Proximal row carpectomy surgery on wrist

[sgilbert]

I am considering a wrist surgery called proximal row carpectomy. If you are familiar with this surgery, I would like to hear your opinion about "mobility" and "grip strength" (as it relates to "buoy chasing") after the recovery period. I am a year-round physically active 65 year-old guy. I live on a man-made ski lake and ski (on average) 7-8 sets per week during the 5 summer months (in Indiana). I would like to continue water skiing at that pace, if possible. Also, if you have any insight into great "hand" doctors (in the U.S.), please let me know. Obviously, any doctor that is both "great" and very familiar with the sport of water skiing would be a big plus. At this point, I have only met with one doctor, so my search for a second opinion is just beginning. Thanks for any help you can offer!

[Orlando76]

Dumb question but is this carpal tunnel surgery? I’m up this year for it.

[sgilbert]

Thanks for your question. To explain, a hand has 8 bones in it (not including the finger bones). With a PRC, the three lower bones (nearest the wrist) are removed. After the row of three lower bones is removed, the upper 5 bones simply slide down to fill in the space. As surgical procedures go, it is actually considered a pretty simple operation. In my case, the procedure would be done in order to eliminate bone-on-bone (caused by arthritis) between one or more of the bones being removed and the wrist bone. As far as hand surgeries go, it is an alternative to what they call a "four corner fusion". With a PRC, the patient will lose less mobility than with a four corner fusion. Again, I'm not rushing to do anything, and I plan to look at all alternatives (including those that would not include surgery). Just trying to get some feedback from other skiers (or other athletes like rowers, etc.) who have undergone the PRC procedure and continue to participate routinely in the sport.

[teammalibu]

i think @scoke knows a good hand surgeon who is a water skier! He is in Batton Rouge!

[A_B]

I had the bones “cleaned up” as the ligament or tendon was basically gone. That gave me 2 summers and now I am feeling a little of the stiffness and hearing the crackles again, but not close to where it was.

 

Dr said he smoothed up everything with the scope and took out the torn stuff.

 

My theory is to buy time before something else comes out before I would consider fusing anything. That sounded like it would really impact my golf swing more than skiing though.

[Craig]

Rick Ahmad at Baton Rouge Orthopedic clinic. He is a hand/wrist specialist and a water skier.

 

http://www.brortho.com/physician/rick-i-ahmad-md-1

[scoke]

@sgilbert

 

Craig speaks the truth. Dr. Ahmad is the man. We used to talk about at his level, it's "art". He was very humble about it but it was the truth. He loves helping people especially skiers then even better, athletes.

 

One time my elbow was jacked. After working on it a bit, he said no skiing 10 days. I started negotiating with him and got it down to 3 days with ice and aleve. He wasn't happy but said "skiers!".

 

Highly recommend at least trying to coordinate with him.

 

Also, someone in this thread got married in his backyard next to the slalom course.

 

 

[sgilbert]

Thanks so much for the feedback. Since writing the original post, I have done a lot of "hands-on research (ha). What I've found is a lot of technical ortho-jargon, but not much real-life feedback from active people like myself who suffers with this---people who use their hands a lot athletically (i.e. think water skiers, rowers, rock climbers). Probably the most insightful information that I viewed was on a rock/mountain climbing forum, and I generally condensed those comments to read as follows: (1) Live with the pain/issue (via medications/PT/rheumatologist advice) as long as you can before contemplating surgery, (2) If all else fails, and surgery is the only option, then think hard about getting a full hand fusion over a partial fusion or a PRC. It is fantastic that we have Dr. Ahmad participating in the sport. Logistically, it may be tough for me to reach out to Dr. Ahmad (I live in the Midwest), but I'm certainly going to look into it. Thanks again for your feedback.

[BraceMaker]

You may have noted his hand fellowship was in Indiana he might have connections there.

[Freddyjustice69]

I had a cmc arthroplasty, Carpaltunnel release, and ulnar nerve release on 7/13/18. I still have excruciating pain and my thumb now has no opposition movement. Recent tests show post op changes. I have to now decide between PRC and 4 corner fusion. Is there any preference as far as mechanical hands are concerned? Is one going to make me lose more strength? Is one better for hands that absorb A lot of blunt force from hammer striking? Will one give me better hand support than the other? I'm sorry for asking so many questions but my hand hasn't worked properly since the arthroplasty and I just want to be sure I make the decision that will give me the best chance at a pain free life. Thanks in advance.

[gapullin]

I'm an emergency physician with 26 years experience, and I must confess I don't believe I have ever seen a patient who has undergone PRC. This could mean I'm merely naive, but more likely that this is an exceedingly rare procedure. I can confidently claim that removing the proximal carpal row will radically change the mechanics and forces upon the wrist. Furthermore, once those bones are gone, there's no putting them back. I would recommend seeing 2 of th most highly recommended hand Surgeons possible and getting an opinion. If they differ, see a third. If you get two resounding recommendations to proceed with this procedure, consider it. If not, I'd think twice. If carpal bone prosthetic implants aren't out there now, they will be coming. It's usually best to try to restore native anatomy rather than eliminate bones.

Sorry I don't have more knowledge about PRC.

[Shell]

@sgilbert Dr. Richard Singer, best hand surgeon around, he is in Dearborn. Ive had several hand surgeries by him and broke both my wrists at the same time, 11 weeks later i was skiing the course and back on the water. He also works on the Redwings players. Check him out.

[LeonL]

@sgilbert, Dr. Gupta in Louisville, KY is world renowned for wrist surgery. I don't know where in IN you're located but much closer than Louisiana.

[sagilbert]

This is sgilbert; I did the original post back in December, 2018. Since the posting, I sought a second opinion here is Fort Wayne, IN. The second hand doctor recommended (eventually) 4 corner fusion. The first doctor recommended (eventually) PRC. The second doctor stated that the recovery period for FCF is a little longer (than a PRC), but, based upon his experience, recurring pain is seldom an issue with FCF (whereas it can be with PRC). Essentially, what leads to the issue I am experiencing (with both hands) is a ligament rupture. Candidly, I don't know when it happened (in either hand), but it's apparent that if nothing is done within a month or two after the rupture, it's not possible to re-attached the ligament---and mine has been going on for at least 2 years. Once this particular ligament snaps, then the bones in the palm of the hand essentially start sagging towards the wrist, which eventually leads to the arthritis I have. To this point, I have only seen three primary remedies to deal with the issue---FCF, PRC and a full-fusion of the wrist. That said, from what I have read, studied, and obtained from the doctors, I doubt that even the best wrist surgeon in the country has other viable options. gapullin (above) makes some great points (i.e. "keep all the parts"), and if I would proceed to surgery, I would most likely go for the FCF (at least with what I know today). For those of you who are having similar issues with your hands, I have been skiing the last 6 weeks and I'm not having any particular issues, other than I'm living with some pain (tolerable), and grip strength is certainly not what it was a couple years ago. Both doctors told me that I can live with it as long as I can tolerate the pain. Of course, steroid injections are temporary options. In my studies, I have found a tremendous number of athletes (climbers, weight-lifters, etc.) have dealt with this issue. Thus, in this day and age, any insights you can provide on this subject via this forum may help a lot of athletes out there (as they Google the subject). Thanks!

[ToddA]

@sagilbert My wife is a hand therapist/OT, and she did her residency at the Indiana Hand Center in Indianapolis. Her comment when I asked her your question, was "He would have the best shot going to Indiana Hand as they set the protocols and did all the research back in the day.". Might be worth another opinion through their Center. Best of luck! I am a PT, and we own a outpatient PT clinic in WA State. Both of our advice would be vigilant with the post op rehab, and you will get through this. The question I would ask of any Ortho, would be, "what will be the ultimate effect on Lumbrical grip strength (not just global grip)."

[sagilbert]

Thanks ToddA! That is certainly the kind of information I am looking for.

Is there any particular hand specialist at Indiana Hand she might might refer me to?

[RLW]

The Indiana hand center is recognized as one of the top hand centers in the country. I suspect any of the staff surgeons there should be able to provide you with the information you need. It may be helpful to show the surgeon a video of a skier on the slalom course to educate them. I'm not sure they really need to be a skier. FYI, I do orthopedics and I ski, but I'm not a hand/wrist specialist. Best of luck!

[ToddA]

@sagilbert I would have to say the same as @RLW ...it has been 20 years + since my wife has been back in Indiana, so I cannot say a specific MD for you to see

[sagilbert]

As the ski season comes to a close (here in Indiana), I wanted to give you an update on my wrists---for those of you who might be dealing with the same issue---with whatever sport you may be involved in that puts heavy demands on the wrists (i.e. water skiing, rock climbing, weight-lifting, etc.). This season, I was able to ski as often as most previous years (i.e. I averaged, say, 8-9 sets/wk) with little issues. There was a period of 11-12 consecutive days that I skied virtually 2 sets/day (very unusually nice weather period for IN), and towards the end of that period my hands were hurting enough that I was ready to back-off a bit. In reality, it hurts my hands much more to do twisting motions (shoveling, raking, hammering) than skiing. In fact, I found that after a couple hours of doing some sort of twisting motion with my wrists, skiing seemed to help relieve the pain a bit. All-in-all, I would say that my wrists feel about the same as they did this time last year, so I'm nowhere close to thinking further about surgical options. I'm 65 and periodically making 28-offs (32 mph), and I have set my goal to do that consistently. During the winter, I'll hit the rowing machine (with my hands) 3-4 days/wk. I may be wrong, but I sense that it's best to keep using my hands as much as a can, although I generally wear wrist braces on both hands when shoveling, raking, etc. In the event that my wrists deteriorate further in the future (and they will), I still welcome any referrals you might offer for ortho-docs who not only know their stuff, buy understand the mind of a skier and the physical attributes of skiing. Thanks!

[lakeside7455]

Maybe consider using Radar vice gloves, like old clinchers, that help take pressure off of the hand and fingers and move to wrist. I have had great success using them and love them. It really cuts down on calluses and much easier on hands, I use them with Kevlar under gloves, great combo. Especially if you ski a lot like I do. Definitely helps.