The Wrist

In mid-February 2024, I took an vacation with my family by airplane. I lifted a suitcase too hard, and injured my left wrist. Now, I didn't realize it at the time, so this is really just my best guess. I noticed a day or so later, when I had a lingering pain in the wrist when I bent it in certain directions. I continued noticing it for the entire week-long trip and then further in the weeks after I came back home.

This is the story of my wrist, which dominates the year 2024. As of the time of this writing, November 2024, it is still not fully healed. But it's affected so much of my life for this whole year that I have to capture it and inevitably look back on this period someday.

One thing I have to note is that after I got back from my trip, I decided to get a rowing machine. Found one in good condition on Craigslist and started using it religiously, like rowing basically every day. Yes, with my injured-but-undiagnosed wrist. It didn't hurt that bad, just occasionally in certain positions. Nevermind that towards the end of a rowing session I'd have a little pain.

Early April I finally decided the pain was taking too long to go away and I should get it checked out, so went to see my physician, who poked it for 2 minutes and, extremely predictably, prescribed me physical therapy.

Started physical therapy basically right away, in April. I went for a month, and then my hand therapist felt I wasn't making enough progress, so referred me to an orthopedic specialist. I saw her in early May and got a steroid injection to reduce potential inflammation, and continued hand therapy. The steroid injection didn't do anything, unfortunately.

After some of our routine progress checks, my hand therapist felt it would be good to try to get a better diagnosis, so I got an MRI. The MRI, frustratingly, did not clearly show the cause of the pain. Their best guess was and still is a partial tear of a lunotriquetral ligament. Certain positions and certain load puts stress on the ligament and consequently pain.

Apparently ligaments don't heal easily and generally get poor blood flow, so it can take a long time to heal. They were also unsure if there is scar tissue vuildup in the area. They tried using ultrasound therapy to break up scar tissue, but it didn't have any effect.

After looking at the MRI, the orthopedic surgeon basically said I had two main choices: arthroscopic wrist surgery to try to clearly see the internals and potentially fix something if it's obviously wrong, or continue hand therapy and see if it gets better with more time. I wasn't ready yet for surgery, so I opted to continue hand therapy.

Continued hand therapy resulted in slight improvements. Certain positions became marginally less painful. But I had to stop rowing. I started finding that my wrist was getting some laxity after the pulling movements, like I could feel the junction between my hand and arm slipping and shifting after I rowed some.

That was uh, pretty alarming, so at the direction of my hand therapist, I just had to stop then. My last recorded rowing session was July 19. I miss it a lot. It was the perfect cardio workout for me, and it had real components of focus and learning and improvement. I could feel my form getting better and the movements become easier, and it was rewarding to be able to push myself. I'd say my goal right now is get my wrist back to a state where I can go back to rowing.

Hand therapy went on until early September, but the pain was still not fully leaving. The doctor finally said we need to try something different and prescribed me a Muenster splint. This next phase of my life was very inconvenient, let me tell you.

The splint

The Muenster splint covers from middle of the hand all the way up to and including the elbow, in order to prevent rotating the hand palm-down (supination). The doctor thought that supination movement might be preventing good healing. It's made of a hard thermo-plastic material, so I also couldn't rotate my hand towards the outward direction of my arm, called ulnar deviation. That's definitely one of the movements that exacerbated The Area.

The splint had some padding inside, and I wore a standalone sleeve thing on my arm for comfort--a lifesaver. Despite all that, it took several rounds of adjustment with my endlessly patient hand therapist to get it fitting well enough. The first week, it was pulling tight against my thumb webbing so badly that I got internal bruising. Later it was pressing so tight against the part of my ulna that pokes out of my wrist that I nearly got bruising there too.

I've been lucky most of my life not to have major surgeries or health issues that have really forced me to change my daily habits for long. This is the first one in ages that put severe restrictions on my daily life. I am 100% aware that I have things way better than others, and yet, it's all relative. This was a big change for me.

You know how you hurt something and then you suddenly learn all the things you secretly took advantage of that body part for? Let's see the things I suddenly couldn't do anymore:

• Type at a computer (!!)
• Spread stuff on a sandwich
• Take pills held in my left hand
• Tie shoes easily
• Turn the steering wheel, especially while looking back when reversing
• Weedwacking
• Food prep, like cutting vegetables

As the person who does all the cooking, I had to lean heavily on simple meals or eating takeout when I was wearing the splint full-time. Notably not on the list is sleeping. Thankfully I was able to find comfortable positions to sleep in. That would have just destroyed me.

