertea,

here's my post from my thread, had what you are describing yesterday


Re: Driving after Basil Thumb Surgery
hi dorothy,

have to type lowercase, left hand is useless

this an excerpt of an email to my work, not up to too much typing yet, surgery was yesterday

surgery went fine. doctors and nurses were great. home now and trying to figure out length of recovery. lots of pain since the doctor actually did two hand surgeries at the same time. did the reconstruction of the thumb with removal of the arthritis and trapezoid bone. trapezoid bone was replaced with part of one of my tendons from forearm. and carpel tunnel surgery also. two operations, one price, not bad--

on two percocet every 6 hours.

they did a certain nerve block, advanced and difficult to do according to anesthesiologist. had the needle probing around into collar bone area for 5 minutes. was sort of awake for surgery. for 12 hours after surgery, lower left arm just dangled if not supported. like a limp, wet noodle. could not even feel where the forearm was located, and would just swing into my face if not careful on recliner.

i expect to get better pain wise quickly and back to work wednesday.

recovery will be a lot longer, but worth it.


ken


update--pain is diminishing second day. i think if i had taken two instead of one percoset when i got home in evening, first night may have been better. plus today dr said i can take 2 percoset every 4 hours instead of six for a day or two. surgery, i believe will be worth it, although early on.

key is willingness to have a few days of post op pain as opposed to lifetime of continued pain. mine was pretty bad every day and an easy decision to operate.
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Last edited by rugmankc; 01-13-2012 at 05:33 PM.

 
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Old 01-14-2012, 02:17 PM   #15
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Re: Bilateral Basal Joint & Carpal Tunnel Surgery

Thanks Ken! Your's is the only answer I've received about getting both surgeries at the same time. I met with the surgeon that agreed to doing both surgeries at once, and he does the basal joint the same way your doctor did. You have a pretty aggressive time line for getting back to work! Keep me posted on how that works out for you...I want my recovery to be fast, I have a list of projects I want to get done.
I'm curious about your anethesia, did your doctor do a block and twilight sleep or just a block. You were aware of the needle messing around with your neck, could you feel it?
My doctor wants me totally out. He says the surgery is going to take too long to do it any other way. I am in the advanced stage of osteoarthritis and my thumbs have slid off the bones that they rest on. He has to 'string' them back up into place. He was surprised I waited so long to come in. I can't say I had any horrific pain in my thumbs, mostly just annoying. I think the carpal tunnel masked the pain because my hands were numb most of the time. Did you notice that? After surgery my hand/arm will be in a hard cast for 4 weeks, a soft cast for 4 weeks and then physical therapy. If all goes well, he will do my other hand right after physical therapy. I will probably really be glad to get that hand done.....I plan to use it to sand all the cabinets in my kitchen while my other is out of commission. LOL I hope your recovery is quick and everything goes well. I really want to believe I can get on with things in a short time. Keep me posted.... thanks, Cheryl
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