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Thread: Impact injury to hand

  1. #11
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    Quote Originally Posted by Jason Donaldson View Post
    Today's update: day 6 of one antibiotic, day 4 of the other, no relief. I've contacted my doc for the MRI order.

    Naproxen and elevation continue to help with pain, but the swelling is still there, especially approaching time to re-dose, and ROM is still jacked up. I've been wrapping the hand and ring finger with a boxing wrap most of the time for protection and rest, and to remind myself not to use it so much. (Snow still needs to be shoveled, but this week's was pretty light. Typing sucks, though I'm adapting to not using all ten fingers.)

    This is one week since it flared up - any reason to wait further before working out an option for something, e.g. on leg machines? Or just focus on walking for activity? Both?
    This is bullshit. If your doctor will not order an MRI today, to be done today, go to the ER.

  2. #12
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    Quote Originally Posted by Mark Rippetoe View Post
    This is bullshit. If your doctor will not order an MRI today, to be done today, go to the ER.
    Oh, he ordered it right away, for "ASAP". The scheduling office has no MRI openings for three weeks. Looks like ER is my option.

  3. #13
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    I hope you're there right now.

  4. #14
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    Quote Originally Posted by Mark Rippetoe View Post
    I hope you're there right now.
    Affirmative.

    It's been over twelve hours of travel and adventure, not unlike Book I of the Lord of the Rings, though thankfully Tom Bombadil did not make an appearance. (Though I think I did see a barrow-wight...) And it's not over yet.

    Short version, as this is ongoing:

    Went to ER #1, seen by the MD on duty, who consulted with the hand surgeons on duty at the other ER, got me in for the MRI. Got additional blood work, still no elevated WBC count.

    Went to ER #2, seen by the (among others) the hand specialist on duty, who was able to make some more specific determinations between the case history, the MRI initial report, and his examination in person. Once the full MRI report came back this morning, now that a musculoskeletal radiologist looked at it, returning "There is osseous edema within the radial base of the proximal phalanx of the ring finger with geographic T1 hypointensity concerning for early osteomyelitis."

    The hand specialist team's initial decision not to open it up has now reversed in light of this finding, and I'm going back in for further work, likely to be admitted and get it explored yet today. The potential for joint or bone infection is not something I want to screw with.

    Rip, I greatly appreciate you for your decisive and effective advice in this. I was unexpectedly laid off in early November (before it was cool, darn it!), and having my typing impaired for my ongoing job search and unable to train for health and sanity has been no small amount of stress on me. The potential of major losses there would be severe.

    Much like the program, the material, and the community as a whole, your help with this specific issue has benefited me and my family more than you know.

    Thank you.

  5. #15
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    Keep us posted about this.

  6. #16
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    Quote Originally Posted by Mark Rippetoe View Post
    Keep us posted about this.
    I should get a full debrief when they do rounds in the morning, but here's what I have so far: Underwent surgery for debridement and irrigation today. They've collected and sent samples for cultures and pathology. My wife's report of their post-op update call is that they discovered fluid indicative of infection, and found and cleaned out "old blood", presumably from the original trauma.

    I'm looking forward to more detail from them and the results of the tests, and will continue to report back.

    I continue to be impressed with how receptive the bulk of staff is to my returning to activity and training, as well as to my input and questions. When the head surgeon was meeting with me in pre-op, she was really taking a partnering approach with me, and she was anticipating and encouraging a return to training limited only by incision recovery, which should be quick.

  7. #17
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    Quote Originally Posted by Jason Donaldson View Post
    I continue to be impressed with how receptive the bulk of staff is to my returning to activity and training, as well as to my input and questions. When the head surgeon was meeting with me in pre-op, she was really taking a partnering approach with me, and she was anticipating and encouraging a return to training limited only by incision recovery, which should be quick.
    That is impressive, and abnormal. You got lucky.

