How to prepare for carpal tunnel surgery & recovery: a patient's perspective
As I write this I'm in the midst of recovery from carpal tunnel surgery. While there are lots of articles online on how to prepare for carpal tunnel surgery, very few of them are written from the patient's perspective. Advice written by doctors and other medical professionals is useful, but it often misses out on key details such as: how to prepare your home before surgery, how to get around after surgery, and how to deal with the fear of going into the operating room.
I hope this will be helpful with you in going through your journey of carpal tunnel surgery preparation and post-op. Yes, it's a long read. But I encourage you to go through all of it because this literally could impact the rest of your life.
Let's dive in.
How did I get here?
First, context. I first started getting numbness in my left hand about five years ago. It wasn't through typing which is very common among carpal tunnel surgery patients. It was probably through competitive sailboat racing where you have to hold on to a rope tightly for hours at a time.
I saw a hand specialist at a local orthopedic clinic and he had me do an electromyocardiogram. That was four years ago. An EMG is where they basically zap your arm with a short dose of electrical voltage, and see how long it takes for the electrical current to travel down your arm. The longer the time, the more your nerves are blocked.
At the time he said that my results were borderline in terms of indicating surgery and that I should try physical therapy first. I did, but it didn't help. Four years later I got another EMG and the results were unequivocally that I needed to get surgery.
Specifically, I had blockage in my medial nerve, which controls the thumb, forefinger, and middle finger. Unlocking that would require an incision on my wrist to loosen up a ligament. I also had blockage in my ulnar nerve. That controls the ring finger and pinky finger. Unlocking that would require an incision on my elbow and moving, or transposing, the nerve from my elbow to higher up on my arm. It would also require my arm to be in a sling for longer than with standard carpal tunnel surgery, which means more muscle atrophy any longer physical therapy recovery process.
The ulnar nerve blockage, to me, suggests that the cause os my hand numbness is primarily due to sailing. Typically after a long regatta, I'll have a lot of strain on my pinky and ring finger, to the point where even if I'm wearing gloves I'll have lots of skin worn off if I don't wear weightlifting tape.
Do online research to generate questions, not for answers
Treat everything you read online, including this, as prompts for questions to ask your doctor, not medical advice.
Watch some patient journey videos so you can see what you might expect. I found this video to be informative:
“Might” is a key word here. This guy had much more pain than I did in the first 48 hours. However, he only had carpal tunnel release a scar on his wrist. I’ve got that as well as a scar on my elbow for the ulnar nerve. So my arm will be in a sling for a while and I will have more muscle atrophy, where his arm was able to move.
Check out Bob and Brad, who have a lot of informative physical therapy videos. Including these videos for carpal tunnel syndrome. Again, this is not to provide advice but rather generate questions for you to ask your doctor.
Picking a physician
I was told earlier this summer, by an older orthopedic surgeon, to go with a younger surgeon because they are trained on the latest techniques. And this was after a couple of glasses of wine. In vino veritas!
I’m glad I did, because she (yes, my doctor is a she) did a great job and I had much less pain and numbness but I have heard other people experiencing.
Here is the surgeon that I used. As you can see, there’s a lot of badassery in her bio: 2x board-certified, Magna Cum Laude, NIH funding, published five times, presented at 25 conferences, residency at UCSF, and awarded intern of the year.
The point is, look for someone not just good, but someone exceptionally good. And if you don't live in a metro area with great hospitals, considering traveling for your surgery. It's a few days in a hotel, but a lifetime of relief if done right.
Ask how many people in both the doctors office, and the surgical center, have not been vaccinated against Covid, for whatever reason. Health, religious, etc. I'm very glad that number was zero for my doctor and her team.
Once you've settled on your doctor, make sure that you have their cell phone, email, and access to any private web portals that they use. They're often have a physicians assistant who is medically knowledgeable and can field questions; make sure you have their contact information as well.
Questions you can ask your doctor
Here are some questions that you can ask your doctor as you prepare for surgery. Obviously this is not a complete list but hopefully helps round out your knowledge of what to ask.
