Injured? Want to move again? Make a physical therapist your ...

An outcome worth every second of work and pain

By Terry Lehrke, News Editor
terry.lehrke@mcrecord.com

An external fixator was surgically placed, held by pins inserted into the bones of the upper arm and in the hand. The hand, wrist and arm were swollen and remained in the unnatural position for five weeks. Getting functional movement and strength back would take more than three months of physical therapy.

You know you’re in trouble when first a general practitioner and then an orthopedic surgeon shake their heads slowly while staring at an X-ray of your wrist and hand.

It’s even more obvious when words like “shattered” and “pulverized” are used when describing what has happened to your bones.

After the accident that brought me to the doctor in the first place, I was sure I’d simply have a cast put on, and be back to work later that week. I did call for help to fill in for me —  for a few days.

Later, I would realize how absolutely ignorant I was about what had taken place during my fall — how long a journey it would be before  the word “use” would actually apply to my wrist, hand and fingers. It’s truly amazing how everything tends to be connected and work together — or not work together, depending on the circumstances.

An external fixator was surgically placed on my arm and hand. It is a device that is placed outside of the body — screwed into the bones to hold it in place because a simple cast would not do. It seemed to be like traction, so the pieces of my bone (I heard them count to eight or 10, and then stop counting) could somehow fuse together.

The orthopedic surgeon said there was nothing to screw a plate onto, which under normal circumstances perhaps, would have been a way to fix the injury surgically.

There this fixator would stay for five weeks — covered only in an ace bandage, with the ends of the screws sticking out about three inches. Nurses at the hospital gave me nice little pill cups to cover the screws, to alleviate my fear that they would hook on anything and everything.

After the five weeks, the external fixator was surgically removed and a cast was put on, thankfully while I was under anesthesia.

The cast stayed for two weeks — making a total of  seven weeks of immobilization — seven weeks for muscle to atrophy, soft tissue to scar and tendons to become so stiff as to allow  no stretch — or movement.

Of course, I had no idea what that meant for the future of my wrist, or its function.

When the cast came off — my orthopedic surgeon, Dr. Virgil Meyer of Little Falls Orthopedics, said  physical therapy needed to begin immediately.

As I looked at the lower part of my arm, shriveled, my wrist hanging in an unnatural position (which I had no power to change), I was absolutely terrified at the thought of anyone touching me. I knew how much it hurt just for it just to be — just to sit there — with no movement. I had been practicing touching my pointer finger to my thumb — a major feat for me that impressed no one. Evidently that was not enough.

I also learned that the nerves had been damaged — the tingling numbness in my fingertips continued for months. The orthopedic surgeon told me to touch things with both sets of my fingertips, to help the fingertips on the left relearn feeling textures.

During the first four weeks after the injury, an ice pack was my best friend — constant ice packs — and pillows that would hold my arm softly in position, to keep the mind-numbing throbbing at bay.  Being upright was painful; being a passenger in a car was painful. Medication was helpful.

The fifth week, I returned to work part-time. Typing with one hand was absolutely annoying. Using my left hand, even to anchor something, was painful and sometimes impossible.

As a right-handed person, I had never fully appreciated my left hand and wrist — how they allowed me to use my right hand more effectively. How they aided my right hand in all of its work and movement and how my left side worked in tandem with my right.

For more than 50 years, that’s just how it has been — two sides working together, one the dominant, but the other equally as valuable as the helper and assistant — each with their own strengths and each, I found, as necessary as the other.

The first physical therapy appointment was set for two days after the cast was removed. Things had “unshriveled” once the cast was removed and swollen was the norm from hand to shoulder.

My brain was as numb with fear as my arm and wrist were with pain and lack of strength. Stories from those who had undergone  physical therapy didn’t help my state of mind.

But, what I had feared the first day didn’t happen. Angie Gunderson, a physical therapist at St. Gabriel’s Hospital, made simple measurements of range of motion and strength. She documented the degrees I could move my wrist down, back, left, right, how far I could bend my fingers, at every joint, how many pounds I could pinch, lift and whether I could rotate my palm face up and face down with my elbow at my side.

Not surprising to me now, but surprising then, were that the measurements all hovered at one, or less — and we were talking about numbers that were supposed to range from 16 – 90.

I was terrified when she wanted to put a compression sleeve and glove on my arm and hand to control the swelling. The very idea of anyone touching my hand, let alone putting a tight glove and sleeve on was frightening. The anticipation of pain was great.

When appointments were made for three times a week throughout April, and then May, I began to wonder how long this would take. My initial thought was four – six weeks. After a month of therapy with some but not a lot of progress, I realized I should have been thinking in months, not weeks.

Over the course of the next three months, April, May and June, Angie would bend my fingers, hand and wrist, and twist my palm face up to stretch whatever needed to be stretched, for just two minutes, often causing me to levitate right out of the chair. Two minutes can be a very long time — especially when it’s two minutes for each different movement over a 45-minute session.

Angie let me tell her when she had pushed me to the absolute limit, and would stop and hold the position as she promised. She’d let me know when 10 seconds were remaining, and I was able to say “a little more” or not. I mostly said “a little more” with the theory being that a person can stand anything for 10 seconds.

Once the bend was as far as I could stand, at the end of the two minutes she’d say, “now hold it there.”

And, she said it as though I actually could.

But at first, whatever bend to whatever degree had been made, would magically come undone, no matter how much I willed it to stay.

In addition, she gave me “homework.” Exercises to do at home, including squeezing putty, at first very squishy stuff. I could barely make a dent in it. Holding a hammer and trying to move it left and right (holding it was a feat). Just holding anything was a major feat, let alone moving it.

It seemed everything I did centered on physical therapy.

One thing I noticed was that as soon as I accomplished a goal, Angie made it harder – it seemed as nice as they are, physical therapists are impossible to please.

Slowly, very slowly, things began to bend a little more and a little more.

Except one — the move to present my palm face up, which evidently requires a lot of suppleness in ligaments, muscles and tendons all the way up to the elbow.

To help that along, Angie asked that a “dynamic supinator,” be fitted. This piece of equipment strapped onto my upper arm and attached to a piece that held my hand. A tension-based spring at the elbow forced the piece on my hand to slowly rotate it in the palm-up position. I was supposed to wear it, increasing the tension and the amount of time, three times a day, up to eight hours. Eight hours? Really?

I never made it to eight hours, but I woke up early to wear it in the morning, came home from work and put it on, and put it on before I went to bed. At first, a half an hour was excruciating, even on the first level, and my hand didn’t move that much.

I was able to ship it back to the company the last day of June —a happy day indeed!

Once range of motion continued to improve, as the 20 muscles, 30 bones, tendons, ligaments and cartilage loosened up, strength training was introduced.

Angie set me in front of machines I knew there was no way I could maneuver. It was difficult just trying to position my left hand to hold whatever handle was there. First attempts were both weak and awkward.

But, with her encouragement, and a few tries, some unsuccessful, eventually I could use the arm pedal, lift and press weight. Each time I successfully met a weight goal, while she expressed her appreciation of my progress — she increased the amount of time, weight and number of repetitions. As I said, she was difficult to please.

Physical therapy for the injury that occurred Jan. 28, 2011, started the end of March  and finally finished the second week of July 2011.

It was with a bit of sadness that I said goodbye to the woman who had gained my trust. Over the course of three months, she visited with me several times each week for 45 minutes. She pushed and motivated me to improve and celebrated each degree of movement gained. Eventually, she helped save the function in my left hand and wrist.

My physical therapist was indeed my BFFAW.