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    Old 11-11-2014, 04:24 PM   #1
    LINZ62383
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    Ulnar Shortening Osteotomy Questions

    I am scheduled for an ulnar shortening osteotomy next Friday, and I am having panic attacks about the procedure so I figured I would ask others to share their experiences and maybe someone could answer some questions for me.

    First, I am having this procedure due to my winning the genetic lottery and having an abnormally long ulna. This didn't start giving me pain until about a year ago. I woke up one morning and my right wrist hurt like I had slept on it wrong. When the pain didn't go away I went to a local urgent care to see if I possibly sprained it - I had been doing a lot of yoga at the time. They took x-rays, said it must be a strain or pulled muscle, gave me a splint and sent me on my way. For the last year I wore a brace on and off when my wrist gave me pain. The pain has never been constant, it comes and goes. The most disturbing thing about it is that when I rotate my wrist there is something in there that snaps and cracks - probably the TFCC, I learned from my research. I finally decided to see an orthopedist about my wrist as I figured it might be carpel tunnel from my office job. My ortho showed me the long ulna bone in the x-rays, which there is no denying - the ulna is visibly longer than the radius, even to an untrained eye. My MRI shows that there is wear on my TFCC, but no tear. I am developing cysts on my lunate bone, which is from the pressure from my long ulna. My doctor said that the way to fix this was the ulnar shortening osteotomy, which is coming next week.

    My concerns about doing the surgery are varied. I am terrified of how much pain I might be in when I come out of the surgery. I know I will have painkillers, but I really don't want to stay on those for any longer than is necessary. I have read other boards about this and it seems like some people had more pain after the procedure than others. I am afraid that this will not be beneficial in the long run. I mentioned earlier that I enjoyed yoga, but my wrist pain has prevented me from doing yoga for the last year. Ultimately, I would like to be able to return to yoga, but since this surgery is essentially breaking my arm for me and then putting a plate in to hold it together, I have doubts about ever being able to return to yoga after this. I am also wondering if this is absolutely necessary. Like I said, the pain is not constant - it wasn't bothering me at all last week. However, since it's degenerative I imagine that this is not unusual, and that if I wait it will progress into being painful more often and that eventually my cartilage will tear. I am 31 years old, and while I don't consider this even close to being "old," it is also easier to bounce back from surgery the younger you are.

    So, if anyone reads this and feels like sharing their own experience with this surgery or if anyone has any other advice it would be much appreciated! Sorry for the novel

     
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    Old 11-11-2014, 07:16 PM   #2
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    Re: Ulnar Shortening Osteotomy Questions

    I had my ulnar osteotomy on my right dominant wrist in 2012. I should be able to find some of my postings as I was going through the experience if you search under ulnar osteotomy.

    At this point, the pain I'd suffered for 2 years prior to surgery is gone. I also have full ROM and participate in my normal activities.

    The surgery is painful, but not unbearable. I've had worse pain. I did keep my wrist/hand fully elevated upright and above my heart for the first several days. I also iced it every hour. I found that crushing the ice and putting it in the bag they sent me home with worked the best because I could mold it around my wrist. I kept the ice on for longer times with the initial cast because it did have to work its way through the bandaging. The ice really really helped. I took the pain medicine regularly on schedule for the first several days, then weaned back to the OTC stuff and the pain meds to help me sleep. When I went in for my 10 day follow-up to have the stitches removed, they x-rayed me then put on the fiberglass cast. He offered to refill my pain meds, but I declined. That was a mistake. The cast transition hurt more again for a couple days. I ended up getting a refill for a few days. Once the initial hurt of the surgery had passed, it was just like healing up from any other surgery for a broken bone. I had to learn to do things more left handed, but was able to use my fingers on the right to assist in many things. I was able to drive too. I was cast free in about 6 weeks.

    I did find my initial PT a bit frustrating. They spent a lot of the first visits massaging and working out the scar tissue, the exercises were added slowly. I made good progress on ROM initially, but hit a point after a while where I wasn't improving. Even more frustrating was the fact insurance dropped my PT approval because I wasn't making enough improvement. I ended up getting another opinion from a different wrist surgeon. When he checked me out, he immediately noticed my plate had come loose and was impeding things. I guess it isn't common, but does happen. I had surgery for to have the plate removed and some TFCC area debridement. Just came out with a wrap for 4 days, then started PT. My last bit of ROM quickly came back after that.

    I'd say that after surgery you should be able to get back into yoga. You may even be able to do some while in the cast if you are careful. Maybe give it about 5-6 months before you are comfortable full weight, but 3 months is should give you back most of your normal activity.

    Have you had anesthesia before? Been on painkillers before?

    I found out I have nausea issues with the anesthesia. I have to ask for extra anti-nausea meds during and right after the surgery. Also, with the painkillers you will probably want to take something to prevent constipation. They can bind you up pretty quickly. My surgeon prescribed something with the pain med script.

