Thumb surgery, help me keep my groove?
February 9, 2014 7:53 AM   Subscribe

I'm getting the tendon in my thumb repaired tomorrow and I'm looking for advice for keeping my life on track during recovery.

I severed the tendon in my left (dominant!) thumb in a freak dishwashing accident (ceramic plate shattered). I'm getting surgery tomorrow to repair the tendon and I'll have a plaster cast to the elbow for 6 weeks. I'm told my other four fingers on my left hand will be free to use.

I've never had surgery and I'm a little nervous about a few things. Any counsel on these topics or any other advice so, so welcome. This post is very helpful but I couldn't find anything about thumb surgery specifically.

1. I'm a writer by profession, so not having full use of my dominant hand is freaking me out. I am told I'll be able to type (without the thumb, of course). How soon? Will I truly be able to type? Is it a fantasy that I'd be able to write messily with a pen after the pain goes? Can I feel confident the cast won't be too much of an impingement on my work?

2. I'm concerned about exercise. In the past six months, I've been on a rigorous 1-2 times daily exercise plan that's helped my body and mind get stronger than I ever thought possible. I run, do Pure Barre and Jillian Michaels DVDs. Can I still do these things, with modifications? How can I get the arm workout necessary to keep my biceps/triceps strong? Will I be able to do forearm planks, lift free weights with my four fingers? If not, how can I get the full-body benefits of push-ups/burpees and not lose the strength I've worked so hard to build? And I'm assuming I will be able to run once the pain of the surgery passes?

3. As luck would have it, I have to move on March 7. I plan to hire people to pack and unpack, but any other tips for moving without full use of a dominant hand/arm?

4. What are some things I should know about having my dominant hand/arm in cast? How much pain should I expect after thumb tendon surgery? Will I be able to do a lot with those four free fingers?

Thanks for any and all advice/experiences. I know I can ask the doctor tomorrow, but I'd like to get as much in place to prepare myself (mentally and practically) today.
posted by annabellee to Health & Fitness (11 answers total)
I've not had that particular surgery, but I have done a broken wrist and a severed tendon in a finger and rotator cuff surgery. My experience with all of these was that I adapted. You learn to make do and make adjustments and life goes on.

I can't speak to the pain specific to that operation, but given the immobility, I'm guessing that it will be easily controlled with meds.
posted by HuronBob at 8:07 AM on February 9, 2014

Agree with HuronBob. You will figure it out and you'll do so pretty quickly. I can type really well with my left hand only because of an immobile right hand (due to a freak dishwashing accident requiring 17 stitches), it only took about three days for my left hand typing ability to increase about 50 fold.

Basically what happens is you try to do a task, if it hurts too much you just instantly do it in another way. I think you are going to be amazed at how quickly you adapt. I actually still find myself doing something in a weird way that doesn't use my right index finger 9 years later.
posted by magnetsphere at 8:18 AM on February 9, 2014

I have had two surgeries to my right index finger -- entirely different kind of surgery, and I couldn't use any fingers (as they needed to be immobile to support the index finger).

Writing: it's pretty easy to type left-handed. The mouse is annoying but not impossible while a touchpad is fine. (This was pre ubiquitous touchscreen.) I wrote much, much more slowly and messily left-handed, but it was legible. If you're a writer, look into dictation software, which has also improved.

Exercise: ask your doctor about these things. It will be much easier to regain muscles again in 6 weeks than it will to repair your tendon again; err on the side of caution. It isn't impossible, but it depends a lot on what you want to do and what the surgery and healing require. You do not want to tear your tendon apart just because you couldn't wait to exercise.

Exercise, part two: when you're done, get physio. Do the exercises religiously. This is really, really important. Bonus: physiotherapists will be able to recommend an exercise regimen that won't risk the tendon, if you need one. If you don't, they'll be able to tell you that.

Other stuff: it's pretty much impossible to wash long hair on your own one-handed. It's easier to take a bath and just hang your hand out of the tub than to take a shower and keep that one hand dry. Avoid shoes with laces. Check the laws about driving. And, if you don't have a history of addiction, take the painkillers. They work much better at keeping pain that isn't back away than at getting rid of the pain that has returned, so don't wait until it hurts again to take one.
posted by jeather at 8:26 AM on February 9, 2014

What are some things I should know about having my dominant hand/arm in cast?

A few years ago I had RC surgery on my right (dominant) side and got great advice in my question here.

One thing I want to emphasize is the problem I discovered in meal planning. Basically, if you can't cook for yourself you have two options: you can eat cheaply, or you can eat healthily. I ended up spending a ton of money and gaining weight because I couldn't use my right arm for a 6-8 weeks and couldn't exercise during that time either. It might not be as bad with thumb surgery but next time I would try to cook and freeze as much food as possible.

Without going into detail, I would strongly suggest you practice using your left hand for all your, um, bathroom needs. (It's not as easy as it sounds!)

The rest of the answers I got were great so I won't repeat them all here.

Will I truly be able to type?

I'm currently in a thumb splint because of ligament problems and it's not slowing down my typing too much, but I'm not a touch typist. Just trying to touch type now and the splint is getting in the way so you might need to work around that.

I'm keeping an eye out on this because if the splint doesn't help I'll probably be needing thumb surgery, too.

Feel free to MeMail me, and good luck!