- What surgical procedures am I getting done?
- How many of these surgical procedures have you done in your career?
- How many of these procedures do you do per week?
- What is your success rate with these procedures?
- When a surgery isn't a success, what are some typical outcomes? How to remedy them?
- How many surgeries do you typically do in a day? Do you do them in parallel, or one at a time?
- What painkillers will you prescribe? When do you anticipate that I will be able to shift to over-the-counter painkillers? What about alternative painkillers like CBD?
- What surgery center will you work perform the operation at? How often do you work there? What is their address, phone, and email?
- What anesthesiologist will you work with? How often do you work with them? What is their address, phone, and email?
- After surgery, what physical therapist will I work with? When will that start? What is their address, phone, and email?
- Before surgery, will you mark the arm to be operated on and the incisions to make? Will this be before the IV is inserted?
- Will I have a nerve block during surgery, and if so, how long after surgery should I anticipate that block wearing off and me starting on painkillers?
- Can we schedule the follow up appointments now, before I go into surgery?
- My phone blocks unknown callers. Could you please share with me the phone number that or their assistant will be calling from I can ensure that it is not blocked?
- After surgery, what finger mobilization should I do to promote healing?
- Who do you recommend that I use for physical therapy? A few choices would be good so I can ensure that I find somebody in network.
- When should I schedule my first physical therapy appointment? Can I book that before surgery?
- How long should I keep the sling on?
- How long should I keep the splint on?
- When will I be able to type?
- When can I remove the bandage from the I.V.?
- How long should I do ice for?
- How long should I keep my arm elevated?
- Is there a time when I can start to safely drink coffee again?
- When is it OK to drink alcohol in moderation, along the lines of a glass of wine with dinner?
- How many people in your not office have not been vaccinated against Covid?
- How many people in the surgical center have not been vaccinated against Covid?
- What are your covid vaccination requirements for patients?
- What are your covid vaccination requirements for caregivers who drop off and pick up patients?
- Where can my caregiver park when they’re dropping me off for surgery? Can they stay at the facility during surgery?
- After surgery, will I be in a wheelchair to my caregiver’s car? How far is the trip to their car? Is it covered in case of rain or snow?
- What is my current grip strength in both hands? (You’ll want to know this to measure your recovery progress after surgery.)
Big things to line up beforehand
This will sound kind of random, but if you’re due for one, get a colonoscopy before you get carpal tunnel surgery. The reason is that you are put under anesthesia, for a relatively easy procedure. So it’s kind of like surgery with training wheels. This helped me because I have never had surgery before. Going into surgery, I was nervous, but not about the anesthesia part.
Line up a good friend or significant other stay with you for the first 48 hours (or more) to make sure that all is good. And by “good” I mean someone willing to give you a sponge bath after surgery.
Confirming insurance: CPT codes
Here are some tips for those of us lucky enough to work with the American health care system.
We've all heard the horror stories around surgical procedures that were not covered by insurance. So, I wanted to check with my insurance company to make sure that all was good to go. I have not yet gotten an exclamation of benefits, but as I write this here are some things that seemed to be good to do.
As I understand it, there are at least two kinds of carpal tunnel release: the traditional one which is more invasive, and the endoscopic one which is less invasive but does not work in all situations. Also, you need to know if you are getting ulnar nerve surgery done as well. This from the surgeon or the surgeons assistant before you leave your consultation meeting.
You need to understand the exact procedures you are definitely getting done. And which procedures you might get done. The reason for this distinction is that sometimes a surgeon will need to “call an audible” and switch to a different procedures mid-surgery. They might initially try endoscopic , but then realize that they need to shift to a more invasive traditional procedure to get the job done.
What do you need to do as a patient is to ensure that your insurance company covers you for all possible procedures that a surgeon might need to do. Don't assume that an insurance company is going to do this by default.
In the healthcare industry, just about every procedure has a CPT code. This is similar to how some restaurants number each of the items on the menu, except the menu for healthcare has tens of thousands of listings. So, you need to get the CPT codes for all procedures that your surgeon will do, and for all the procedures they might do.
