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by Lazarus Long




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things you do not want to read on an mri report

imageNo bone marrow edema is seen. There is extensive deep soft tissue edema about the palmar aspect of the small finger centered about the flexor tendon. Findings of tenosynovitis of the flexor tendon.

There is palmar dislocation of the flexor tendon, the distance between the middle phalanx and flexor tendon is 7mm. There is disruption of the A2 pulley best seen on axial series 3 image 24 and sagittal series 4 image 5.

The flexor tendon itself is intact. No significant joint effusion. No bone marrow edema. No dislocations seen.

So what does that mean? If you look at the way your finger operates, the tendons that allow you to flex (close/contract/etc.) your finger start somewhere around the middle of your forearm and run all the way to the tips of your fingers. If they were just hanging around loose, every time you contracted your finger, that tendon would form a taught line between the tip of your finger and the palm of your hand – kind of like how your hamstring does when you flex it. Obviously, this would cause problems for the whole "manual dexterity" thing that supposedly separates us from animals, so those flexor tendons run through sheaths attached to each of the three bones in your hand that keep the tendon flush up against those bones; these sheaths are, oddly enough, called pulleys.

It turns out that I somehow managed to rupture the primary pulley on the first bone of my right pinkie finger sometime between six and nine months ago – take a look at your pinky; 7mm is a lot of distance for that particular appendage. I thought the pain/swelling/lack of range of motion/etc. was due to a cut a soup can lid inflicted on the first interphalangeal joint, but the MRI indicated that it was completely and totally unrelated.

Incidentally this just goes to show that doctors are not omniscient. Mine did not really see the point of doing an MRI, since nothing showed up on x-rays indicating that anything was wrong, but being an engineer, I wanted to know why I was in this kind of pain, so I insisted… and, lo and behold, we found an answer, and one that was completely unexpected. As always, you and you alone are responsible for your well-being.

So what does all that mean? My right pinkie finger is functionally useless. The whole first segment of the finger is swollen to about twice its normal circumference, any attempts to put pressure on the finger in any direction on any axis results in increasing amounts of pain, its range of motion has been cut to 50-60% of normal, and it can no longer grip with anything approximating force (My left hand can grip with 110PSI; my right is down to 85, and I am right-handed.). Resting pain, with the finger doing nothing at all, runs about a 1 or 2 depending on the day, with the maximum hitting about an 8 today when the doc was verifying the MRI reading by poking and prodding and telling me to push against his finger. Radiating pain (or whatever the term is) and swelling runs all the way down my palm into my wrist, making push-ups possible on good days, but not pleasant.

Treatment consists of physical therapy to try and beat the swelling down (which sounds awesome) followed by using tape, compression hose, or even just a ring to basically take the place of the missing pulley. Extreme cases can be addressed by surgery, which basically involves flaying open the entire finger, taking a tendon (the doctor did not specify from where, I noticed), and creating a new pulley, but even that will take 2-3 months of PT to recover from (and involves the aforementioned finger-flaying). While your body is capable of marvelous things like knitting bone and so forth, regrowing/repairing tendons/pulleys is apparently something evolution never invested skill points in. Never figured on wearing a pinky ring, but I guess I have a while to find an awesome one (any metalsmiths amongst my readers?) – the ring I wear on my right ring finger cannot even fit on my pinky at the moment.

Apparently this is a fairly common injury for rock climbers and the like, given that they are frequently trying to suspend their entire body’s weight by their fingernails, but I honestly have no idea how I managed to accomplish it; it might have been karate, but it might have been something as silly as trying to carry too many heavy grocery bags in one hand. I certainly do not remember any distinct popping sensations.

So what does this really mean, to you? Not much; I was just sharing the results of my first ever MRI. Posting frequency will probably decrease a touch – typing is distinctly painful – and I will be even more cranky than normal, especially since any range time will cause more pain than it will alleviate stress, but we have full health insurance and everything is covered. You have no idea how silly I feel over having to go to physical therapy for a pinky finger, though… If you are feeling generous, however, I can think of someone who could use your help a lot more, and you might even get something more than warm-and-fuzzies out of it to boot.

(Also, MRIs? I do not see the big deal. But, then, I have never been claustrophobic… ever, so far as I can recall. Put that MRI machine on the edge of the Grand Canyon and we might have problems, though…)

14 comments to things you do not want to read on an mri report

  • Glad to hear its fully covered.

    I have arthritis in the thumb and pointer fingers, and wrists, of both hands, so I can sympathize, though at least mine don’t require me to wear additional jewelry! Good luck with PT.

  • I whacked my right pinkie years back while diving off a dirtbike into a pile of wet rocks in the rain – now it’s permanently bent but still functions to close tightly on a grip – or under it as the shorty-guns grip may be. The PT was bogus and mainly served to fill the coffers of the PT machinery-end of the Medical-Money Insurance chain, and included electrical zappers and some weird fetish with hot wax. At lest it did no harm and one of the PT chicks was damn hot.

  • rickn8or

    Hang in there guy and don’t give up on the cutting until you’ve tried everything from the outside.

    My first MRI (fourteen months ago) revealed spinal cord tumors. Then I got two from scalp to hips to make sure there weren’t any more. About an hour and a half apiece. Not the place you want to stick a raving claustrophobe like me. Got another one coming up shortly.