    Plan ahead for some of those things you will need to do one-handed for the first couple weeks. Easy on/off shirts, exercise or easy waist pants, front-hook bra, pre-made or microwave meals, etc... I used a product called CastShield to keep my wrist dry so I could shower daily. It was incredible. It rolls up over the cast and stays in place by itself, then rolls down when you are done. I never had a drop of water get in and I was able to use it by myself.

    Good luck with your surgery.
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    Old 11-12-2014, 05:44 AM   #3
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    Talking Re: Ulnar Shortening Osteotomy Questions

    Thank you so much for sharing your experience and helping to alliviate some of my fear. Really, your response has made me feel better. I am probably just building it up in my head to be a million times worse than what it will actually be like. I have never had a surgery before or broken a bone, so this is all new territory for me.

    I have been under anesthesia before, but that was 16 years ago for my wisdom teeth. I got something from my doctor saying they would be using a nerve blocker and I might have the option of being sedated and awake for the actual surgery with that blocker. No way, I do not want to be awake! I appreciate the suggestion of anti-nausea meds and being prepared for feeling sick. I never thought of that. Also, a big thank you for the suggestion about the cast covering for showers.

    My ortho actually said I will not need to do PT, but I may do it once I am cleared to go back to work just to make sure I can regain full use of my arm. At this point, my pain is a dull ache on the ulnar side, and some shooting pain through my entire forearm on the ulnar side. Plus, my ring and pinkie fingers are becoming increasingly numb, they feel like they are falling asleep a lot of the time. I know I have to get it taken care of, it's just nerve-racking for me. I really do appreciate hearing from you, it made me less worried

     
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    Old 11-12-2014, 12:44 PM   #4
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    Re: Ulnar Shortening Osteotomy Questions

    Hi I just had the ulnar shortening (along with a few other things) done 2 weeks ago 10/28. I posted about it here: http://www.healthboards.com/boards/arm-wrist-hand/992644-tfcc-tear-ulnar-shortening-carpal-tunnel-release.html#post5327621

    I listed some things to think about/do to prepare especially if the surgery will be on your dominant hand. I'm posted here as well for you.

    OK a few things to think about if you are facing this surgery:
    *Premake meals and freeze them ahead of time in containers you can open with one hand
    *Recruit a designated driver as you won't be able to drive
    *Don't plan on signing things if you're surgery is on dominant hand. Write out checks for bills ahead of time, or use online banking to pay bills
    *Cut the one sleeve off some old sweatshirts if it's cold weather so you have something to wear that keeps your good arm warmth
    *Women, get a sports bra that you can put on/remove with one hand - no hooks!
    *Plan to wear pull-on pants, sweats, yoga pants etc.
    *Purchase shampoo & conditioner in pump bottles. It's much easier to dispense from those with one hand in the shower
    *Get some umbrella bags to cover your cast in the shower. Secure them at the top around your arm with a rubber band. The hospital where I had my surgery had them in the lobby, they let me take them free of charge to use for this.
    *In cold weather use a sock to protect you casted hand, a glove/mitten won't fit.
    *Have a small tote bag with handles that you can sling over your good arm for carrying things
    *Keep easy to open, healthy snacks available. Since you are not going to be as active, you won't eat as much. You may want light snacks. Tuna in pouches, peanut butter crackers are sweet but still have protein, etc
    *Drink lots of water
    *Be sure to take something to combat the constipation caused by the painkillers. Miralax in water will help plus you'll be drinking water!

    I hope that all goes well with your surgery. Keep us updated!

     
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    Old 11-12-2014, 06:57 PM   #5
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    Re: Ulnar Shortening Osteotomy Questions

    I highly recommend pushing for PT after the cast comes off. I had 2 hand therapists tell me that some people need more rehab than others after the surgery. Early work on the scars and adhesions during therapy could really be a big benefit. A lot of exercises they can show you are ones you can do at home, but it takes someone who knows what they are doing to work on those adhesions.

    I've had nerve block before with a different wrist surgery. They put me under just enough I didn't feel or remember anything, but it was much easier to come out of. The nerve block was nice because it lasted for a while during that painful first day and made it 'less bad'.
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    Old 11-13-2014, 06:54 AM   #6
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    Re: Ulnar Shortening Osteotomy Questions

    How long did it take you before you could do things like cook again? I just wondered since I really enjoy cooking and I am hoping I might be improved enough by Christmas to make a cake or something.

     
    Old 11-13-2014, 07:28 PM   #7
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    Re: Ulnar Shortening Osteotomy Questions

    With regards to cooking, I think it depends on what you are doing. Once in the fiberglass cast and had adjusted, I was able to do some basics with my casted hand. I'm right handed and had the surgery on that hand so cutting was really tough. If it was on my non-dominate hand, I probably could have held the item with the tips of my fingers while cutting with the other hand.

    Heavy pots of food that take two hands didn't work, draining stuff didn't work, but a single light pan I was able to work around.

    Lifting something and scraping may be more challenging. I could stabilize and guide with the cast, but couldn't grasp. Also things had to be not heavy to lift with one hand.