Typing adaptations

Typing was the worst of it. Since my job is in software, there is a pretty good amount of typing every day. Without being able to supinate, at first I had to raise my desk so high that my entire elbow was raised, to the point my hand could be in that palm-down position for typing. It was awful.

I immediately looked to buy a split keyboard, hoping that I could independently reposition the left half in a near-vertical position. I was able to buy a used ErgoDox EZ off eBay, and it's been a lifesaver, though it didn't start that way.

The ErgoDox EZ is a split keyboard, but it's also what's known as an ortholinear keyboard, meaning the keys are in straight columns as opposed to staggered, like most people are used to. At first, my fingers kept hitting the wrong keys constantly. And the keyboard doesn't have the usual shape, so I had to reposition a bunch of punctuation, numpad, etc..

It took me a solid 6 weeks to get comfortable using it. The first week or two, my productivity dropped to about 25% of normal. But why, you ask, is simply slower typing causing such a dip? Well, it's because every time I wanted to type something, I then had to focus on what keys to hit to make it happen. Imagine instead of just speaking, you had to concentrate on making every sound. By the time I typed something, I'd lost my train of thought. I'm just not used to operating that way. It was incredibly frustrating. All I could do was push through and hope.

Another thing that worried me is: what if I retrained my muscle memory so that regular keyboards don't work for me anymore? I'm writing this blog on a regular keyboard and thankfully it seems I can keep track of both layouts in my muscle memory.

Road to surgery

I kept the splint on nearly full-time for 2 months. During this time I went to hand therapy twice a week and did daily home exercises as they prescribed. By the end of it, I had lost a large part of my range of motion (due to extended immobilization), had a lot of stiffness with certain movements (due to immobilization), but had overall decreased pain in The Area with some of the movements that caused problems before. I'd say it was net positive, with the hope that the stiffness could be worked out over time.

I saw my orthopedic surgeon again at the end of October and, in light of the lingering pain, I decided to finally go for the surgery. It's scheduled for mid-November.

A break

This is wild. I'm now continuing this over a year later, December 2025. At one point I had planned to write about the surgery and aftermath much closer to when it happened, to get a better account of all that took place. Well, instead I waited a year and you get this. This stupid wrist thing really messed up about a year and a half of my life, so I still feel it's important for me to catalog it even at lower fidelity.

So... the surgery

The surgery was a whole day affair, as I suppose most surgeries are. They gave me all these pre-surgery instructions. I had to wash myself with an antibacterial soap the night before. On the morning of, I couldn't eat any food after a certain point, and I had to drink certain amounts of water on a certain schedule, eventually disallowed after a certain point.

At the hospital I of course had to wait around a decent amount. Gramma came up and watched the kids while my wife took me, waited during it, and took me home. Eventually they brought me back and set me up on a gurney, stripped me down and draped a sheet over me. Most interesting was how they put these inflatable balloons all over me and pumped them full of hot air to raise my body temperature. We joked that I had transformed into a pool floatie.

My doctor (who is also the surgeon) came to make some marks on my wrist. He talked to me for like 15 seconds and then ran off. I got the sense that he was doing like 8 surgeries that day. Nurses etc prep everything, he wades in and deploys his expertise to cut for a little bit, then hops over to the next guy.

Finally, they had me breathe in some stuff, and next thing I know, I'm waking up and it's all done. So what did he even do in there? Well, luckily they took detailed notes. Have a look and let your eyes glaze over as you read this, unless you're a doctor, in which case... enjoy!