Then you need to get written authorization that your insurance company approves of all these CPT numbers.
Using CPT numbers is crucial because there are multiple CPT numbers for carpal tunnel release. For traditional carpal tunnel release, I believe this is 64721. For endoscopic, 29848. And here are the ulnar nerve codes. Of course, double check on all these by asking your doctor.
Confirming insurance: NPI numbers
Next, you need to understand that your surgeon, the surgery center, and your anesthesiologist all need to be in-network with your insurance company. You would think that this would be a package deal. Especially given the high price that we are paying for surgery. But no. You need to separately confirm that each one of these is in network.
To do this you need to ensure that you are accurately identify each one of these medical providers. To do that you should get their NPI number, as well as their Tax ID number. For the surgery center, this might be called a facility code. All this will make it easier to reference those providers when you call your insurance company.
Confirming insurance: building a paper trail
No you might be thinking: it's 2021. Why can't I look all this up on my insurance company's website? You would think that it would be a core capability of an insurance company to have a complete and accurate website that steers you to their in-network providers.
But unfortunately, my insurance provider’s website was inaccurate and did not list all their providers. So I had to burn up a couple of hours of their time during several phone calls. If anything, it was a great education and why the American healthcare system spends more than other countries, for worse outcomes.
During each call, get the name and email of each person you talk to as well as the call reference number of the conversation. Then follow up with a confirmation email the conversation and giving insurance company a chance to correct any in accurate statements. Conversely, if they do not correct for the statements you should be able to but they are correct.
You want to build up a substantial paper trail in case there's any dispute with the insurance company after surgery. Don't forget that insurance companies are for-profit entities and they will pray on the weak — those who have not done their homework. A good paper trail is Kryptonite for insurance companies.
Confirming insurance: what you actually pay
Ultimately, you want to know what is your out of pocket costs per surgery. This will be a function the difference of the billed amount and covered amount, your unused deductible, if any, and the co-insurance portion. Co-insurance isn’t insurance at all, but rather what you as a patient are individually responsible for paying. By using a misleading term like this, insurance companies are doing are great job of rallying popular support for their demise.
Insurance coverage questions
Here are your questions to ask, using the healthcare industry’s native language of CPT codes and NPI numbers. The first two are an expansion on one of the above questions, now that we have more background.
- What surgical procedures am I definitely getting done? What are their CPT codes?
- What surgical procedures am I possibly getting done? What are their CPT codes?
- What physical therapy activities will I need post-therapy? What are their CPT codes?
- What is the NPI number, taxpayer ID number, billing phone number, and billing email of the surgeon that I am using?
- What is the NPI number, taxpayer ID number, billing phone number, and billing email of the surgery center that I am using?
- What is the NPI number, taxpayer ID number, billing phone number, and billing email of the anesthesiologist that I am using?
- What is the NPI number, taxpayer ID number, billing phone number, and billing email of the physical therapist that I am using?
- Are these NPI numbers in-network for my insurance plan?
- Are these CPT codes covered by my insurance plan?
- Do I have authorization for all possible CPT codes, performed by the NPI numbers and taxpayer ID numbers of my surgeon, anesthesiologist, surgery center, and physical therapist? What is the authorization number and authorization date?
- What is my unused deductible?
- Can I use my FSA to pay this unused deductible?
- What amount will be billed by the surgeon, surgery center, and anesthesiologist to the insurance company? What portion of this will the insurance company cover, and what portion of that is coinsurance to be paid by me?
Ultimately, you want to work through the math and come to a dollar amount that you are likely to pay out of pocket. Then put that into one more of your confirmation email see you create one more step in your paper trail.
Preparing yourself and your home
Prepare your home so that your postop recovery is a stress-free as possible. Bills paid, house clean, laundry done, sheets clean, out of office message turned on. If you live somewhere like San Francisco, make sure you’re parked somewhere where you’re not going to get a ticket for a week or so.
Make sure you’re stocked up with food that can be prepared with one hand. Jars are brutal. Transfer items in jars to tightly-sealed Tupperware containers so that you can open them up with one hand.
