New Knuckles and Straight Fingers: Metacarpal Phalangeal Joint Replacement Surgery.

My friend gave me before and shortly after photos of her friend Debbie Morris who just had her knuckles replaced in an operation called a metacarpal phalangeal joint replacement.  Debbie agreed to let me use them here so that others could see the successful results she has had. 

                                                            Before surgery
Here is her story:

"I decided to go ahead with the surgery, as my hand had become quite deformed and the pain was constant. The surgery took two and a half hours. My knuckles were replaced with little silicone joints, that are slotted into the finger joints. 

                                      After surgery

The outrigger (below) although it looks like a hindrance, is amazing. Within the week of using it, the movement in my fingers has improved. I am already doing finger exercises! The best thing of all is hardly any pain, other than normal post op, bruises etc. I am having my stitches out next Tuesday and then exercises will begin to reduce the scar as much as possible, as scarring can restrict movement.

                                After surgery. No splint

Here is a picture of outrigger, it's a splint in a sense with metal bits on connected to elastic. It helps prevent them drifting until the muscles are built up in your hands again, as it's the muscles that keep the implants in place. It also allows you to exercise the hand. After 3 months of physio and exercising regularly, I expect to see a massive improvement.

                                                        Hand With Outrigger

I have been told movement won't be as good as in a normal hand and it's questionable if I will be able to make a full fist, but I’m keeping an open mind, anything’s possible!  Recovery is all about listening and doing everything the physios say, they are the experts. For me I think it's the best decision I could have made."

Debbie said she is glad that we think photos are useful. She feels very proud of herself right now.

Gillian says "It gives us some hope for the future when you see results like that."  (I agree with that completely.)

Debbie said she will send another picture when she gets the stitches out so we will be able to see the whole story.
Congratulations Debbie!!

Wrist Fusion Surgery

My wrist has a lot of damage that occurred before I was diagnosed. A few years after diagnosis I saw a surgeon who would have been happy to do a number of procedures to make my hands look and function better but I could not believe that it was necessary then.

25 years later...

Recently I was worried that I might have a ruptured tendon so I saw an orthopedic surgeon.  His opinion was that I had to have my wrist fused before he would do any other hand surgery. He said a replacement wrist joint was not an option for me, given the spotty success rate.  Since I had only about 10 degrees of movement in my wrist it sounded as though I would not lose much flexibility and my hand would be in a more functional position.

This is one view of how it looked before the surgery:

You can see that my hand above has an ulnar deviation. The whole hand is no longer straight. More often in RA it is the fingers that sway to the side. This is the way it looks now, after surgery:

Much better than before. Very strange how you don't really notice as things change over the years.  Finger deformities always seemed more obvious than the orientation of my hand. 

My operation was 5 weeks ago.  It was done as day surgery and it took  2 1/2 hours to complete.  I had a nerve block that numbed my whole arm.  When I saw my arm raised in the air after the nerve block and just before the operation I thought it belonged to someone else.  

After the operation they put a cast on from below the knuckles to above the elbow. That left me able to bend my arm a little.  You can't tell that from the picture because the cast is wrapped in a tensor bandage.  There is an open gap down the whole cast to accommodate swelling.  That purple arrow on my shoulder marks the correct arm for the surgery.  There were more markings under the cast.

The nerve block was very effective and I have moderate regrets I did not stay  conscious through the operation to hear the surgeon talk his surgical assistant through the process. However my curiosity wilted once they started.  I have heard the noise level in the OR is high and I know surgeons use power tools in their work. Remembering the noises was not on my bucket list.

Now that my wrist is fused it is supposed to be a pain free joint and stronger than it was.  It's early to say how that will work out but my fingers still move well. They were very bruised and swollen but that's normal after surgery.  Anything the surgeon touches seems to bruise and swell more dramatically now than it did when I was younger.

I am told that the incision is healing well and it is meticulously stitched - it will probably not be very noticeable. In the following picture you can barely see it.

                                               4 1/2 weeks after surgery

                                             just after stitches and cast were removed


I was glad to see this blog before my surgery. Reading someone's actual story of the process is more illuminating than reading the technical sites like Wheeless. I had read enough that there were no surprises after the surgery.

All in all my hand looks better in profile and straight on. After the cast was removed my elbow range of motion was diminished but with rehab exercises from the Occupational Therapist (OT) I have regained all of the motion of my elbow.

There is still some pain in my wrist as it heals, and I must wear a splint for the next month. The OT custom-makes them for each hand surgery patient.  The splint can be removed for washing and exercise.

                                     The Splint

I am doing a follow up post showing how it looks 4 months after, and also the X-rays of the hardware they actually use for the fusion. I can hardly believe what is under my skin.  You can see it here.