Impact injury to hand

[Jason Donaldson]

First follow-up was today. Turns out that the full staff surgeon I met with is the one who actually did the surgery, and the resident assisted.

She reiterated that there was no pus within the hand, but generalized inflammation of the tissue of the hand itself, and that the infection appeared to be in the old blood from the hematoma. The culture on this has come back positive for a streptococcus infection, which should be susceptible to the current antibiotics. Further testing is proceeding on the culture that was grown, to verify what kills it, results of which could indicate a change in course. Basically, when I took the hit to the hand, I created a subcutaneous Petri dish full of culture medium for whatever got out of hand there. That's been cleaned out now, and the antibiotics should help finish up any residual presence. Overall swelling is mostly resolved, incision and sutures look great.

From their direct observation, the MRI evidence of potential osteomyelitis was most likely from some bruising of bone, not infection. What they opened up inside (e.g. the joint), they closed back up with dissolving sutures. Again, no evidence of septic arthritis, which is good.

Progress and prognosis are excellent. Next follow-up is next Thursday, for re-exam and suture removal with a PA.

The doc had no preference between tension vs. compression for loading, as I get back into training. She's leaning toward about 4 weeks off from full training, and definitely no loading of the hand whatsoever until the sutures are out. We discussed the low bar squat, and how the weight is not in the hands, and she said that's fine, if it's not loading the hand (after sutures out), just be very careful about risking anything where the hand could have to catch weight, even accidentally. Physical activity that does not load or risk the injured hand has no restrictions. I can continue to work ROM on the hand subject to what I can put up with. Progress on ROM is very encouraging.

From the block they used, my whole ring finger was numb for 24 hours after surgery, but has been steadily recovering, with a small amount of residual numbness toward the fingertip yet. I am told this is normal, from poking around the nerve, and that full recovery can take months. Were this a case of surgical damage to the nerve, it should be affecting all the way from the incision site, so this is no cause for concern.

We discussed the actions taken from time of injury to present, and she says that she thinks all decisions were correct, from my immediate action at time of injury through approach to activity through medical care and decisions.

It's not often I get to hear "Donaldson was right", so that's nice.

So, it sounds like another week of trusting in the persistence of strength adaptation, then carefully easing back into things for a bit. A nearby gym has an informal push/pull meet on 01 Apr 2023 that I'm considering. I can ask about that timeframe at the next follow-up.

[Jason Donaldson]

Another update: My course of Augmentin ended yesterday. I had a follow-up appointment today for the recheck and suture removal.

The distal half of the incision has fully closed, but the proximal end has not. The outer skin layers still have some gapping. Two of the four sutures came out, but the other two are still in. I'll have another visit in one week. There is still a bit of redness and a small but noticeable amount of edema yet.

Still no loading of the hand yet, and I am to stop even working on ROM, to ensure the incision closes up. (I had already backed way off on that, actually.) They have zero concern with my getting the ROM back in time, it's just not time yet. We don't want to reinfect, so getting the incision to close is the primary immediate goal. Typing is okay, but they want me to avoid even closing the fist. I think it may behoove me to start wearing the brace from the OT around the house during the day, and not just while sleeping.

They have no concerns at this point about doing lifts that do not load the hand. Leg machines are fine. Upper body machines where the arm and not the hand is the point of contact are fine. The PA who was the main contact today (thought in consultation with the surgeon) was mainly concerned with wound care and cleanliness, so we discussed how to take care of that. Interestingly, one of her big concerns was that I not seal in sweat or other moisture, and thereby cause maceration. (I learned a new context for that term today!)

The overall four weeks' no loading guideline from the head surgeon puts me at no press/bench/deadlift for sure until 21 Feb 2023 at least. I brought up that there's a local gym doing a push/pull meet on 01 Apr 2023 that I had been planning to enter. They don't have a concern about that timeline in principle, though we did discuss that I'm not looking at time to train up fully for it. I did ask specifically if there was a concern with the stress itself if I were looking at, say, 90% of my PRs at the event, and there was no concern on their part. Entries must be postmarked by 18 Mar 2023, so I have time to think and to see how things go.

Our family has a YMCA membership yet, so I scoped out all three in the area today for machines. I have available to me various combinations of: hack squat/hip sled leg presses, a couple other kinds of leg press/squat machine, the ubiquitous hip ad/abductor machine, leg extension and seated leg curl, seated calf press, and an adjustable pec deck/rear delt machine that might adjust enough to work without hands. I think I can also manage using the arm cuffs for hanging knee raises on a machine to get something functionally akin to the Nautilus pullover. I know it'll be a lot of bro-style fooling around, but I want to do something. I'm also considering some careful unilateral dumbbell work, like clean and press.