Have grippy oven mitts that will make it easier for you to unscrew other items before your grip strength is restored.
Knives are a challenge. Pre-cut as much food as you can.
Download videos, podcasts, and books so that you can zone out for a day or two and I have to deal with any hassles around WiFi that you need to troubleshoot. Plugging and unplugging devices will be very hard if not impossible with one hand. Charge all your devices.
Work out how to do dictation to your laptop so you can more easily dictate text like I am right now. This article goes into more depth. Make sure your AirPods are fully charged and paired with your laptop to make the dictation more accurate. Set up Grammarly to catch errors that inevitably come up during dictation.
Have baby wipes next to the toilet, since you will not be able to bathe for a few days.
Buy 13 gallon bags with a drawstring for bathing without getting your bandages wet. These are big enough to cover your arm up to your shoulder. The drawstring help keep water out.
Get 48 hour deodorant because it might be that long after surgery before you can reapply.
Get floss sticks, since you're not gonna be able to use your hand to floss your teeth.
Take anything that is in a high shelf, that requires you to get up on a step stool and put it somewhere lower. You do not want to have a fall after surgery.
Buttons are brutal with one hand. Have sweats, shorts, and shirts without them.
Get Tide pods, since they don’t require you to unscrew detergent containers.
Build up your shoulder muscle strength and flexibility. Since one of your arms will be in a brace, you will need to keep it lifted when you are bathing for maybe 20 minutes or so. Here is a workout you can consider.
Build the grip strength in your other hand. It will need to do double duty during your chores through the day. It will also need to be very good at opening jars and doors by itself. I have found the Prohands Gripmaster to work well.
Build your balance and core strength, whether via yoga, a standing desk, surfing, or some other activities. I shudder to think what would happen if I fell on my arm post op.
Spend time doing everyday tasks with one hand. Those that require two, you need to address.
Have stool softener on hand. Also buy lots of fruits and vegetables with fiber, the day before surgery. Peel the citrus fruit and put into a sealed tupperware. I explain why below.
Have three ice packs if you were getting just carpal tunnel release and only need to ice your wrist. Have six ice packs if you're also getting your ulnar nerve released and need to ice your wrist and elbow. This way you can have one or two ice pack in use with the others being chilled in the freezer. Ice plus over the counter medication can help you avoid taking opioids which, as explained below, can be a very good thing.
Pain management
Before the big day, write up a medication schedule on a piece of paper and put it somewhere easily accessible and visible. List out the next few days across the top, and list your time slots, e.g., midnight, 4 AM, 8 AM etc. going down the left side of the page. In each box, track whether you took — opioids, Motrin, Tylenol , etc.— during that time slot, and at what dosage.
This way, if you need to talk to your doctor around post op pain issues, you will have a clear and complete record of information that you can scan and email to them.
(This is why it’s important to have not just their cell phone, but also their email. Sometimes when working with the medical profession, you encounter this ad resistance to communicating in a streamlined manner. So make sure you have your doctor’s email because sometimes that’s the easiest way to communicate.)
Try to get your opioid medication before surgery, so it’s one less thing to go wrong. And so you can unscrew the cap before you go in for surgery. Stock up on over-the-counter painkillers Motrin and Tylenol. CBD too, if that's something you're doing. Citrus fruit, salad, fiber gummies, anything to keep your gut filled with fiber.
I only had to take three opioid pills post-surgery which I’m thankful for. I was prescribed hydrocodone/acetaminophen 5–325 TB, which has the brand name Norco. The postop papers I was given say it has a 25% addiction rate which is crazy. The sooner you can shift to a combination of Motrin and ibuprofen, or maybe CBD, the better.
I found it helpful to shift to the following schedule for pain medication:
- midnight: Motrin/ibuprofen
- 4 am: Tylenol/acetaminophen
- 8 am: ibuprofen
- noon: Motrin
- 4 pm: Tylenol
- 8 pm: Motrin
Motrin: max 800mg per dose. which is 4 pills, 2400mg max/day.
