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  • Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

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    Old 08-30-2014, 08:39 PM   #1
    jays825
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    Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    Hi everyone!
    First time ever doing this but I am in much need of some advice. I am looking for anyone who has knowledge of, or preferably actual experience with, an actual wrist Tfcc REPAIR, using actual sutures (NOT a "debridement"), as well as an Ulnar Osteotomy (shortening ) during the same surgery.
    Here's the reason why. I had, 10 weeks ago, an arthroscopic suturing repair of a peripheral, ulnar sided tear of my TFCC on my right, non-dominant wrist, as well as a shortening of the Ulna by 4mm, set with plate and screws ,during one surgery, for ongoing wrist pain. This was a "degenerative" issue, not an "acute" tear, basically from years of biking, mainly mountain biking, plus wrenching as an auto mechanic for last 18 years, plus gym time.

    So its been 10 weeks since surgery, 4 weeks since last cast came off, and i am having a really hard time, but how hard may be mental due to the time frame involved. What i mean by that is, Dr told me before surgery, i would be %100 in 12 weeks, 6 weeks in cast, 6 weeks in therapy. He said "it could take up to six months, but for you and your situation, no reason should be longer than 3". I have seen him twice since surgery, and both times he has said i am good to go, on track for 12 weeks. He did send me to OT therapy, but I've only seem them 3 times in the 4 weeks since cast came off (NOT my choice, they never have any appts!) and they too think i am doing well and on track, and they think i can do near all the therapy myself, which i have been doing religiously up to two hours a day, everyday. But heres the thing, i can't for the life of me figure out how they believe that time frame!?
    Why? Well with only two weeks left to that "good to go 3 months", i am in regular pain, both from the wrist itself, and the osteotomy/plate, plus i only have not even half my ROM i had before surgery. With much warming/stretching/coaxing, i can get maybe 60 degrees in most ranges, but otherwise on an everyday basis, i am stuck like a rock at 45 degrees and anytime i even gently force it past that, or god forbid lightly bump my wrist, its excruciating! And the osteotomy is a whole other thing, doing anything vigorous, even just doing dishes, or lift anything over maybe 10lbs, and its agonizing pain from fingers to elbow for 2-3days. Example, mowed the backyard the other day, and holy cow, PAIN for 2 days straight,non-stop.
    So in 2 weeks, 12 weeks from this "2 for 1" surgery, i am ok to go back to wrenching on cars, mountain biking, gym time?? Am i missing something here?
    All the internet research i can find, refers only to these two procedures recovery time separately , so am wondering is there anyone out there who has had both done at the same time like myself? Can you tell me your experience/recovery time? Someone who can tell me if I'm not the only one thinking this recovery time frame just doesn't sound right? If they told me it would be 6 months, i wouldn't be so worried, but the when i have brought this up to my Dr/OT, they don't seem concerned. The whole thing is really getting to me now, just two weeks from when i was told i would be good, and this wrist is still totally useless to me...

     
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    Old 08-31-2014, 06:05 PM   #2
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    I had an Ulnar Osteotomy a couple years ago. I can't speak to the TFCC Repair healing, but will say that the 12 week healing time they gave you seems pretty ambitious even if it was just the osteotomy. I started PT with a hand therapist when the cast came off after week 6 after the bone looked good. I started with twice a week for a couple months. The therapist said the rehab from ulnar osteotomies can be pretty tough for many people. There was another patient there who was in her 8th month of therapy after her surgery. I know that even when my Ortho Surgeon said I was fine, I was having pain in the exact place on the ulnar side and was no where normal in terms of ROM. I had the surgery in February. In June of that year, my insurance denied approval for any further PT because I wasn't making enough progress with my healing. I still had a long way to go in terms of ROM. I was totally frustrated and felt that both had given up on me. Later that fall, I went to a hand surgeon who had a fellowship from the Mayo clinic with an expert in the field of ulnar sided issues. He examined me and pointed out that my plate had come lose. He said the plate could be causing me the exact same pain in my TFCC area that I had before the surgery. He tried shots again, but they didn't help. I ended up having the plate removed and the TFCC area scoped because he thought a tear was likely. He ended up just doing debridement. Anyway, after I had the plate removed, my ROM came back very quickly. I'd say give it more time.

