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Four weeks post-crash. Based on xrays, MRI and two hand ortho consults, no fracture, first CMC capsular sprain, "low-grade strain of ulnar fibers of the thenar musculature," and full-thickness tear of deep palmar oblique ligament. Incidental finding of (non-symptomatic) early stage arthritis.
First ortho said "nothing to be done, splint it for six weeks, hand therapy at week four." Today second ortho laid out options as (while arthritis is in early stage) metacarpal extension osteotomy (which may delay progression of arthritis); Arthrex tight rope as a more long-term solution; and if nothing is done, likely looking at either a tendon graft or fusion down the road. He said first ortho may have been reluctant to do anything because of the arthritis.
Met with an OT today that seemed to confirm that a complete ligament tear in that location is a pretty bad thing. Going back to see her tomorrow. She is making me a removable hard thumb cone to wear while cycling.
I'm feeling pretty overwhelmed by this. Anyone have any info they can add? Or been through something like this?
Thanks.
No coasting in running and no crying in baseball
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Tri3: Oct 11, 17 3:23
Disclaimer: I'm not a medical professional. Just someone who's crashed before, and like you got differing medical opinions and didn't know who to trust. If it were me I'd splint/immobilize and let the body part rest. I would not do surgery. Let the body heal. It knows what to do. After it heals then do some PT. PT is like magic when done correctly. But you need to find a competent PT person. Again, it is back to not knowing who to trust. Lots of people are in medicine for the income and they really don't know what they are doing despite 200 years of schooling and 500 years of internships.
Disclaimer: I'm the son of an MD, so I may be accused of being biased in believing they are more good than bad. I AM NOT AN MD. That said....I've been to my fair share of idiots. My wife, and daughters have also been to (more than) their fair share of idiots. I *think* based on my background with my Dad, that I have a better than average "idiot detector" when it comes to MDs.
I'm of a differing opinion than Dilbert. In my experience the MD that lays out a singular option as "they one true path" is the least likely to be trusted. The one who sits down with you and discusses ALL of your options "in detail" along with the long term prognoses and associated risks...to include "do nothing", is the one who is much more likely to know what he/she is doing. You can also look up your two doctors online and get a little background. Better yet, ask your primary care about both docs.
Sometimes "do nothing" and try PT for a while works ok. Maybe it helps, it probably doesn't hurt. However, that is not ALWAYS the case. So, that would be the first question I would ask doctor #2. I'd want to know the risks associated with the tendon graft versus the previous two options....and I would discard the "fusion" option outright. Uh...no thanks.
Another option would be to put your first Ortho on the spot. Tell doctor #1 straight out...that you went and got a second opinion, and doctor #2 gave you two surgical options. And ask why they didn't..and, what their opinion is of these other options.
You could always get a third opinion and hope for a "consensus", but you might also just get a 3rd set of choices differing from both of the first two. So, that can be a bit of a crap shoot.
Dunno if that helps....but, it is how I would (and have) approached similar problems of conflicting medical advice. Well, that and call my dad and see which one he laughs at. :-)
I am an MD but while I do practice non-operative sports medicine I do not see patients for hand issues...too complicated and best left to those orthopedists that have been specialty trained etc. I do however agree with the above post. There are always options and they may span from do nothing to immediate surgery. Make sure that you understand the risks and benefits of each of these options including recovery time and extent of recovery expected (100% better, mostly better etc.). In my experience, if there is no risk (no time window that is closing) to the OT, rest and time approach, always try that first and see how you do. I wish I could count high enough to tell you how many patients I see that were told 20-30 years ago they would be paralyzed without surgery. Somehow most of them come in walking now without anything more than some rest and time back then. They were scared of surgery then and turned out fine now. In most cases the long term prognosis is debatable and therefore start at the most conservative and work your way toward more interventional, stopping when you feel better. Good luck.