Tylenol: max 100mg per dose, which is 2 pills, 3000mg max per day.
This is what worked for me, but ask your doctor. If you were on blood thinners, for instance, all that Motrin could negatively impact wound healing. The bigger point: plan a specific pain management dosage schedule with your doctor, then write out that schedule in detail, knowing how many pills to take per that schedule. Not milligrams, pills — you want to keep it simple when you're feeling loopy. And have a pad of paper to log what medication you took.
One video that I saw after surgery recommended CBD as a very effective painkiller for post op recovery. That would be worth asking your doctor about so that you have another tool in your pain management toolbox. If it helps you stay off of opioids, that is a great thing. 25%.
In my case, 48 hours after my surgery, I did not need any more Tylenol or Motrin. I'm assuming this is the result of choosing a really good surgeon. This is just one data point and I'm sure your mileage will vary.
What about all that fiber I mentioned? Well if you’re squeamish or eating now, you might want to stop reading here. I learned that opioids, in addition to being highly addictive, basically turn your poop into cement. I didn’t have a bowel movement for a couple of days, even though I've been eating salads and fruit. 48 hours after I got off opioids, let’s just say it was moving day. So, if and when I do this again, for my right elbow, I’m gonna be pretty much on a high fiber diet before and after surgery.
Build a project plan
Consider the economics of surgery: doctors make money for the actual surgical procedure, but not for what happens after the operation. There’s no CPT code for post-op advice over email or phone. There’s a CPT for in-person post-op visits, yes, but no CPT for postop telehealth, which would typically takes less time than a visit. Yet another inefficiency for an industry stuck in the 1950s.
Lawyers can bill for time spent on emails, calls, and Zooms; doctors should be able to as well.
But that’s not the world we live in. So, there is little incentive for a surgeon to invest in providing you with guidance around what to do after the operation. This means you need to build your own project plan of what to do when after surgery, during the billable time of an in-person visit, and to be efficient by sending the questions above in advance.
Even doctors that are excellent at their craft won't think of all the different details that patient needs. For instance, my doctor had me sign up for a private messaging portal after surgery, which required me to fill out a form, not easy to deal with one hand.
It's helpful to keep in mind that medicine is a field where a book on the importance of checklists was a major revelation to doctors. Which is kind of crazy when you think of how other skilled professionals to hold peoples lives in their hands, such as airline pilots, have been using checklist for decades.
As you talk to your doctor, map out what will happen on the days post surgery. This is something I dramatically failed in. And a major motivation of my writing this post.
This is frustrating given the high price that we pay as patients. We’re getting a fast food experience for Rolls Royce prices. But it’s the reality that we face.
Week before surgery
I got my Covid booster on the Wednesday before my surgery, which happened on a Tuesday.
I got my Covid PCR test on Saturday morning which was 72 hours prior. As it turned out, I did not get my test results until the morning of surgery. That was nerve-racking, because a negative test result was required for surgery. I hate to think what kind of insurance dispute I would have if surgery had been canceled at the last minute. After talking to the physicians assistant, he said that they have been recommending that people get the PCR test four days prior to surgery. This is one more example of how medically knowledgeable people can fail in terms of managing the surgical process. And why you need to do it for yourself as a patient.
I had a big meal at about 8:30 PM the day before my surgery, and had my last drink of water at about 11:45 PM. This is to comply with the doctors orders not to eat or drink anything the day of surgery.
I made sure that I had my drivers license to serve as my ID, credit card, insurance card, and vaccination card all in my wallet. I should have taken all other cards out of my wallet since this is just one more thing to get lost. A Costco card does not help a whole lot during surgery.
I had the address of the surgical center already plugged into a calendar invite that I sent to my caregiver who is driving me to and from the operation. I also should have had information of where to park but thankfully we lucked out and had parking nearby.
Day of surgery
It's OK if you're scared. This is a big deal. But remember, you did a lot of preparation that will serve you well.
Grab a shower, shave, and take care of all your personal grooming needs for the next few days. For me it was a couple days before I could take a bath after surgery.