  • That blows. And it’s your shooting hand to boot!!! Stick with therapy; it might not seem like much, but it helps. Best of luck!

  • Derek D.

    On June 9th, 1998 I went from riding on the highway on my motorcycle to riding on the highway off my motorcycle at about 70mph.
    Stayed in the hospital for a week. A week after I was discharged my PT started.
    I had to use a walker to get there. Sure, it was a cool looking walker–polished aluminum and motorcycle stickers all over it (I borrowed it from a friend who had a wreck a couple years before this) but it was a walker.
    I never used a walker again since that first round of PT.
    In my case it was exactly what I needed. I went in balls-deep and got a lot out of it. Totally worth it.
    I really hope your PT goes the same way.

  • Ouch.

    Here’s hoping the PT helps.

    As for pinky rings. It is on your working hand…

    Well there’s always the Engineer’s ring. In either Canada or US version.

  • chiefjaybob

    You’re supposed to pull it out BEFORE you sit down. [edit] Sorry, just re-read this and saw it was your PINKY finger. Poor reading comprehension skills.

    Anyway, sorry for the discomfort. Physical therapy can sometimes do great things. Get better soon, please.

  • agirlandhergun

    Ouch! Hope it heals quickly!

  • @ Ruth: Yeah, my mother has had arthritis for about as long as I can remember… I am definitely not looking forward to that apparent eventuality, and I can only imagine this situation will aggravate it in the future.

    @ NotClauswitz: I have not been terribly impressed with the PT I have received thus far, but everyone was operating under the incorrect assumption that they needed to break up scar tissue from the cut inflicted by the can lid. Apparently that healed just fine, so whatever they were doing was not actually doing anything at all – in fact, I almost have to wonder if they were not unintentionally compounding the problem I actually did have.

    @ rickn8or: Getting your hand MRI’d in a normal machine is kind of … awkward. They put you face-down on the sliding tray, and have you stick your arm into the machine. You are in it up to your waist, but you can see out, which I guess might have helped any “small space” concerns I might have had. Still, I managed to doze through most of the procedure (about half an hour), and woke up with both arms hard asleep. That made it fun to get up.

    Unless they told me otherwise, I would probably just zonk out in a full MRI… with muffs on, it felt too much like my old rack in the Navy.

    @ ChrisZump: Doublestacks are still thick enough that the pinkie can get some purchase on them, but my PPS is probably right out for the next few months. Not sure how it will take to the recoil of my 686, given the pinkie is pretty much the anchor… *sigh*

    @ Derek D.: I am hoping now that they know what is wrong and what they need to do to fix it (specifically, reduce the swelling so they can figure out how best to actually handle the blown pulley), PT will be more useful. Before, it largely consisted of things that only seemed to make matters worse, which rather makes sense, looking back on the exercises where they had me work “therapeutic putty” (otherwise known as SillyPutty) with my hands and do other things that put tension on the tendon that is very much out of place at the moment. Not their fault, I just wish the doc had volunteered the MRI when nothing obvious was on X-rays, but something was obviously wrong.

    @ The Jack: I had not ever heard of the Order of the Engineer, which is unfortunate, given that Georgia Tech does appear to have a ‘link” there. I may have written it off as another professional society just wanting money, which, looking at it, was wrong of me (if I did it). May use that as a design basis, though I get the feeling wider might be better.

    @ chiefjaybob: Here is to hoping. I have a decent pain tolerance, but constant, low-level pain is just plain annoying.

    @ agirlandhergun: My understanding is that it will not heal ever, but it is manageable, which is better than the current situation.

  • no less than 5 different doctors all looked at a light spot on the MRI of my wife’s brain for about 15 years (not all 5 were involved at the start of course…but all looked at the archives) and it wasn’t until the histology report came back post surgery did the word “Tumor” ever get uttered.

    That was an ugly day.

    Best wishes to you! So is the ring/compression a permanent crutch, or will this thing sort itself out over time?

  • I’d forgot about the width. They are rather narrow rings.

    I’ve got a spare that I can send, but bith width and diameter are likely off.

  • Tam

    Yeah, what Weer’d said; is this chronic or does it eventually heal?

    And thank you, Linoge. 😮

    (Every time I read about MRIs, I remind myself that I need to get “NO MRI!” tattooed somewhere on me. I’d hate to wind up stuck to the tunnel by my shin. 😀 )

  • @ Weer’d Beard: Yup, right up until the MRI, I had managed to render three doctors at three different practices and three occupational therapists clueless as to (a) what was causing the inflammation / pain, and (2) how to address it; there were lots of theories, but no one had a good, definitive answer.

    Unfortunately, the way the doctor presented the finding indicates that the pulley is well and truly done. They will either have to replace it (stitching it back together did not even seem an option?), or supplement it with something external.

    @ The Jack: Heh, at this point, I genuinely have no idea what ring size that finger should be. Like I said, I have time :).

    @ Tam: Ligaments, not having many blood vessels running through them, are not known for healing, and once I went and split it all the way, it was all over. Doc stressed that it was manageable, but not something that would fix itself.

    I take it you are a bionic woman? I found out that titanium is definitely non-magnetic… managed to wear my wedding band into the machine, and then frantically started squeezing the “oh crap” bulb they gave me when I noticed; the tech said if it was not causing me problems, do not worry about it.

    And now worries.

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