Stephamie's disease process

It started with me on Easter Sunday 2016 (March 27th). When I was writing by hand, my right wrist suddenly hurt (I'm right-handed). In retrospect, I may have had a slight decrease in strength in the weeks before, nothing more. Over the course of the week it got more and more, on Thursday I went to my family doctor who prescribed me a bandage to keep me quiet. I thought of an overload. I didn't need an au certificate, I told her. At first I tried (without success) quark compresses, savior poultice compresses, Kytta ointment and Voltaren gel. After another week of working and increasing pain, I took sick leave for a weekend, because otherwise I would have been on call (I'm a dermatologist in a rehab clinic, in an emergency I have to be able to reanimate), which I didn't trust my hand to do. I then switched from home remedies and pain creams to diclofenac tablets. Since 50mg didn't help, I got a stronger prescription and took 75 mg 1-2 times a day for 10 days. Without success. From mid-April onwards I took sick leave all the time (that should last a good 19 months ...).

Then I remembered my cousin, who is conveniently a hand surgeon, and I asked him on the phone what I should do. He advised an X-ray and an MRI with contrast agent, if 10 days anti-inflammatory painkillers don't help, what's wrong! Apparently my luck when I hear how long it took others to make a meaningful diagnosis. The MRI was performed on April 24, 2016. The radiologist brought me to his desk, showed me the pictures (all other bones white and one black or vice versa) and gave me the diagnosis of lunate malacia.

I googled that on the way back home. And called my cousin again, who said that I would be out for 2-3 months. I should send him the pictures and he would inquire about the current state of research. Coincidentally, he wanted to visit me a few days later anyway, so we discussed more: it would make sense to shorten the radius. He said the only clinic where he would have something like this operated on was Bad Neustadt an der Saale. There I got a pre-inpatient appointment for my birthday on May 24th. By then it was so far that I could barely get my signature when paying by card or the like, my hand hurt so much. The force had also decreased significantly. Due to the pain, mobility also got a little worse, but not much. My hand was never really swollen.

During the appointment in Bad Neustadt, I was looked after by a very friendly and technically competent assistant doctor. She soon got the senior physician Dr. Kalb also had a CT done (diagnosis was stage 3a with impending carpal collapse), developed a plan and wanted to operate himself: He advised an arthroscopy with denervation according to Wilhelm, a radius shortening osteotomy and a temporary STT transfixation. If that weren't enough, you could do a partial stiffening of the STT, after which the next option would be a cartilage-bone transplant from the knee (you would have done it 8 times, 7 times with success ...). I didn't want to hear that exactly anymore. The operation was on June 16, 2016 in Bad Neustadt an der Saale, in plexus anesthesia (of which again anytime!), 5 days inpatient. I cried in pain the first night after surgery, but my bed neighbor comforted me. The painkillers only helped to a limited extent, but they weren't good for my circulation ... 6 weeks in a cast. Still quite a pain. Even the shock of walking hurt. Cooling felt good, medication either didn't work or blew me away. (After months, I found the first pain reliever that really helped me: Arcoxia)

MRI check-ups after 7.5 weeks and 3 months after surgery in the MVZ Bad Neustadt: No improvement, but also no progress. During the second check-up, the doctor told me that the 2 wires (from the temporary STT transfixation) should remain, then she sent a modified letter after consulting Dr. Kalf, that they could get out. At first I was confused and asked my cousin for advice again. He talked to a colleague and we decided to leave the wires on for the time being and hope that the moonbone will still recover. Unfortunately that didn't happen. After exactly 6 months (December 16, 2016), the two wires were removed by my cousin on an outpatient basis and denervated again. The arm was only anesthetized via the vein, that worked well, I only had "circulation" as it seems to be usual for me.

An MRI check-up in February 2017 showed progression, incipient fragmentation and change in shape of the lunate, a new scapholunal dissociation and increasing radiocarpal joint space narrowing. I still had pain (exactly in the same place as before the operation but not quite as bad) and the mobility was still worse than before the first operation. On March 21, 2017, the 3rd operation (again with my cousin, who rarely or hardly treats LM, but does such small interventions): Arthroscopy with synovectomy, disc smoothing, capsule smoothing, irrigation and denervation now of radial nerves. Plexus anesthesia was actually planned again, but it didn't work when you tried to cut, which wasn't really nice, so general anesthesia was followed up. Then 2 weeks in plaster. That was a breeze compared to the 6 weeks the first time. ;-)