I wore a loose shirt that was synthetic , which I did not care much about. Being loose, it was easy to get back into after surgery. Being synthetic, it did not hold body odor as much as a cotton shirt would. And being older, I wouldn’t have any issues with having to cut the shirt in order to get out of it in order to take a sponge bath.
I wore shoes that are easy to pull on and off. I didn't wear contacts. I wore jeans, but sweats would have been a better choice.
Take a few pictures of yourself before surgery. They will be a nice complement of your postop photos. Here’s mine.
When you get changed into your gown, request an extra plastic bag for your shoes to go into.
Use the restroom one last time before you get your IV inserted. I'm sure the surgical staff will clean your arm, but I made sure to use a lot of hand sanitizer just to be doubly sure.
Before I got my IV installed, the surgeon marked what incisions she was going to make my arm, and put her initials as well. This is something that I urge you as a patient to insist is done before the IV is installed.
It turned out that the anesthesiologist was a friend of a sailing friend and a good conversationalist. That led to a nice conversation about different sailboat races that I had done, and when I was in mid-sentence, I was out.
—
After surgery, they asked me if I wanted anything to eat. I chose the animal crackers and water. After maybe an hour of waking up, my caregiver picked me up and took me home.
The nerve block wore off after a few hours and I was able to slightly wiggle my fingers. My instructions were to not move them very much the first day. Thankfully there was no numbness in any of my fingers. I told that for some patients, numbness can persistence is or even weeks. Your mileage will vary.
No one told me that I could remove the bandage from the IV a few hours after surgery. As a result, it dug into my hand for 24 hours until I finally was able to speak to someone I could remove it. Another example of how the medical profession is not good at project management.
After surgery: day one
Here are some thoughts on that project plan that I will hopefully fill out over time.
The guidance that I heard was, for the first couple of days, don’t do anything that requires judgment. And it's true. Even though I think I didn't have impaired judgment when I look at the first draft of this blog post that I wrote after 48 hours it had all kinds of miscommunication.
The day of surgery I pretty much hung out on the couch, took my opioid painkillers, and vegged. I read the postop guide they handed me before I left, which was incredibly sparse, hence this blog post.
I drank a lot of water to try to flush out the anesthesia from surgery out of my body so I could start to clear my head.
After surgery: day two
I scheduled my follow-up appointment with my surgeon. I still need to make a follow-up appointment with my physical therapy but I won’t start for another month given that I had ulnar nerve release. If you only had medial nerve release, you might start physical therapy earlier.
I experimented with switching to over-the-counter pain medication, and was happy to see that worked.
I emailed my surgeon and her assistant a bunch of the questions above, which I wished I had asked before surgery.
I brushed my teeth, flossed, put a bit of water on my face, and reapplied deodorant, so I was not a complete slob.
I went out for dinner and walk slowly, with my caregiver on my left side, ready to body-check anyone that came to close to me. We ate a big salad that was helpful a day later for reasons explained above.
After surgery: day three
I took a couple of Tylenol in the morning and that was it in terms of what I needed for pain management. This won't be the case for everyone. In one video I saw, the patient felt like his hand had been run over by a truck on day three. But he knew that it would be temporary and the pain would subside over the coming days.
I was able to start to lift my arm, while keeping it in the sling, in order to exercise my shoulder.
I walked around a bit to get an errand done. Walking down the stairs I held onto the railing. I have a good sense of balance and this is something I never do, but which I did this time, because the impact of a fall would be very bad. I was super careful while crossing the street and made sure to make eye contact with the drivers so that they could see there was a dude in a sling that they absolutely did not want to hit.
I started writing this blog post and it had all kinds of crazy typos. Again a testament to why you don't wanna do anything crucial right after surgery.
I took a bath and just washed from my waist down. Very, very carefully so that I wouldn't get my bandages wet.
After surgery: day four
Woke up pain-free. I was able to easily wiggle all the fingers in my left hand, but still and being careful not to overdo anything. Lifting my arm in a sling is easy.