    A lot of the baking process for a cake may be OK for you. I guess it depends on how fancy you get.

    Also, I found washing the dishes to be one of the challenges since that is a total one-handed thing so the cast doesn't get wet.
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    Old 11-14-2014, 05:28 AM   #8
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    Re: Ulnar Shortening Osteotomy Questions

    Thank you both so much for all of your information and sharing your stories. The list will be a huge help, I hadn't thought of some of that stuff. I really appreciate it!

     
    Old 11-14-2014, 06:20 AM   #9
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    Re: Ulnar Shortening Osteotomy Questions

    I have another question. How soon before you were able to take a shower? I assume it will be a few days, and I may be able to take a bath with help. I'm thinking investing in dry shampoo might be a good idea for those first few days, but I thought I would ask. Also, what did you do about wearing a coat if you got your procedure in the winter? I'm from Ohio and it's that time of year here.

    Last edited by LINZ62383; 11-14-2014 at 07:53 AM.

     
    Old 11-14-2014, 11:08 AM   #10
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    Re: Ulnar Shortening Osteotomy Questions

    I was able to take a shower the next day. Just had to cover the cast so it didn't get wet. I used the umbrella bags and rubber bans for that.

    On cooking and washing dishes, I'm not able to use the hand that had surgery, so I can only do one handed things. i did pre make many meals and froze them in ziplock bags or containers that they can be cooked in or are easy to open with one hand. I do find I need someone to help scrape things from one container into another. The ziplock bags were helpful since I could use one hand the kind of squeeze the contents out.

    To help stabilize bowls, pans dishes when stirring or washing them, I place one of those rubber grib things you use to open jars on the counter or sink under the bowl/dish/pan. It helps to keep it from spinning around while you are stirring/washing it.

     
    Old 11-14-2014, 06:32 PM   #11
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    Re: Ulnar Shortening Osteotomy Questions

    I think I waited 2 days to shower. I used the CastShield when I showered to keep everything dry.

    I wear my hair kind of short. Before surgery, I went to my hairdresser and he gave me a shorter cut. He dried and styled it with only his left hand like I was going to have to do. He showed me a way to put styling product on one handed too. Made things much easier.

    I had my surgery in February and it is cold in Utah in winter too. I bought myself a winter cape to use, but ended up not wearing it much. I used a vest and the cape a bit with the splint/cast after surgery, but once the fiberglass cast went on, I found most of my winter coats and jackets fit right over it. I also found quite a few of my shirts worked over the cast too, either over the cast or rolled or pushed up.

    It did take me a week or so before it was more comfortable when I tried to put the longer sleeves on though. Every little bump is uncomfortable in the beginning. I hung out at home the first week though.

    If you are worried about your casted area getting cold, they make fleece cast covers that are kind of fun. I didn't use those, but did use some fun decorative cast covers. They kept the cast from snagging on things and made it easier to get things over the cast. They also make fleece mitts now that are designed to go over casts to keep the hand warm. Very nice.
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    Last edited by MountainReader; 11-14-2014 at 06:54 PM.

     
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    Old 11-17-2014, 07:17 AM   #12
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    Re: Ulnar Shortening Osteotomy Questions

    One of the things I am most afraid of is how painful it will be once I wake up. Is it really bad? I know I will be on painkillers and stuff but still, I am very scared about that. Also, how do you sleep with your arm in a cast? I am a side-sleeper, luckily on my left side but I still imagine it will be painful.

    Last edited by LINZ62383; 11-17-2014 at 10:04 AM.

     
    Old 11-17-2014, 10:05 AM   #13
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    Re: Ulnar Shortening Osteotomy Questions

    I had the nerve block with general anesthesia, the pain really wasn't bad at all when I woke up. The nerve block was a huge help! It gets you past that first several hours.

    Wishing you the best!

     
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    Old 11-17-2014, 02:33 PM   #14
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    Re: Ulnar Shortening Osteotomy Questions

    Do you have any suggestions on sleep? That is something that I am not sure about, since I keep reading that I will have to keep it elevated.

     
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    Old 11-17-2014, 02:52 PM   #15
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    Re: Ulnar Shortening Osteotomy Questions

    I typically sleep on my back and side. Since the surgery, I have slept on my back with a thin pillow under my wrist/forearm. The first few nights I used 2 pillows. The trick is to elevate it just enough to help reduce swelling and therefore reduce pain, but do so in such a way that allows your shoulders/neck to relax and rest comfortably.

    As time has progressed, I have tried sleeping on my side. Not the affected side which would be preferred for me. Again I used a pillow placed under my affected arm to hold it up above the level of my heart. It actually provides better posture for my shoulder and back!

    I will be honest with you, I have not slept well in the 3 weeks since the surgery. Mostly from my fear of accidently rolling onto my arm since that is how I prefer to sleep. The pillow being there when sleeping on my back is kind of a physical reminder not to roll as well.

    I do find it quite easy to fall asleep in a recliner with my affected arm elevated on a pillow on the arm of the chair. If this is an option for you, you may want to try that.

     
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