Scaphoid ligament reconstruction surgery - Brunelli procedure

I was writing this in my diary (well actually using the voice text on my phone as I can't write and left handed typing which takes ages!!) and until I started writing didn't realise how fed up I'm actually feeling about my wrist. I've decided to share my journey (if you can call it that) and feelings on my blog. (Which I actually haven't written on in years so writing about this and keeping people up to date will encourage me to start writing on my blog again (well that's my aim!!!)).

It has just been over six months (Thursday 21st November 2013) since I actually hurt my wrist. I never imagined that me trapping my wrist in the car boot would cause this many problems and still be going on now!!

So how did I do it and what problems and treatment have I received so far?

Back in November I drove some children from my daughters school to an archery activity at the local secondary school. In between dropping them off and picking them up, I went and picked up a Christmas present for my daughter. I didn't want her seeing the box so I tried putting it in the boot of the car - but everytime I tried to close the boot the box keep failing out (Ford Galaxy - little boot when all seats are up), so in a mad genius moment I thought I could hold the box in place and slam the boot shut at the same time, of course the plan was to remove my hand in time before the boot shut. I have to say I have done this before and when I do tell some people they do say they have done it too - thinking when your going camping and all your camping things don't quite fit in, how many times have we held them in place and shut the door, easily removing your arm/hand in time OR am I just trying to justify what I did!!!!! I think the difference is when I did it this time, I didn't take into account that the car we have now is a Ford Galaxy and the car boot door is twice the size and heavy as our last car - so the distance in removing my arm was a little bit longer than our old car. OK YES I AM TRYING TO JUSTIFY THAT I HAD A MOMENT OF MADNESS - A STUPID IDEA AND NOW I AM PAYING THE PRICE FOR IT.

I didn't go to hospital that day as I really just didn't see how I would have time but yes it did hurt like hell and yes I did have to sit at the side of the road with tears rolling down my cheeks while I tried to think of what I was going to do - I still had five children to pick up and a swimming lesson to go to. So I gritted my teeth and carried on. But by the next day my wrist was so swollen that Paul took me to the hospital, they x-rayed it and said there was no break and that I just needed to rest it. A week later I was in agony and the swelling was worse, I went back to hospital - they re x-rayed it and still found nothing but because of the swelling they decided that I should see a specialist, which was a few days later.

I never expected the problems that have resulted in this accident, I actually thought that I had broken my wrist and how I wish I had because it would have healed by now. Whenever I'm at hospital that's all I ever hear, 'if only you had broken a bone, you would have been healed by now, ligaments are so much worst' - well yes thanks for telling me, I know that now!!!! I saw an orthopaedic consultant who straightaway had me in a cast and booked me two days later for an MRI - she was concerned that I had partially teared my scaphoid ligament in my wrist. The results from the MRI was inconclusive but she was still concerned and wanted me to see a orthopaedic hand surgeon. Throughout this time I was in a cast for a few weeks then put in a splint. I couldn't drive and found it really difficult to do things like write and make cakes!! I was in loads of pain and the swelling was still there. I went to see the hand surgeon the second week in January. He looked at my MRI and moved my wrist around - his conclusion was that he really didn't think I had torn my ligament. He booked me into phsyio and said he thought that would help and fix the problem but would also book me into having an wrist arthroscopy surgery in case phsyio wasn't working - if my wrist was feeling better then I was to cancel the appointment. So I had six weeks before surgery to get fixed - well after six weeks (actually eight as surgery was cancelled night before and rebooked two weeks later) of wearing a splint and lots of phsyio there was no difference - I was in loads of pain, the best way I can explain it is - it felt like someone was stamping on my wrist ALL the time and then if I moved it, it felt like someone was trying to chop my hand off!! I know someone said they thought I was making it up - if only!!!! I didn't even think for a moment when I first injured my wrist that the pain would be so bad. It would bring tears to my eyes on many occasions and since injuring it I haven't slept a full night - I just can't sleep, I'm in pain and can't get comfortable.