Took a full-body bath and got a shave. Covered my left arm in a 13 gallon plastic bag with drawstring to keep it from getting wet. To prepare, I made sure I could do 10 reps of waiting by arm in a sling above my head, before taking off the sling. My caregiver pulled the bag up all the way to my shoulder, so no water would get into my bandages, and helped me wash my right arm and back, as well as dry them off, and apply deodorant to my right arm pit. The point is, your caregiver has to be someone who's willing to see you naked and somewhat helpless in a bath tub.
I felt great afterwards being clean.
After surgery: day five
Woke up pain-free once again in my left hand and arm. Ironically, my right elbow, which was not operated on, more sore. This is a chronic, golfers elbow condition that I am trying to treat through physical therapy. I am guessing that it is getting stressed because I have not been doing my PT exercises recently and because I am doing everything with my right hand.
I am regularly doing reps of 10 reps of my left arm over my head to keep my left shoulder relatively strong and flexible.
I can regularly wiggle my left fingers through maybe 10° range of motion for a few seconds before things feel uncomfortable.
Since I was well off of painkillers, I went to a local brew pub with my friend. They drove. We ordered two flights. When I saw how much was in each sample — not a shot, but half a glass — I cancelled the second flight. No need to risk stumbling and falling.
After surgery: day six
No pain. Doing shoulder lifts and finger wiggles. I really wish I had a PT to consult with to know what is the right amount to do. The physician’s assistant is saying, “let pain be your guide,” but I don’t want to overdo things and mess up my recovery. I wish the same level of precision was put into my postop activities as my surgery.
I just remembered a on-armed action hero — Furiosa of the Mad Max franchise. It might seem silly to anyone who hasn’t gone through carpal tunnel surgery, but it’s important to have role models for recovery — and that’s what Furiosa is. I find myself asking, “what would Furiosa do in this situation?” (I’m not saying that being without the use of an arm for a few weeks is anything like losing one permanently.)
I want to get rid of the 25%-addiction-rate opioids. I check the prescription information printout from Walgreens. It says, “check with your pharmacist on the best way to dispose of these drugs.”
You really want me to spend 30 minutes calling my pharmacy and waiting on hold? Why not just explain on the printout? Yet another paper-cut contributing to American healthcare inefficiency.
If any doctors are reading this: the reason so many of your patients come to you with information they find online (of dubious validity) is that your industry, frankly, does a horrible job at keeping them informed. This is not news. “Ask your doctor” should be a last resort, not the default guidance it is today.
Thankfully, this time google points me to an authoritative site — the US FDA — which says that I can safely flush Norco down the toilet. So I do. Relief.
After surgery: day 13
I got the sling and bandages off today in the doctor’s office. The physician’s assistant snipped off the stitches. Really was disconcerting to have my arm unprotected. My instructions were that I could leave my arm in the sling to keep it elevated and help reduce swelling.
Afterwards, my surgeon looked at my hand. My mobility was much less than she expected. I could barely move my fingers. So, she moved up my physical therapy from four weeks from post-op to three weeks post-op. She gave me instructions to move my fingers and wrist much more, as much as I could without pain.
Shortly after this, I went to the gym regularly. My “workouts” were all around trying to move my fingers and wrist more and more every day. I’d spend anywhere from an hour to two trying to do this. It takes time.
After surgery: day 22
First day at physical therapy. I went to Golden Gate Hand Therapy, which specializes in fingers, hands, and wrists. You walk in, and that’s all they’re doing. Having done sessions with them, it makes sense. Hands are complex, with lots of nerves and thus pain sensitivity.
My hand is super swollen. “Hulk hands” is what a friend calls them. My therapist says that we need to get the swelling down, so that the gunk in my hands doesn’t coagulate. Yikes!
We worked on bending my fingers, wrist, and elbow. I was pretty stiff. I couldn’t touch my thumb to my forefinger, nor could I touch my head. So we worked on pushing through.
One key thing is to have the same therapist each time. You need to build trust with your therapist, so you know that they won’t harm you. This is easier said than done: pushing my wrist and fingers DOES lead to mild pain, maybe a three or four on a scale of ten.