Attention was drawn to her left upper extremity. Tourniquet was inflated after left upper extremity was exsanguinated with Esmarch. Index finger as well as the ring finger were utilized to apply finger traction. Then this was hooked to the wrist arthroscopic tower with appropriate distal traction tension. After this was done, I did inject 1% lidocaine with epinephrine solution to her 3-4 portal which is just distal to Lister tubercle over the radiocarpal joint. A small skin incision was made, blunt dissection carried down to the level of the capsule. Then, the arthroscopic cannula was inserted to the radiocarpal joint without any difficulty. I then performed a careful examination through her radiocarpal joint as well as TFCC. It was noted that the patient has an intact synovium tissue around the radial styloid. The patient has good short radiolunate ligament as well as radioscaphocapitate ligament. The patient's SL ligament appeared to be intact with no any dissociation or significant synovium fray. Arthroscope was then introduced to the ulnar aspect of the joint. The patient does not have any significant radial detachment of the TFCC.it was noted patient has central perforation on the degenerative tear of the TFCC. Her peripheral attachment of the TFCC appeared to be intact. At that moment, I did establish 6R portal. Utilizing same procedure with 3-4 portal, then arthroscopic probe was introduced to the joint. With careful probe evaluation, the edge of central perforation appeared to be inflamed and frayed but appear to be stable. I then introduce arthroscopic shaver, then shaved excess synovium tissue to obtain stable edge of the central TFCC. After this was done probe was utilized that shows stable edge. The shaver was then also used to perform to remove all excess synovium tissue at the dorsal aspect as well as volar aspect of the TFCC. Again, the radial attachment appeared to be intact. Then, I did switch the portal. I introduced a camera portal through 6R portal. I then visualized volar aspect of radiocarpal joint. Then, shaver was then introduced from 3-4 portal. Then, I did clean up synovium tissue at radial dorsal aspect of the capsule including dorsal aspect of the scapholunate ligament. I then performed thermal shrinkage to his TFCC. Good tightness of the TFCC and good trampoline sign is noted. Negative hook test. I then performed midcarpal arthroscopy. Radial and ulnar midcarpal portal was established in the same manner. Arthroscopic camera and shaver was introduced to remove excess synovium. It was noted patient has slight dissociation of the lunotriquetral interval with probe gently forward into the interval. There is no instability noted. I did perform thermal shrinkage to shrink down dorsal lunotriquetral ligament structure to see if this can shrink down his interval between lunotriquetral ligament. Radioscaphocapitate ligament was also visualized and he was frayed. Therefore some shrinkage was performed. At the moment, final pictures were taken. Arthroscopic instruments were removed. Arthroscopic portal was closed with arthroscopic portal closures with 5-0 nylon, Xeroform dressing, as well as 4 x 4. The patient was placed in an ulnar gutter splint in neutral position. The patient was awakened from anesthesia without any complication and brought back to PACU area in stable condition.

Postoperatively, the patient should be nonweightbearing to her left upper extremity. The patient can remove her dressing and then transition to his brace. Patient is to wear his Muester splint postoperatively up to 4 weeks. Hand therapy will be initiated. I am going to see him back in 6 weeks.

In summary, it sounds like they found that my ligament was partially torn. They used "thermal shrinkage" to tighten up the ligament and strengthen it around the partial tear. They used a shaver to get rid of excess scar tissue. Read on to see whether or not this helped!

I do not know why they kept referring to me as she/her, sometimes even switching within the same sentence. Ok.

After I woke up I remember being groggy, but I don't really remember much about how the rest of that day went. My notes say that I slept a lot, 15 hours straight. That's wild. Body was like wow what just happened to you? Better shift 100% of your energy to healing that. And so began my aftercare.

Aftercare

Here's what the discharge instructions said:

Keep dressing clean and dry for 48hrs. You may remove the dressing after 48 hrs, and wash the incisions with soap and water. Normal soap and water washes, showers ok. Avoid soaking such as in pools, tubs, dishwater, and avoid ointments/ lotions over incision. You may use bandaids as needed until the incisions are dry. Activity as tolerated, let pain be guide. If too painful then should discontinue activity. Recommend avoiding any heavy lift, pull, push until next appointment.

I had some kind of bandage dressing around my wrist. With hydrocodone I was able to manage the pain very well. No real discomfort from the incision sites at all. But tell you what, I was scared to look under there after that 48 hours. I did not know what it was going to look like. Do you want to see? It's not bloody or anything. The incisions are quite small. I won't embed it, but you can click to see what my wrist incisions looked like.

So 48 hours later rolls around and I have a shower and take off my wrappings. I got my wife to help me undo them cause I was nervous. Whole wrist was swollen and tender under the wrappings, and I was very careful with my movements, but I used that antibacterial soap to wash it, dried it off, wrapped it in new wrappings, and put it back in the Muenster splint.