So now the plan was this wrist arthroscopy key hole surgery where a camera was going to be inserted into my wrist in three areas to see where (if one) the partially tare in my scaphoid ligament was and if one was found then my surgeon Mr Field would repair it at the same time. I expected to wake up from surgery fixed (well after recover!) but I woke up to be told by Mr Field that he couldn't fix it without talking to me first as it wasn't a partial tare but a full scaphoid tare - when catching my wrist in the car boot I had ripped my ligament straight off my two wrist bones!!

So why is this ligament important in my wrist? The ligament between the two bones in the wrist (scaphoid and the lunate) should normally move together as they are joined by a ligament. When the ligament is damaged they don't, this causing pain and early onset arthritis.

Two weeks later I was told the next plan - I would be having a surgery called the Brunelli procedure were an incision is made over the back of the wrist and the two bones identified. Three small incisions are made on the front of the wrist and lower arm and through one they take half of the tendon used to reconstitute the ligament, which is then passed through a drill-hole made through the scaphoid bone. The ligament is then taken up through the scaphoid bone and fixed onto the lunate bone to try and reconstitute the ligament. The two bones are wired in place. These wires are left in for eight weeks after which time they will then need to be removed by surgery. Without the surgery I would loss about 30-40% range in my movement and be in pain most of the time. With the surgery hopefully the restriction of movement will decrease to 20-30% and the operation is very successful in helping the pain in 80% of cases. Complications from the surgery are - a chance of fracturing the scaphoid while drilling through it. A chance of infection. PAIN!! The operation is painful and will take twelve months to recover from and the original pain prior to surgery can persist. Potential damage to the blood supply to the scaphoid with avascular necrosis, this is a complication that could occur and could result in your wrist becoming stiffer and more painful.

So I had a lot to think about before saying yes to surgery but decided that the surgery was my be option.

Six weeks later I had this surgery - I'm just over five weeks post surgery now and have so many mixed emotions about the surgery/the pain after(!)/and the future!

The pain from surgery has been so bad - it hurts all the time and with the bad reaction I had from the medication, it has been horrible. I have just had enough, I just want A GOOD NIGHTS SLEEP!!!!! The surgery itself went well but like I said the pain...........not only is there the pain from surgery, there's the pain that was there before (the all the time pain) but also I have pain often from moving one of my fingers resulting in shooting/cramping style pain in my wrist lasting for what seems like eternity. Then there has been the pain from the casts - I've had four in four weeks (finally having one that is comfortable) the first was ok until the swelling started going down then it became too big and started rubbing, the second was cracking so they wanted to change it and the third was on so tight I had continual pins and needles in my arm. Like I said finally the fourth one is ok. I do hate having a cast - my thumb is immobilised in the cast which drives me mad!

One of my friends asked what I'm looking forward to the most once my cast is off, my reply straight away was putting my hand in the bath - but within five minutes I think I changed my mind about 100 times.....buttering my own toast, shaving under my left arm without asking Paul to do it(!), opening a bottle of Pepsi max, driving (well that's still months away), writing with a pen, writing on my book blog, using a pair of scissors, ironing (yes I know - sad!!)...............

Will it be worth it? I have read lots thought and comments from people who have had this operation, and it's been really mixed reviews - some say it's been a success even though they still have some restriction in movement and some pain but less than before the operation. Others have said it's the worst decision they made, with worst or no range of movement and extreme pain for years later. I guess at the moment I have no way in knowing which way my results will be, I hope they will be for the better. I know my wrist will never be the same - I have been told that on many occasions and I think it's this that gets me down. I do try to be positive but I do think I'm allowed some down days. I am just so grateful for Paul who has been such a great help, and for my family and friends who have given me moral support - especially my one friend Frances who has listened and supported me throughout this whole thing. And I'm lucky to have a great job looking after a little boy whose parents (and friends) have been very supportive and allowed me to have time off whenever needed.

I would love to say this is the end of it, but as I have previously said I'm still in a cast. My next operation is 25th of June - I will be put to sleep again to be opened up to see if the ligament has taken and healed. If it has the pins well be removed and I will be in a bandage for around four weeks, then physio will start - 12 to 18 months!!!!!

Honestly what an idiot was I trapping my own wrist in the car boot.....yes a complete idiot I hear you say!! I will keep you up to date and let you know my progress.


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