In this age of COVID-19, we are all wearing masks, so my physical therapist can’t see me gritting my teeth under my mask. So I’ve gotten in the habit of calling out pain measurements as she bends my fingers or wrist: “1, 1, 1, 2, 3, 3, 3, 4”. She knows to hold at four.
The best example I can think of is those physical trainers who stretch the hamstrings of football players as they’re warming up. They need to push hard… but not so hard that they snap a hamstring. As the recipient of this therapy, you are helpless and need to put full trust in your PT. For this reason, you can’t have a new person each time. So, insist on the same therapist each time.
One thing we do is heat therapy. I did my hand and forearm in hot wax, which they cover with Saran wrap.
Then they put it into a hot pad with a cover on it. It’s effective in boosting blood flow, which reduces swelling and increases mobility of the wrist and fingers. All this aids in recovery.
To do the same thing at home, I order the hot pad and cover, both of which are sold by a company called Chattanooga. I start doing this at home a few times a day.
To heat the pads, I use a large stainless steel pot with lid to heat up the water. I set a timer for about 15 minutes, so that the water is hot without being scalding. Then I use tongs to get the hot pad out.
Sometimes the hot pad is too hot. In those cases, I use a towel for an extra layer of insulation.
Another thing they do is putty therapy: having me play with very malleable putty. It’s called TheraPutty, from a company called CanDo. I get the tan color, which is extra extra soft.
After surgery: day 23
Every day, I take a couple of ibuprofen (Motrin) to help reduce inflammation in my hand, as well as to encourage myself to be more adventurous in moving my hand and wrist. Each tablet is 200mg, so this 400mg dose is well below the 800mg max dosage.
After surgery: day 24
My caregiver suggests that, at night, I rest my hand on a thick pillow that is on my chest. This way, my hand is well above my body, and the swelling will start to reduce. I sleep really soundly, so my hand stays on the pillow all night. Over the next few days, the swelling goes down markedly. However, my lower back starts getting sore and hamstrings tight, given that one shoulder is flexed forward (towards the ceiling all evening).
After several days, I stop doing this so I save my back. But it’s been good to reduce the swelling. It’s also amazing how everything in the body is connected. Who’d have thought that a swollen wrist leads to tight hamstrings?
After surgery: day 25
T-day! “T” here stands for typing. I can bend my elbow up to mid-chest and twist my hands inward to type with a standard keyboard. This makes me more productive for work, but more crucial, gets my fingers moving for several hours a day. That means more blood going to my hand, to carry out more of the gunk causing my hands to swell up.
Graduation: day 99
99 days after surgery, I “graduated” from physical therapy. Meaning that, after 14 weeks (3.5 months), my hand therapist felt that they did all they could with their services. Here’s a photo of me and my therapist:
A good day indeed!
Complex Regional Pain Syndrome
But one weird thing is that I am left with complex regional pain syndrome (CRPS) in my left hand. It’s a rare condition, with fewer than 200,000 cases in the US each year.
In my case, I don’t have pain in my left hand, but a lack of mobility in that I cannot easily make a fist. Joint stiffness, and decreased ability to move my left fingers. According to my surgeon, my brain thinks there’s been some trauma to my fingers, and is immobilizing them so they can heal. The way to address it is to keep working out, keep doing heat therapy, and keep pushing my fingers to make a fist.
My arm strength is okay, and getting better. Here I’m holding a 20 pound barbell. (Notice the barely-visible scar.) It’s just that I can’t firmly grip anything that’s less than half an inch in diameter.
Hopefully this goes away.
Tendonitis
My surgeon said to watch out for tendonitis. Before surgery, I didn’t even know what tendonitis felt like. Now I do. Thankfully, I only get it when I do pullups.
Per-surgery, I used to be able to rip off a dozen pullups. Now I struggle to do just a couple, and if I do three, I feel tendonitis in my left arm, indicating that I need to back off.
Back in the saddle
Even with CRPS and tendonitis, I’ve been able to get back to competitive sailing. I’ve got more work to do in order to get stronger, but I can still get a boat around this course, as I’m doing here in March 2022:
