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Old 08-26-2013, 02:44 PM   #1
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Ulnar Shortening Failure? What now?

I had an ulnar shortening osteotomy and tfcc debridement on may 24th. I had been misdiagnosed with tendonitis for three years, then an MRI revealed a tear in my tfcc. They cleaned up the tear and then shortened my ulna by 6mm.

So my bone is healing and stable. I have almost all of my range of motion back. But the pain in the soft tissue on the ulnar side of the wrist is worse than before surgery.

I have adjusted my whole life around the pain. I no longer have hobbies, cook my own food, or even pick up my three year old son (which is heartbreaking). The most daunting part of this is that I can not do my job. I can type and email, but I can not use my drawing programs for more than 30 minutes a day without screaming. I have spent my whole life training for this career, and all of a sudden I am no longer able to do the job I am paid to do.

I met with the doctor today and he said there is nothing more he can do for me medically. I don't know if this is a failed surgery or not, but I know that I am no better off than before. I had the surgery because I could no longer do my job, and now I have had the surgery and still can't do my job.

The doctor also said there is nothing he could do for me pain wise.

My questions are:

Is there really nothing they can do for the pain? No shots? Nothing? Am I expected to work in excruciating pain or not at all?

Would I even have a chance at disability? I can work at a computer, I just can't use the skill set I have that makes me employable. I feel like I would have to start from scratch.

Is this considered a failed surgery? Should I get a second opinion? My surgeon is the best in my state and is really nice. I don't know if there is a better surgeon out there.

Do any of you live with chronic pain? How do you do it? Do you have any tips as to where to start?

If any of you have any stories about pain after tfcc debridement and ulnar shortenings, I would love to hear them.

Thanks!

 
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Old 08-27-2013, 06:58 PM   #2
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Re: Ulnar Shortening Failure? What now?

I had some similar issues myself. You can see my story on one of the other ulnar osteotomy threads.

I'd highly recommend reading up on UT Split Tears. This is actually a 'new' medical discovery and the information in it was only published in 2008. The ulnotriquetral (UT) ligament is part of the TFCC area. Basically, it can 'split' down the middle like when you open a book vs. tearing across. This results in a seemingly 'stable' joint and normal MRI's because there isn't disruption to the blood flow in the area. The test for it is an ulnar fovea test. It is basically a test where you push on a certain spot on the wrist in the TFCC area to see if it causes pain. It is something like 90% predictive of a split tear.

The bad part of this is that because it is 'new' most wrist doctors still aren't trained in identifying or treating it. Because it doesn't show on MRI's and isn't even easily seen via arthroscope unless you know what you are looking for, many doctors/surgeons completely miss it.

Dr. Richard Berger at Mayo Clinic discovered this and developed a treatment to pull the ligament back together (like closing the book) and stitching it into place to heal. He has published research and done short videos on identifying and treating UT Split Tears. The challenge is finding a doc who is trained in this.

After my ulnar osteotomy healed, I continued to have my ulnar sided pain. I actually found a doctor who had done a fellowship with Dr. Berger and upon diagnosis, he even thought I had a split tear. He went in arthroscopically. Turns out I did need debridement. My plate had also come loose and was evidently causing me the exact pain as my pre-surgical pain. Evidently the wrist is tight with so many small parts that it didn't take much for the plate to trigger the continued issues in the area. I had the plate removed and I was much better after that. Within a few months, I'd regained almost full ROM. Before the plate removal, I wasn't even close.

Keep us posted on how you are doing. I've done tons of research on the ulnar sided wrist pain. I'm happy to share any of what I've learned if you have other questions. I understand how frustrating this can be.
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Old 08-31-2013, 07:38 PM   #3
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Re: Ulnar Shortening Failure? What now?

I too have had issues after my ulnar shortening... I have dealt with chronic pain in my left wrist for 12 yrs (I am only 24.) I had the ulnar shortening back in June of this year (this was my 4th surgery on that wrist). And like you, at this point I am in the same if not worse pain than I was before the surgery. I have been in therapy for a month now and am not even close to having the ROM like I used to. My therapist says i have a long history with this and extenuating circumstances so I shouldn't loose hope..

It is very hard not to get discouraged.. A lot of people on here talk about how their pain was gone within a few weeks of the surgery and they were no longer having to take pain medication. My hand surgeon decided he did not want me on prescription pain meds anymore and that I should only take over the counter medicines. It has been two weeks since I have tried to transition to OTC meds and it isn't going well. We have all but stopped any progression in therapy, we are only trying to get the pain under control right now. I am constantly using heat and a TENS unit to help with the pain but more times then not have ended up having to take the remainder of my prescription pain meds. Although it can be inconvenient the TENS unit may help with your pain as well.

My surgeon also told me that if this surgery did not work there was nothing else he could do for me. So I know how frustrating it can be. My suggestion would be to see if your doctor will refer you to pain management specialist. (This is my next step as well). The problem here is trying to find a good one. As I said before I having been dealing with chronic pain for 12 years now. The first 2 pain dr's I saw we're the kind to write you a prescription and send you on your way. Example - I was put on morphine and fentanyl when I was 15 years old before they ever tried to figure out what the problem was. My last pain dr actually took the time to try and figure out what was causing the pain. He wanted to find the cause of the problem and use treatments other than high dose pain killers. Which i was very grateful to come off of, they dulled the pain but the side effects can take over your life. Him taking the time to listen to me is what lead to the discovery of my tfcc tear. Unfortunately he recently retired. So you'll have to do your research and find one that follows evidence based practice.

Hopefully they will be able to find what pain treatments work for you and get you back to a functional life where you can work and pick up your baby again. Another tip of advice is talk to your friends and family about your pain. They may not be able to understand but a good support system is needed. Chronic pain is not something to go at alone.

MountainReader - this UT split tear sounds interesting. I will be doing research. Can you point me in the right direction?

 
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Old 09-01-2013, 12:17 PM   #4
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Re: Ulnar Shortening Failure? What now?

In addition to the TENS, my PT also used iontophoresis. It uses pads similar to the TENS, but it actually has a current that 'pushes' topical pain meds into the area of pain. You might ask your PT about it if you are still having such pain.


The UT split tear was discovered by Dr. Richard Berger at Mayo Clinic. He has published information about it on the internet.

My first Orthopedic doctor told me there was nothing wrong with my wrist when I complained my original pain was still there after the ulnar osteotomy healed. I sought out another opinion. In this case, I found a doctor who did a hand fellowship with Dr. Berger so he knew about the UT split tears.

I say, don't give up. You are still early in your healing. Honestly while I was using my hand early on, it was a year out before I was back to 'normal' or as normal as I could expect.
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