    I hope others on the board can give you some advice on the TFCC tear. Good luck.
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    Old 08-31-2014, 09:27 PM   #3
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    Thanks MR for the input, the reassurance is much appreciated! I am totally willing to give give it the time, its the DR/OT that i don't think are . Next week i have a therapy appt and i am gonna ask her bluntly if she really, seriously thinks i'll be ready to get wrenching on cars again :/
    Either way i'll repost by the end of my recovery so at least the next guy knows how it goes.
    Thanks again!

     
    Old 09-02-2014, 02:38 PM   #4
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    my dr wants to shorten the radius and fix the tfcc as well. Its very annoying and bothers me all work day. Post op will be a cast then OT as per usual, but do they remove the bar in a yr or so? Do they cast it again?
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    Old 09-02-2014, 06:52 PM   #5
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    Plate removal isn't necessary unless you have a problem. I had my plate removed and some ulnar debridement during my second surgery and just wore a bandage for a week. No cast after that surgery.
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    Old 11-01-2014, 07:43 PM   #6
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    Timely thread this is. In 2012 I had my scapholunate and TFCC ligaments repaired. A long road to recovery, but at that time my surgeon predicted that at some point an ulnar osteotomy based on my positive variance.

    Well, its finally time, I think. I recently torqued my wrist a bit mtn biking and regular abuse playing ice hockey has left me, according to his diagnosis, with most likely a small tear in the TFCC. My main scapholunate repair still looks good. The ulnar impingement is just continuing to irritate the TFCC.

    I was told similar timeline for recovery/PT for this surgery as well. I was 6 months post SL/TFCC surgery before released from PT (reduced range of motion, but good strength and use) - but my SL repair was fairly invasive open procedure. Man, I have to admit, the stories I'm seeing about the recovery from this "combo" surgery have not supported that. Nervous about whether I'll lose even more ROM, more chronic pain, and reduced use. Just not sure what alternatives there are really? Just continued TFCC issues, multiple scopes/repairs without the osteotomy??

    Sorry, didn't mean to hijack the thread, adding my $.02 and what I heard from my surgeon…

    Jay825 - I'll be keeping track of this thread, good luck with the rest of your recovery.

     
    Old 12-15-2014, 09:24 PM   #7
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    Hi guys. Its been six months now since surgery, thought I would update. Well I was supposed to be good to go by now, but sorry to say I am far from. By 4 months i had progressed to about %90 ROM in all ranges except flexion(bending wrist downwards), which was/is stuck at about %50. And all that ROM varied a lot day to day, some days good, some days bad. Pain varied a lot as well. Strength was fairly poor, about %50. At 4 months OT said good luck to me bye...surprising considering only %50 ROM/strength?! I would later find out that was because the dept was short on OT's, she was only one, and they usually had five! Anyhow, i have made little to no progress since then. So I went to a new OT at 5 months post op, since ROM had not changed at all in a month, and pain was actually increasing in the Ulna area. At that time my arm starting making strange noises as well, evolved from a crunching sound into a slight cracking sound,coming from right at the Ulna plate area, mostly when supinating the wrist. By second visit she decided i was not making ROM progress due to inflammation in the arm so i decided to see doc. I saw him the other day. He had an xray done, didnt show anything abnormal. We discussed the increasing pain in the Ulna area, and the noise, and during his check found a very sore area around where the last screw(closest to the elbow) is. He said that either my body was not liking the plate, or that a screw may be loose, and that either way he recommended i have the plate removed. He said at 6 months that was ok, since my bone was fully healed otherwise. I told him i would think about it, but by the next day i decided i will have it removed, as the pain is so bad when trying to place any stress on the arm at all at this point, even simple tasks like reaching over and putting on my seat belt, pushing open a door, etc is very painfull around the end of the ulna plate area. I have not been able to lift anything over 10lbs, or even less at certain angles...still. Needless to say i am super bummed at this point, the whole point of having the 2 ops at once was to avoid another surgery, but looks like im having another anyways.

     
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    Old 12-15-2014, 10:34 PM   #8
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    Sorry to hear you are having such a rough time.

    For me, it was the supination that I struggled getting back. I was also kicked out of PT with my hand therapist, but mine was because insurance said I wasn't making progress fast enough. I guess it isn't enough that we actually still have the problem.

    I ended up having the plate removed too. Mine was at about 9 months post-op though. This was a fairly easy surgery. The new surgeon made the incisions on the same spot the first surgery was made. You can't even tell the second surgery was done. Actually, I was expecting the same 4 inch incision as when they put the plate in. This time, he made 1/2-1 inch incisions on either end of the first one. He also stitched everything with one thread...just pulled it out easily since most of the stitching was on the inside. I expected a cast or splint after the plate removal. Instead, I just had a wrap that came off within a week. I went to see a different certified hand therapist for PT after this and regained full ROM pretty quickly after the plate was out. I also saw significant improvement in the pain pretty quickly.

    I hope this next surgery really helps you like mine helped me.
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    Old 12-19-2014, 09:57 PM   #9
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    Thank you MR for the reassurance again. We wont see for awhile how it turns out, my Dr is apparently so backed up my surgery will not be till mid-March. Back and forth with my insurance company all this week with no luck, they even refused to allow me to switch to another Dr who could perform the surgery. All my Dr can do for me now is offer more painkillers, which i cannot take due to work. Already been on several anti-inflammatorys on and off for months now, no use anymore. Not sure how im gonna do this for the next three months, feels like im walking around with a fractured arm that no one can treat...

     
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    Old 09-02-2015, 03:18 PM   #10
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    Re: Tfcc Repair + Ulnar Osteotomy, at same time,anyone?

    Hi all! So its been 15 months since the first surgery, and 6 since the second, and thought i would finally give my "end results". I choose this point as i wanted to wait until i felt the wrist was basically as good as it was gonna get, which was apparent about a month ago. So the second surgery was an exploratory in a way, but the doc was going to remove the ulna hardware regardless of what he found and thats what he did. This second surgery was a breeze compared to the first. And so what was found? Well as presumed, the last screw holding the ulna plate (the one farthest from the wrist) down was found to be not seated fully/correctly. They found no other issues. The nurse offered to give me the hardware so i accepted. You could clearly see the bone growth had grown into the both the threads of the last screws head, as well as the corresponding threads in the plate( and yes, they did clean/sterilize it before they gave it back to me, but they could not get that bone growth off of it, it was too grown in). No wonder all that time it had been hurting so much! Anyways, i knew something was dramatically better this time as i was in almost no pain this time, didnt even have to take any narcotics, just some Tylenol. The next day, though still in a soft cast, i put full pressure on my arm(not on the incision area obviously), and what do ya know, no pain at all, zero! Just two days earlier that would have been excruciating because of the screw issue. As for follow up, well i was so over all the medical stuff at this point, i didnt even go back to my dr for my post-op. Took the soft cast off after a week and took out the suture myself (it was one long one, about four inches long), very easy. I did my own PT for several months (before the surgery they already told me they weren't going to send me to PT anyways, yes my insurance really sucks...).
    After the hardware came out i finally starting making good progress in all areas. So now, two years later, 15 months since first surgery, and 6 since the second, i can say this is as good as its gonna get. Not perfect, but im finally happy with it now. I have %95 ROM in all directions, %95 strength in all areas (except pinky/ring finger, they maxed out at about %50), and for the most part pain free. Only time it bugs me now is if i do heavy manual stuff for an hour or more, its achy and stiff for a few days, but no biggy.
    Anyhow, best to you all and thanks for your support!

     
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