  8. #18
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    Quote Originally Posted by Jason Donaldson View Post
    I should get a full debrief when they do rounds in the morning, but here's what I have so far: Underwent surgery for debridement and irrigation today. They've collected and sent samples for cultures and pathology. My wife's report of their post-op update call is that they discovered fluid indicative of infection, and found and cleaned out "old blood", presumably from the original trauma.
    I am debriefed, discharged, and back home. So yes, it's looking like there was a hematoma, presumably from the impact injury in December, and that clotted blood provided a medium both rich for bacteria growth and where the body can't effectively bring the fight. (Might this explain the lack of elevated WBC count and no fever?) They made about a 1 cm incision over the metacarpal, from the knuckle down, and found the fluid and the hematoma described above. They opened the joint to check it, and found zero evidence of infection there. All infection was dorsal to the bone structure. They collected samples, including some scraped from the bone, for testing. Overall time from anesthesia to waking up in the recovery room looks to have been 30 minutes or less, I think.

    They administered further IV cefazolin post-op, switching to oral amoxicillin and potassium clavulanate (Augmentin) post-discharge, subject to adjustment depending on culture results. Follow-up will be with the hand surgeon in clinic in one week for re-examination and suture removal.

    Overall pain and stiffness are better, incision effects aside, and swelling is of course way down, having been cleaned out. The effects of the general anesthetic and its associate tubal invasion have been far milder that I'd expected. (Admittedly, that was breathing tube only, no Foley...) They agree that my approach to the injury from the beginning was correct - resuming training and activity since it was all tolerated, not going in to the ER at the time of the injury based on overall symptoms, treating with immediate ice and ongoing ibuprofen, etc. They also agree that ER X-rays and any other work indicated at that time would neither have detected nor prevented what arose later. This situation did not come from imprudence or overuse. Based on what they found when they went in, the treatment decisions for pushing for the MRI right away, and for the surgery and its alacrity were proven correct.

    The OT who met with me is on board with "inaction is injury", and wholeheartedly agrees that my working ROM as assertively as I want during recovery is a great idea, as long as it's not negatively affecting the sutures and the incision. I've already gotten back to being able to close the fist completely, though lightly, with a bit of effort. I forgot who said it originally, but the OT really, really liked when I mentioned the "motion is lotion" truism, and promises to steal it for her patients. If someone wants, I would be happy to send her a correct attribution.

    Pending the incision healing, she and the surgeon both want no lifting with the left hand, no restrictions otherwise, except for insofar as to mitigate risk to that hand, e.g. where I could accidentally end up catching weights with it, falling and landing on it, etc. The OT crafted a splint for the hand, for protection while sleeping only. They gave me edema gloves for wearing during the daytime. When I broached the topic of getting access to a commercial gym for machines as a stopgap measure, the big concern they voiced was to be careful about infections like MRSA.

    Quote Originally Posted by Mark Rippetoe View Post
    That is impressive, and abnormal. You got lucky.
    Yes, I'm very thankful. As general caretakers, they were all very good to outstanding, and the overall tenor of the providers on training, across multiple roles, was great to experience. I'm sure it also helps that I understand that they are my contractors, not the other way around, and I have learned to take charge of that relationship respectfully and productively.

    From intentionally interacting and observing carefully, I've come to suspect that these folks are dealing with so many people who simply do not take care of themselves that they're happy to get someone who is taking ownership of understanding and executing on their own health and maintenance. I'm not saying this to pop off about myself - I've had excellent support and good role models to learn from on this, and an exploding number of counter-examples - but I'm sure it's nice for them to have patients that they can work with, not just on.

    Then again, the OR nurse who took me in to pre-op told me she'd spent all day in multiple transplant surgeries, the longest of which was a double lung, so maybe an easy procedure was refreshing, too...

    So, this is one and a half solid weeks off of training, with at least a week expected for getting back to easing post-layoff transition back in. I plan to work aggressively on the ROM no matter what. What should I be thinking as far as doing what I can in the meantime?

    Also, one of my favorite questions: What else should I be asking at this point, that I'm not? (From them, or on here?)

    As always, thank you.

  9. #19
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    There are two ways to load the grip: compression, as in the press and bench, and tension, as in the deadlift and chinup. Ask the hand guy which to start first.

  10. #20
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    I would not have thought of that - will do. Thanks. I have a follow-up visit tomorrow, so I'll ask then.

    This is a teaching hospital, and the surgeon is a resident. My follow-up is with his supervising surgeon. She met with me in pre-op, and called my wife after the surgery. I've been really happy with both so far.

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