I need some thoughts about whether to have hand surgery

sholt576November 9, 2007

This is my first post on this side of the forums, so if I don't look familiar to the regulars, its because I spend most of my time drooling over your kitchen pics.

Here's my dilemma: I have finger on my right hand that was injured and no longer bends at the middle joint. Think along the lines of flipping someone off any time you make a fist.

I could have surgery to fix this and there's a pretty high likely hood that I'd get close to normal range of motion back. But, I'd have to have surgery and the resulting recovery time and PT time. Working all that into my schedule is a bit of a hassle. Most likely it wouldn't involve any time having my hand immobilized in a splint. In fact, keeping that finger moving would be key to its recovery.

Anyway- its just a finger. I've lived with it like this for a year. It's mildly annoying and it is at somewhat increased risk of injury due to sticking out all alone even though you may think it's tucked in (one must be careful when chopping or shredding things, closing doors, etc). Plus you lose grip strength.

I met with a surgeon today, and need to decide whether to schedule. WWYD? After all, its really just a finger.

BTW- the injury occurred when a glass dish from the OTR microwave exploded in my hand. Now after hanging around here I'm wondering if it would have destroyed my future induction cooktop that I dream about, because it landed forcefully right in the middle of the current cooktop.

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Fix it, get it over with. You'll wonder why you even hesitated.

Good luck!

    Bookmark   November 9, 2007 at 8:29PM
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Absolutely. Do it ASAP.

Frankly, after your initial evaluation and workup, a good deal of your PT could probably be done at home/work on your own. If time out for PT is a major concern, ask your surgeon about it.

    Bookmark   November 10, 2007 at 10:58AM
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I'd want it fixed - but make sure you do some research on your hand surgeon. Any surgery no matter how "simple" has risks and surgeons are not all equivalent in their skill. Unfortunately sometimes people do come out of surgery with more problems than they had going in. Don't just assume because the person is a hand surgeon that they're competent.

DH fell from a ladder and dislocated his shoulder and fractured a bone in his hand. He took whatever hand surgeon was available for a follow up appt. That moron ordered an xray of the wrong part of his hand - looked at the wrong bone - deemed him recovered from the wrong condition - and approved removal of his cast. Unfortunately the other non-physician staff who recognized something was in error deferred to the good doctor.

    Bookmark   November 10, 2007 at 12:13PM
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faire- I'm sure you're right. Once the hassle of scheduling it is history, I'll wonder why I waited. Hopefully.

pecanpie- yes, I think I could switch to a more convenient therapist at some point. I'm not sure how long I would need to go to the therapist that work most closely with the surgeon. I think it depends a bit on what the reason for the lack of function turns out to be. They can hypothesize at this point, but they can't know for certain until they take a look at it.

gibby- getting a good hand surgeon is very important. The Dr. who did surgery on my hand last year after the injury has declined to do further surgery on it because its not really his specialty. He made some phone calls and set me up with a guy who (hopefully) is really good. Hope your dh made a full recovery.

    Bookmark   November 10, 2007 at 10:47PM
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Personally I'd try a concentrated period of manual physical therapy, first. I don't mean manual in the sense of it being your hand, but PT done by someone trained in intensive PT therapy using their hands. Of course all PT's do use their hands, but manual PT is different from what many people think of as PT which is mainly exercise-based.

During manual PT the therapist gently massages, presses, stretches, and manipulates the injured part (and its adjacent and some not so adjacent parts). One school of manual therapy is based on the work of John Barnes (myofascial release), another uses Trigger Point therapy developed by DR. Janet Travell (among others).

I am just ending a long (almost 6 months) course of manual physical therapy (myofascial release and trigger point among other disciplines) for a shoulder injury that my orthopedist wanted to operate on last winter. When I started, my right arm was completely useless, now I'm back to working in my garden.

It can be time consuming to go to PT, but you'll have to do some PT after surgery anyway. I decided I had nothing to lose by trying it first. I started with conventional exercise-based PT and found it only made things worse. Luckily, I had a client who knew about manual PT and he sent me to the right place.



    Bookmark   November 12, 2007 at 11:09PM
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I would get it fixed. I had an accident on my pinky finger on my right hand when I was a kid. It wouldn't bend but since it was my pinky, it didn't bother me too much. Still, I wish it had been fixed. Had it been any other finger, it would have driven me crazy. At least with mine I can look like an upper-crust tea drinker instead of a New York cabbie, LOL.

Think of all the time you'll live with the problem if you don't get it fixed, and the time you'll have to put in to get it to work right seems pretty insignificant in comparison. As far as the dangers of surgery, I personally wouldn't worry too much about a finger in the hands of a competent surgeon (ha ha).

    Bookmark   November 13, 2007 at 2:51PM
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I've had surgery on my right hand about 10 years ago and I'm a hairdresser by trade (30 years now). Even though I don't work outside the home, I do have a home salon and have about dozen or so family members that use me regularly.

