Our Opposable Thumb: Ruptured Tendon

Early January: One of the things that distinguishes us as humans is our thumb: its flexibility in movement and opposition to our other fingers allows us to do such incredible things. In early January, my right thumb, seemingly without any memorable injury or action, stopped working. I could not bend it, or the individual knuckles, independently. I panicked: but after a visit to the orthopedic urgent care center, thinking it was only a remnant of the swelling of my carpal and wrist area almost a year and a half post arm break, I was relieved. The nurse said she’d had similar incident, which comforted me that maybe this was a temporary condition. She recommended icing and wearing a brace at night; if I saw no or minimal improvement in ten days, to visit my orthopedic surgeon.

My thumb did not improve. I did not receive good news from the orthopedic surgeon. I ruptured a tendon that runs from below the wrist through the thumb, the tendon that enables it to bend, to move, to grasp, to play the piano, to hold a pen or pencil, etc., etc. The “opposable” function — and critical importance — of this digit was gone.

The doctor will only be able to determine exactly where the rupture is, and the extent of damage, after an MRI, which is somewhat difficult because of the metal plate in my wrist (think aluminum in a microwave and sparks flying). After the MRI (and insurance approval first), we’ll discuss the planned surgery. He is recommending removing the metal plate, repairing the rupture (hoping he doesn’t have to graft the tendon using part of another tendon, but we won’t know until MRI results and/or once he opens up my hand), then cast (six weeks?) and extensive physical therapy. Sounds so invasive.

I didn’t cry but I am sad, deflated. The surgery (except undoing the plate) and rehabilitation are so reminiscent of the fall 2017: three months of intensive PT followed by almost a year until my arm felt strong and flexible enough to do most of what I’d done before the break. This time, with second surgery, more scar tissue, and tendon healing time, I am not as optimistic.

It could be worse, right? A blip in the road. An interruption of plans. Time, once again, to focus on other things. But still, but still…

February 15, 2019: A friend suggested I seek a second opinion on the proposed surgery and recovery plan for my ruptured tendon, given how critical that opposable thumb is. Although getting a second opinion extended this process, it was definitely worth it.

Having lived with my mostly non-flexing thumb for over four weeks, I’ve been scared, worried, and concerned about a possible invasive operation, the long recovery time and rehabilitation commitment, the impact on my ability to continue to do what I love (including a planned vacation with the grandkids to San Diego, a birthday celebration for a sister in NYC, a half marathon, the National Senior Games competition in New Mexico, my philanthropic work, but most importantly, the daily tasks for which this thumb is vital), and the ultimate success (or not) of the operation.

Finally, after waiting for over a week for an MRI appointment (a special machine was needed because of the metal plate in my right forearm, near where we believe the ruptured tendon is), the results, and then scheduling an appointment with a hand orthopedist (my second opinion doctor became the first opinion through a referral), I am relieved. The doctor is very experienced, kind, and a good listener; overall, I feel good about putting my fears, hopes, and hand in his hands!

I will have the surgery next Monday, where they’ll open my hand along the scar from my broken arm surgery, remove the metal plate (good-bye friend), and either repair the ruptured tendon directly or reconstruct it using the “third vestigial” tendon that most of us have in our arms. We won’t know the extent of the damage or which course of treatment until my forearm/palm are open, but I have confidence the surgeon will make the right decision for me.

A bright light in all this is that he does not recommend a hard cast (what I thought would be required) but a splint for a few days and then a removable soft case. He will start very light physical therapy three days after the surgery. Once the ends of the tendon begin to grow back together, the physical therapy will become more aggressive. His goal is to get the thumb moving, albeit slowly, as quickly as possible to enhance chances of good functionality.

While I’d also read that I might be restricted from almost any physical activity for 10–12 weeks, he assured me that should not be the case. Whew! I will need to be very careful and perhaps not be able to continue the half marathon training or lift my grandson or granddaughter when I see then in two weeks, but overall, I will be a functioning human.

In the scheme of things, as one friend reminded me, I am healthy, I do not have chronic diseases, I have a good support system of family (Doug has had to become somewhat of a cook as result of the broken arm and now, again) and friends, decent health insurance coverage, good health care professionals close by, and an active life-style. I can wish this hadn’t happened to me, that plans didn’t have to be interrupted or cancelled, that the original fall hadn’t happened, but magical thinking isn’t reality. One doctor said that, of course, if I weren’t active these things wouldn’t have happened, but isn’t it better to strive, to push oneself, to have goals, and to occasionally fail (or break something), than not to have tried at all? My philosopher son is better suited to answer these questions, but for now, I will try to be positive, even those times when trying to button a shirt or open a jar will not be possible!

February 21, 2019: First doctor’s appointment three days post-surgery. My surgeon confirmed that the metal plate that was inserted during surgery for the 2017 arm break had caused ruptured tendon. While unusual for new plates to cause tears, because my break was so bad, the original surgeon had to insert plate close to my wrist. Likely the subsequent bending of wrist over time must have irritated and finally caused rupture. This hand surgeon is overall pleased with progress so far, primarily my ability to bend middle joint of thumb, oh so slightly: this means everything is attached! I even received bonus carpal tunnel opening as part of tendon reconstruction.

I now am wearing custom removable splint, although removable is defined as keeping it on 24 hours/day except when doing prescribed exercises. My physical therapist specializes in hands, which will be important once aggressive therapy starts in six weeks. She’s also a runner so appreciates my frustration with being inactive.

While the site still hurts and throbs and arm is bruised and swollen, having the initial splint and dressing removed definitely boosted my spirits. In addition, I can wash my arm and hand and start doing some movement. I do not like being dependent, so asking for help is a key part of the treatment.

Thank you all so much for your encouragement and offers of help, sending me books to read and dropping off music to enjoy. My patience is being tested as this journey continues!

March 14, 2019: My birthday wish this year is to regain “close to full” functionality of my right hand. Three-week post-surgery visit was on the calendar today. Doctor reported good progress with healing going well and assured me that stiffness and swelling were normal. We are working on range of motion and stretching with strength work to begin in three weeks (due to weak muscles and stiff joint he wants to wait until ROM is better). It is so difficult to try to bend thumb at middle joint, taking steely concentration and some props and still, it barely moves! I can start weaning myself from the arm brace over the next several weeks and even do some running so long as I don’t trip or slip on ice.
 
 Lots of work ahead to get most of the functionality of my opposable thumb back, but I can now run, swim, walk and hike without too much fear of causing damage to the repair if I were to fall. Grasping and gripping remain elusive. Strength training of my overall hand, fingers and thumb are critical to rebuild my muscles. Flexibility is its twin to allow flexion and extension of the wrist.

First days back to running three weeks post-surgery