On preview, ugh, yeah, dealing with my long hair sucked hard, in and out of the shower. I lived in a hair clip and my hair was thrashed by the time I was healed.
posted by Room 641-A at 8:45 AM on February 9, 2014

I nicked that tendon in a non-freak accident with table saw. No surgery, but I was fitted with a removable splint to immobilize the thumb/tendon for a couple weeks. It started at the wrist and ended at the tip of the thumb. The MD instructions were basically, any movement that the splint allows is permissible. (Check with the doc to make sure this is the case.) You'll be surprised what those remaining four fingers can do for you.

I ran about 25 mi/week with the splint - no problem. You really have to check with your PT/OT about weight lifting (and moving).

Ask the doc about nerve damage/repair too. I lost the medial branch, and opted out of surgical repair. Make sure you know what the plan is for that.

Try to be the bestest rehab/PT patient evah, because regaining flexibility with that thumb is typically a bitch.

Here's a link dump of my post-injury research - it's mostly rehab-oriented:

Brigham Womens FPL PT
Western Ortho FPL PT
AJOT Postop Mgt of FPL Laceration
posted by klarck at 8:46 AM on February 9, 2014 [1 favorite]

Oh my goodness so helpful so far. I forgot about my LONG HAIR. I guess I will become a lady who gets her hair washed and blow-dried at a salon once a week or something. Thanks for the heads up.
posted by annabellee at 9:00 AM on February 9, 2014

Oh, you may need to rethink bras and other clothing options. I was more restricted with my shoulder, but I would invest in a few step-in style bras like this*. Now in my thumb splint I've gone back to those exclusively agaoin.

*random google link, not an endorsemement of the seller.
posted by Room 641-A at 9:09 AM on February 9, 2014

FYI, I had no bra issues using normal back clasps, and I too went to the salon every week because what else could I do? My hair looked great, though. Invest in a bunch of hair claws or hair sticks for the rest of the time, those are the easiest to use one-handed.
posted by jeather at 9:19 AM on February 9, 2014

I am typing with a wrist cast now--had basal thumb arthritis surgery almost three weeks ago on my dominant hand. The worst part so far for me was the 10 days in the surgical dressing--huge, hot, heavy, & awkward. The cast is a dream in comparison. It is also waterproof, so no more plastic bags. They make a waterproof sleeve that you can put over your cast. I had one from Walgreens. It was awful; hard to put on (not easy "one-hand" as it said on the box), plus, you need arms like sticks for it to be close to comfortable.

If you have a nerve block, be prepared for the extremely weird sensation of not having any idea of what/where your arm is. My block started to wear off at about 12 hours--middle of the night--with unbelievable itching. It was done by morning. I took the big meds for a few days and then just
Tylenol extra strength. Listen to what they say about taking them before the block wears off.

My thumb is immobile with the fingers free from the knuckles up. It is only today that I can type using both hands, sort of, without excruciating thumb pain with every movement. Even immobilized in the cast, the thumb moves slightly when finger move. You will be able to type after awhile, but not efficiently. I can write holding pen between first two fingers, but I wouldn't want to do it a long time.

Thumbs matter a lot in daily living, you will learn. Everything is harder. Expect everything from showering to laundry to eating to getting dressed to take 3-4 times longer than normal. You will get faster, but it takes awhile. You will be able to cook, but I would plan/stock up on things that are convenient to prepare/eat--skip the stir fry. Driving is a challenge. It is also very tiring to have a cast--I can't believe how much I have slept.

Take whatever sick leave/PTO you can. Pushing too hard, too early won't help anything. Don't risk delaying the healing or re-damaging the thumb by pushing the exercise. You can re-gain anything you have lost after you've healed. Ask for help from family, neighbors, friends, co-workers, strangers in the grocery store--people will be happy to help out.

I just keep reminding myself it's only 12 weeks; not permanent, thank goodness. And, I hope, way less pain than before. My mother lost some use of her hand from a stroke. I am lucky.

My daughter was about 4 and we were reading Babar. She remarked, "Having a trunk would be useful." She was right.

Good luck with the surgery and healing!
posted by Nosey Mrs. Rat at 5:37 PM on February 9, 2014

You don't specify whether it is flexor or extensor, but from an exercise standpoint, it doesn't matter. You aren't my patient, but if you were, what I tell all of them is no unrestricted use of the hand for three months. Cardio is fine, running is fine, weight lifting-no. Planks- no. Same for burpees and push-ups. The therapy afterwards is as important as what happens in the OR so don't skimp on that. You won't be in a cast for 6 weeks because you will be starting therapy long before that time period. After a week to ten days, sutures out and custom splint that can be removed for showers and therapy. ETA: I'm a hand surgeon, but not yours, etc, standard internet disclaimer.
posted by karlos at 7:54 PM on February 9, 2014

For your question #4, after being discharged, you'll be responsible for controlling your pain. It is important to keep ahead of the pain and don't let it get out of control. I don't know what kind of drugs you'll be on, or for how long, but opiates are constipating, so take a stool softener until you're off them. Ice, elevation and over the counter drugs can be pretty good at managing pain too.

Also dry shampoo might be just what you need until you can hit the salon or have a friend give you a sink shower. Spray it at your roots, rub it into the scalp, let it dry, brush it out. It's not perfect, but it'll cut the grease. The greasiness around the hairline is a lot of of what will make your hair look dirty.

I had to move without full use of my leg, so at least I could plop down on the floor and pack a box. I also hired movers, but really appreciated the help of family and friends. Don't let moving day pass without getting one room set up with the equipment/free space to keep your PT routine going. Moving has a way of breaking good habits since everything is a bit chaotic.
posted by fontophilic at 6:09 AM on February 10, 2014

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