Well, I had my first post-we-finally-know-what-it-is-and-can-treat-it-properly-now follow-up with my orthopedist today regarding my pinkie finger. Here is the rundown.
- My A2 pulley is definitely broken, and is definitely not going to grow back. No surprise there.
- Swelling has definitely decreased, but it is still swollen, and the range of motion when flexing the finger is still significantly limited.
- Neither the doctor nor my physical therapist are willing to admit it (and I can guess why), but I am 95% certain the therapy I was doing before the MRI actually caused the previous swelling. Before we had a good look at the problem, everyone firmly believed that all of my troubles were due to scar tissue building up in the second joint of my pinkie from that cut to the inside of it, and the treatment for scar tissue buildups consists of really working the finger, especially with "therapy putty" (really, silly putty), resistance, and the whole shebang. Well, when I was trying to flex my finger against resistance with a busted-out A2 pulley, you can only imagine how much that was probably pissing off that finger’s tendon. Now that we know better, we are not doing that kind of gos-se any more, and, lo and behold, the swelling has reduced. The compression, ice, and everything else is unquestionably helping, mind you, but I have to wonder how much harm we did previously.
- Surgery is on the table as an option, but "most people" – i.e. folks who are not rock climbers, musicians, etc. – simply cope with the injury.
- Said surgery would involve finding a "spare" tendon (I apparently lack the easiest one to use – the palarmis longus tendon. Put your pinkie finger to the tip of your thumb, and curl your wrist inwards; if a little tendon bows up out of your wrist, you have a "spare" tendon. My physical therapist tells me 60% of the population has at least one; I have neither, Better Half has both. Due to this, apparently my "spare" tendon would either come from my ankle (the plantaris tendon), or be shaved off an existing one.), cutting it out (neither the physical therapist nor the doctor like it when I say "cannibalize", but that is what they are doing), and wrapping it around the bone and tendon of my pinkie finger where my A2 pulley should be, then attaching the ends to one another. The incision on my finger/hand would be about 3 inches long, from what the doctor showed, and would require "multiple months" of therapy to recover from. The finger would always have a bulge in the first segment, just due to the kitbash nature of the repair.
- We have postponed any decision until we have had more time for therapy, and until we get back from visiting my parents.
So now my thoughts on the matter.
It still hurts, and pretty much all the time, regardless of whether I am using it or not; the only variable is amplitude. I am starting to understand how/why people get addicted to pain killers – not that I am, mind you; I am only taking the WalMart knock-off of Aleve, but I can see how people end up in that rut. Worse than just my pinkie finger hurting though, my entire hand, all the way past my wrist, aches. I can only imagine this is due to the swelling, the compression I keep on the swelling (Coban is still awesome stuff), the pinkie tendon being pissed off, and the other fingers trying to pick up the pinkie’s load, but that understanding does not alleviate the pain. Push-ups are impossible, and even resting my hand on my mouse can hurt.
My right hand is weak; there is no way around that. I do not know what its strength was before my injury, but my left hand can squeeze with 110 psi of force, while my right can only manage 85… and I am right-handed. Your dominant hand is typically supposed to be able to exert 10-30% greater force than your non-dominant hand. I see this weakness present itself in all kinds of ways I had not previously considered, but the one most relevant to this site you have probably already figured out.
Shooting firearms, both pistols and long guns, is both more difficult and painful now. Think of shooting handguns – every time you do so, you are basically creating rotational force around a horizontal axis somewhere between your index finger and thumb. That force is typically counteracted by, you guessed it, your middle, ring, and pinkie fingers… and the annoying thing is that the farther out the finger is from the axis, the more important it is / the more force it will be fighting against. Hell, last time I went shooting, I actually had to close my pinkie finger around the pistol grip with my other hand, it was that bad; granted, that is the grip you are supposed to use on handguns, but still.
Speaking of, when it comes to its load-bearing properties, the A2 pulley in your pinkie is actually the third-most important one of your four fingers, per the American Association for Hand Surgery.
Honestly, "most people" do not encounter this kind of injury unless you are a rock climber or otherwise put some kind of inordinate strain on your fingers when they are held in strange fashions. I still wish, to this day, I knew what I did, mostly so I made damned sure not to do it again…
And as for surgery… I cannot say I am terribly keen on the idea of being sliced open and having to cannibalize my own body (according to my doctor, there are no suitable artificial replacements for pulleys), but this is already taking "months of therapy" to get what limited use I have back anywise, and things like this concern me:
Medical or functional treatments never allowed climbers to reach their former level. The only efficient treatment was surgical, whatever the time elapsed between injury and surgery. After this surgical procedure, five of the twelve patients improved their results, five recovered their former level and two decreased. The results are analysed and compared to other surgical procedures.
Granted, they are talking about "high-level rock climbers", but the point is there. The Germans, of course, disagree with the French, though:
Nonsurgical treatment of single pulley ruptures is recommended. The clinical outcome was good to excellent, and no long-term strength deficit for the injured finger could be observed.
When it comes to blowing out both the A2 and A3 pulleys, though, the Austrians agree with the French (squeamish warning on the pictures at that site):
Thirteen patients were treated with an extensor retinaculum graft (Group A). At a mean follow-up time of 48 months, the average PIP flexion was 97%, the power grip strength 96%, the pinch grip strength 100% and the thickening 94% of the uninjured side. Ten patients were treated with a free palmaris longus tendon grafts (Group B). At a mean follow-up time of 57 months, the average PIP flexion was 94%, the power grip strength 98%, the pinch grip strength 100% and the thickening 95% of the uninjured side.
Both techniques proved beneficial. All climbers returned to their previous standard and all non-climbers regained full finger dexterity in their previous job.
Neither of these techniques are what my doctor is proposing, mind you, but both are still surgical. I am looking into this "extensor retinaculum graft", which involves harvesting (apparently that is an acceptable word, but "cannibalizing" is not) part of the fascia that holds your hand’s extensor tendons and muscles in place, but it is still fairly "new" (they only found useful donor sites in 2001) and there is not a lot of information about it, aside from the fact that it opens up an even larger hole in my hand.
So now that you all are probably bored out of your everloving minds, two quick questions:
1. How does one search for hand surgeons on the intertubes? It is not like there are review sites out there, but I guess this is a good starting point.
2. Does anyone know if Dynarex Sensi Wrap is comparable to actual 3M Coban? I bought some not-quite-Coban stuff at Walmart, and it was, frankly, crap, but something tells me I am going to need a bit of it by the time this is all said and done.