Despite physiotherapy (started before the first operation and only paused for the plaster phases and trips from the North Sea, where I live, to the doctors in Bavaria and North Rhine-Westphalia) and 10x occupational therapy from mid-February 2017, the pain was not really good. After each operation I tried to work again by means of gradual reintegration, but it didn't work. Writing by hand was the worst. It was due to the mobility, but it hurt during and afterwards. In my private life I got along, you learn to help one another and to ask for help, but when it comes to work, I was pretty scared. When it started I was 36 years old, now 38 (about 30 years of professional life ahead of me), my sick pay was soon over and my boss didn't want me to fail in a fourth reintegration. So I applied for rehab, which was initially rejected (like a GdB), but after an objection on my part, I then received the permit for Bad Bentheim, from 1.8.2017. On the first day the orthopedic chief physician "knew" that I would be able to do anything after the rehab and would not be awake anymore! Well, the physiotherapists and occupational therapists were more technically competent and helped me a lot. I was in pain every day, but I learned to use my hand anyway and my mobility got better too. Fortunately, I also got 14 days extension. In retrospect, I should have done the rehab much earlier, then the third operation would probably not have been necessary.

I then discussed with my employer that I would get speech recognition software so that I would have to write as little by hand as possible. The mouse and keyboard had already been converted to ergonomic. So the 4th reintegration was finally successful. I still had to apply for ALG 1 after the sickness benefit expired (that is possible if you are controlled despite an existing employment contract), but after about 19 months I was officially able to work again on November 10, 2017. Fortunately, with a lot of remaining vacation time and old overtime to give the hand plenty of breaks. Incidentally, the employment office rejected the so-called "benefits for participation in working life" after about 12 months of processing, the pension office decided on my 2nd GdB application with only 10 (and that more because of a few accompanying illnesses than because of the hand). So much for this socio-medical excursus.

Mid-December 2017 routine MRI check-up: lunate stable poor, now also significant STT arthrosis (I suspect due to the temporary STT transfixation, the wires were pushed in and out several times until they finally sat) and a moderate rhizarthrosis (on the I also have one on the other side, because I don't see any connection with the LM). Because I didn't want to go all the way to Neustadt again, I went to another hand surgeon (Dr. MN in L.) whom fellow patients (with different diagnoses) told me about in rehab. He considered putting a spacer in place of the lunate and doing an STT arthrodesis if it continued to progress, after 6 months I should have an x-ray. When I requested a report, it said there was an MRI check-up after 6 months, if necessary one wanted to insert a vascular-pedicled bone chip from the radius or the above-mentioned operation. Interesting to find out from the letter! So I made an MRI and a follow-up appointment with him after 6 months. The MRI was at the beginning of June 2018, and there was a decrease in the height of the lunate. So it was time for OP No. 4 ?! I went to the hand surgeon again, his senior doctor was there instead of him and said that an operation now had to be performed. I asked if it could not be postponed (until I was entitled to sickness benefit again and my employer replaced me). She strongly advised against it, so I was given an appointment 3 weeks later. Two days before the appointment I was told that this hand surgeon had almost 40 pending lawsuits, so I decided to cancel my appointment and get another pre-inpatient appointment in Bad Neustadt (5 weeks later the first one was free), as this was the Clinic that had been recommended to me two years earlier and that I had lost interest in experiments.

The pre-inpatient appointment was there on August 14, 2018. Dr. Kalf was brought in again. I was asked about the course and my complaints and examined. Like me, they were very satisfied with the mobility, but of course they didn't like the fact that even such minor stresses as writing and holding a mug hurt. I said that I would not have come back sooner because I did not want the next step of STT partial arthrodesis that was suggested at the time, as the temporary STT transfixation would not have helped me and I had more problems with wires during the 6 months than after pulling. Dr. Kalb said he was not dogmatic, just because he had mentioned that as the next step back then, it didn't have to be now. A CT and current x-rays were taken. The deterioration is minimal, I am still in stage 3a. However, all the usual treatment methods for this stage have already been exhausted. I now had 3 options to choose from: 1. Revascularization with a cartilage-bone transplant from the knee. Has been done since 2006, so no long-term consequences for the knee are known, mostly unproblematic. Might work well overall or end in disaster. You couldn't know beforehand. 2. STT arthrodesis, connected with cancellous bone from the radius and fixed two K-wires. Or 3rd PRC. With the shape of my capitat, it was not clear whether this would not cause problems after a while due to the incorrect position of the joint surfaces on one another. Dr. Kalb (apparently?) Didn't really have a favorite and left the choice to me. I chose No. 2, which is what I didn't want before, but what seemed to me to be an opportunity after all the deliberations. The operation would be done under plexus anesthesia, 3 nights inpatient, 6 weeks in a cast. The wires could stay in the radius like my old plate. If the OP didn't work well in the rarest of cases, you would soon notice. What made me particularly relieved was that he said that as long as I can cope with the pain and nothing unforeseen happens, the operation does not necessarily have to take place promptly and I can wait until April (new sickness benefit claim). Even if it progressed a little further, the procedure could still be performed. So now I have 8 months to adjust to the fact that my mobility, which is now almost normal, will never be the same again.