My notes say that by day 4 I was able to make a sandwich and didn't wear a brace. That feels like too short of a time, but I don't think my notes were lying. I just remember being nervous about smacking my hand into stuff for a while.

Rehab

I started going back to see my hand therapist twice a week, probably starting around day 5. At 7-10 days after surgery, the incisions had closed and my hand therapist took out my sutures. That was weird. She just pulled and they came out. Really weird. I haven't had a lot of surgeries, in case you couldn't tell.

After the sutures came out, the incision sites became the main characters in my life. I had to do scar massage a few times a day with cocoa butter lotion to keep scar tissue from forming underneath. Scar massage was not fun. Yes, go to these really sensitive spots and press on them a lot with the express purpose of breaking up any clumps underneath. Despite my best efforts, one of the spots stubbornly kept trying to form a lump under there. Both I and my hand therapist kept massaging away at it every day and session to stop it from growing. Now, a year later, I can't feel anything under there, but I sure remember.

Another exercise I remember was called "tendon glides". It was simply moving each finger such that the tendons would move through the places under the incision sites. Also uncomfortable, also important.

I had a lot of shifting and grinding feelings inside my wrist during this time. If I bent my wrist here or there, I could feel it loose inside and kind of crunchy in there. Really unsettling. My hand therapist said it's normal and will sort itself out as we go through strengthening exercises.

I worked a lot on range of motion of my wrist. Side to side, forwards and back. The long immobilization prior to the surgery and the surgery itself lost me a lot of range of motion. The best exercise I used for this was simply to take a playground ball, set it in front of me, put my palm down on top, and roll it forwards or backwards and around in circles. It felt like a really good stretch, and I kept doing that exercise for a long time.

After my followup appointment with the surgeon, he said the wrist was healing nicely and cleared me to start strengthening exercises at hand therapy. Now my home program shifted to a lot of elastic bands and pulling in different directions against resistance. They were tiring and boring, but they worked. My notes say that by 10 weeks after surgery I was feeling noticeably better every day. After 10 additional weeks, I was discharged from hand therapy entirely, having recovered to a good enough point to do the rest with home exercises.

Insurance fight

Before I get to the final results, I need to write about this dumb insurance snafu. I was cruising along with my hand therapy when I suddenly got a notice from my insurance that part of the surgery was considered "experimental" and therefore not going to be covered, to the tune of about $5000. I'm sorry, what?

Let me get this straight... my hand surgeon, an expert, decided this was the best course of action, performed the surgery, and now some rando is deciding actually what he did was experimental? Boy, if I had know that was coming I would have at least paused and figured this out, not plowed ahead to get unwittingly charged for it later. Ridiculous.

Insurance had this complicated process of appeals whereby I could write a letter pleading my case... but why would they listen to me? They need to talk to my doctor, not me! My hand therapist (she was so awesome) had the winning idea: call my surgeon's boss and have them set up a call between my surgeon and my insurance company to make the case. It's weird to think of surgeons as having bosses, but they do. People who help run the clinic and figure out logistics and stuff. Anyway, once I got the right person involved, it went just like I hoped. Insurance came back saying that in this situation, the chosen treatment was an appropriate one, and they ended up covering it. Whew.

One year later

The point when I felt I was ready to end hand therapy was when I tentatively got back on the rowing machine and was able to row at a lower resistance settingi without difficulty. From earlier in this tale, that was causing me problems before. I sent my hand therapist an update by email a little while ago, that by now I've been rowing at least 3x a week this whole year and generally getting better over time, most importantly without any pain.

My wrist's range of motion has still not fully recovered, and I'm not sure it ever will. Basically the only position that worries me is putting heavy load like doing a push-up. I don't think I can do push-ups anymore. But I can lift heavy cast iron pans and stuff, which is more important for my daily life, so I'm fine with it.

I kept the ErgoDox keyboard as my main work keyboard. My typing accuracy with it is still only about 75% of that with a staggered keyboard. Frustrating. Worse, my accuracy with regular keyboards also took a hit. But it's not too bad.

These last two years were really annoying. By far not as bad as some people have it, but still nerve-wracking and frustrating in their own way. Basically daily I am thankful for the care I got in getting past this. I was so tired of thinking about my wrist all the time. Happy to move on.