My point: get it fixed. You'll have more issues because it's not fixed than recovering. I don't think it took longer than 6 weeks to be completely up and running. My life improved so much immediately that the recovery time in my mind has evaporated. Believe me, in no time you'll be using that hand as though nothing ever happened. As long as I don't take too much time off, I can keep my mobility in my hand. The computer is also good therapy. :)

    Bookmark   November 24, 2007 at 10:06AM
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I agree with Housekeeping. I think you should try nonsurgical therapy first and only get the surgery if that doesn't help.

It seems that in this country, doctors often want to go the most invasive route right away, which is not necessarily the best way to go in the beginning. Scar tissue, for example, can cause more problems later at the surgical site.

A couple of times in my life I've gotten doctors' advice to get surgery immediately and decided not to for different reasons (in one case because I was nursing a baby, and the doctor told me to "go home and take care of that" and report to the hospital in five days! Then it turned out I was also pregnant. Surgery would have been a very bad idea. ). I've been very happy that I decided to wait and see, and ended up not having surgery.

Of course you should do what's best for you. Be sure and get a second and even a third opinion on the surgery. Very important!

    Bookmark   November 24, 2007 at 2:56PM
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I'm facing a similar decision--have you made your decision, sammi?

May I piggyback and ask if anyone's ever had trigger thumb? I admit I haven't even consulted a doctor about it, because it seems laughable, even though it does interfere and can cause me pain if my thumb is involuntarily bent... The alternatives are cortizone shots, which I haven't even tried yet, but the surgical option is down the road... Surgery does scare me, not because of the surgery itself but because of the risks and the staph in hospitals, etc...I guess I should say that I prefer not to be involved with *hospitals* , vs. surgery per se.

Odd that there are several of us with fingers that don't bend--who knew? I had never even thought about this until just this past fall, when it crept up on me, I think as a result of the epic tile-edging project. This past week I watched Daniel Barenboim playing one of my favorite concerti and thought "isn't he lucky he never got trigger thumb"...I guess he doesn't do many of his own home remodeling projects...

    Bookmark   November 24, 2007 at 6:47PM
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flyleft.... If you start with cortizone shots you will end up with surgery to replace a joint. Six or seven cortizone shots will destroy cartilage. In my case, I had to have my hand to work and the pain was unbearable and there was nerve damage that was running up into my shoulder/neck area. It was imperative that they operate.

I had two corizone shots in my elbow that was ruined carrying around a very heavy little boy. It is permanently bent at the moment and I just work with it. When I made an appointment for my third shot, the doctor said haplessly, "I hope you know this is a temporary fix that will force you to have joint replacement surgery before you're 30. You can't get more than seven of these shots because your cartilage will be gone." I was off that table in two seconds. My mother has RA and I decided to live with the pain. I know how she's done with replacement joints, etc., which is not good.

I hope you make a wise choice about your hand.

    Bookmark   November 24, 2007 at 7:22PM
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Flyleft (and Sherilynn, too),

I would try manual PT, first, and even before the cortizone injections.

Those were recommended to me too as a first step, while the Dr. was getting set for surgery. I skipped both the shots and the OR, but I had to be stubborn about it. And persistent when Drs. wanted me to be a good girl, and then questioned whether I was really as disabled as I was reporting since I was refusing all their treatment recommendations. But I am so glad I dug in my heels.

The thing that is hard is finding a good manual physical therapist, and I didn't get lucky, at first. I started with conventional PT for my shoulder, but after the the phyiscal therapist dislocated my shoulder during treatment, I did waver about not getting shots or surgery. Fortunately a day or so later I mentioned my bad experience with PT to a business client and he put me on the track of what turned out to be an excellent manual PT practice. I had no idea such a thing even existed, but now I know the difference.


    Bookmark   November 28, 2007 at 2:03AM
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DD2 had trigger finger. PT on the thumb, NSAIs and eventually a soft cast and period of rest solved the problem. It has not returned.

Surgery was never mentioned.

    Bookmark   November 28, 2007 at 9:13AM
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Wow, I forgot about this thread and just noticed it again--thanks so much for all that information! Sherilynn, I'll avoid the cortizone, and try to go with housekeeping's and pecanpie's daughter's plan. I'll make sure to try to find a good PT practice, although with my recent track record with medical services in this town, I can't promise anything...*sigh*

sammi, what have you decided?

    Bookmark   December 3, 2007 at 1:29AM
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I'll probably have the surgery. It'll probably need to wait til February, though, because of holidays and vacations and such.

Everyday I do things and say to myself- see, this is why you need to do it. For example, decorating a gingerbread house with my dd tonight. Fine motor work like that becomes a difficult task.

    Bookmark   December 7, 2007 at 11:14PM
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