The buzzing sound of the cast saw marked the beginning of the next phase in his wrist reconstruction project. With the removal of my husband’s cast, all attention shifted away from the surgeon (whose job was done) to the hand therapist whose job was just beginning. Although, a question will always remain in my mind: Was that cast really necessary? Some research studies have come to the conclusion that early immobilization is not necessary following a proximal row carpectomy (PRC). But after seeing what my husband went through, I’d say that the cast certainly did help, if only to protect the surgical site while some healing took place and to prevent him from doing too much. As soon as that cast was removed, my husband noticed the vulnerability of his new hand and wrist immediately.
He experienced some initial swelling and increased pain in the first week without the protective cast. Fortunately, the topical anti-inflammatory, Pennsaid, helped keep those symptoms to a minimum. Thank goodness for samples, because I doubt he could have gotten that medicine from his insurance; trying to get my husband to take pills is challenging.
His first few weeks in therapy have gone very well but the therapist cautioned him against trying to do too much. He can no longer expect full range of motion from that wrist or full strength. In fact, the expected outcomes from a proximal row carpectomy (PRC) are well documented. One study shows that expected range of motion following a PRC to be less than 50 percent of normal and strength to be less than normal as well. However, the alternative to PRC is a wrist fusion. Although a fusion usually results in better strength, it also completely limits the range of motion. Thus, we opted for the motion sparing procedure because his activities rely more on motion and less on strength.
The biggest unknown at this point is whether or not my husband will experience significant pain relief. Some people experience no pain or mild pain after having a surgical repair for wrist arthritis. His fingers are crossed that his pain will also be relieved - pain relief was his ultimate goal for having this surgery in the first place. We will not know how much residual discomfort he will have to live with until all the dust has settled. He was told it could take up to a year post-surgically.
This year will be a process of learning what he can continue to do with his dominate hand and what he can’t do any longer. If he remains compliant with his hand exercises and remains patient, I am confident that he will ultimately be very satisfied with his outcome. Right now, he is not very sure it was worth it. Although his hand and wrist will never be normal, he is willing to accept his new reality that will not include push-ups, shoulder presses or breaking bricks with his bare hands. As long as he can still go fishing, he should come away from all of this with a smile on his face.
Orthop Traumatol Surg Res. 2010 Sep;96(5):513-20. Epub 2010 Jun 11