To steal and expand on another man's apophthegm...I find I am not mentally and emotionally normal in the absence of hard physical effort, either. Prior to learning about proper strength training about six and a half years ago, I had an extended period of being fat, weak, and broken. I refuse to go back to that. But that's a story for another time...

[Jason Donaldson]

Final sutures were removed today. The incision is all but completely closed - just a small amount of outer-layer skin yet to go, and the closing of the holes from the last two sutures. No swimming until they're completely closed, since we don't want to risk more infection.

With the skin closed up, I can go back to working ROM, and can be massaging the area around the incision and along the tendon to break up scar tissue. Still no loading the hand until 21 Feb 2023.

I've been hitting the 45-degree leg press machine for 3 x 5 work sets, along with 3 x 12 sets on both the leg extension and leg curl machine. It's good to be working and progressing something again. I've also been fooling around with DB clean and press and DB snatch, with just the right hand. Probably not too productive, but it's fun for now.

I'm curious if anyone has experience with straps for hands-free deadlifts. I seem to recall Capt. Broggi showing someone using one, but I'm not sure. Searching online, I've found the Aldridge Arm, which straps around the torso and replaces a single arm. I've also seen what looks to be the Monster Multi Strap from Spud Inc used for hands-free deadlifts.

Or is something like that not worth worrying about and spending money on, vs. just progressing the leg press as much as I can until I can start easing back into regular squats and DLs?

Thanks.

[Mark Rippetoe]

Just wait it out, Jason. It's not like you're just fucking around not training. You're going to end up reinjuring the damn thing, and it may not tolerate much more of this.

[Jason Donaldson]

Just wait it out, Jason. It's not like you're just fucking around not training. You're going to end up reinjuring the damn thing, and it may not tolerate much more of this.

Understood. Thank you, sir.

[Jason Donaldson]

Update: Today was the four-week mark, as clarified by the medical staff on the 9th as the day to start carefully loading the hand again. I'm planning to continue progressing the leg press as I've been doing while slowly and carefully adding in primary exercises and transitioning back to the big and proper lifts.

Today, I added lat pulls (real ones, not the homebrew banded ones that led to all this...I'm dumb, but I'm not that dumb), working up to an easy three sets of 12 at 100 lbs. No discomfort or aggravation yet... My plan is to add light presses later this week, and progress those two exercises with caution.

I intend for the leg press to suffice until I'm feeling confident enough with the hand to start adding in the squat, and ultimately the deadlift, and transitioning off of that apparatus.

So far, so good - constant forward progress on the objective.

[Jason Donaldson]

One last follow-up with the surgery clinic today - I am now cleared hot for all activity, with zero restrictions.

All lifts, swimming, hitting a heavy bag, whatever...she was extremely happy about the state of my hand and cheerfully encouraged me to reengage with whatever I want to do.

Everything I am now experiencing is normal and consistent with good healing. I have some scar tissue inside and out, with adhesions that will need to break up over time. The knuckle and around it are still visibly larger, which she says is scarring, not inflammation, and not a cause for concern. There is residual redness of the skin around the suture site - she says this is also normal, and takes about one year for the pigmentation to resolve fully. I can use sunscreen when outside to protect this process, or not, depending solely on how much I care about the appearance.

ROM is still complete. Going on walks in the Wisconsin weather, I get the usual effects of cold on scars - also not a concern, according to her. I have some unusual feelings from the scarring - twinges, pulls, and such - as it pulls at skin and whatnot. No concerns there, and it should slowly change over time. Aches and pains and weird feelings are normal for this. She very much wants me to keep being active with the hand, encouraging me to get as much movement as I can tolerate, and massaging around it to help move along the breaking of the scar adhesions.

My training plan is to continue my approach of phasing back in proper barbell movements, though a bit faster now. It will be interesting to see how much the leg press has preserved of my squat and deadlift. The sign-up deadline is this Saturday to decide whether I want to do a local 01 April push-pull event just for fun.

Rip: Thank you once again for all your direction and advice throughout this. It is beyond a doubt that it is because of your help that I've had so good an outcome here. I greatly appreciate you and what you do.

[Jason Donaldson]

I went ahead and decided to drive in and drop off the check to do the push/pull meet with the two weeks of lead time. I registered for masters bench and deadlift, and open (242 lb class) bench. Masters was age-adjusted Wilks'.

Weighed in at 238.0, morning of the meet.

BP: Went three for three, grinding out a 5 lb PR of 350 for my 3rd attempt.
DL: Solidly hit my opener at 385, failed hard overreaching for a small PR attempt at 435, failed it hard again for my third with the DL of Shame.

Brought home 4th place for masters and 2nd for open.

I'm considering this objective evidence for the PA's evaluation of my recovery. Also evidence that capacity for compression has returned faster than for tension...not too surprising.

Back to regular training as of this week.

Thanks again.