Wednesday, 15 June 2016

Facing My Own Everest. One Hand, One Day at a Time

If you recently fractured your wrist or you're caring for someone who has, and you want to know what to expect after surgery and during rehabilitation, I hope you'll draw comfort from my experience. After a fall that broke my right wrist, I find myself facing my own Everest, so I improvised and learnt to cope with my non-dominant hand. 

February 12 (2016): I had surgery for a distal radius fracture and  distal ulna fracture, commonly known as a broken wrist. A titanium plate was fixed to my radius (the larger bone on the thumb side) and a K-wire to my ulna styloid (the head of the smaller bone on the little finger side). 

The K-wire's out!
April 28: I went in for day surgery and had the K-wire taken out under local anaesthesia.

Today, 5 months post-op: My non-dominant left hand has grown so used to picking up the slack sometimes I forget the right one's on the mend.  With my left hand, handling a fork and spoon, switching TV channels and opening doors has become as natural as kaya on toast. That's one unexpected icing on the cake.

As for my healing right wrist, about 90% of the post-op numbness and tingling pins-and-needles is gone, little is left of the tight muscle twitches and stretches I had to endure up to 2 months post-op, and my scars are fading into  works of art, except where the healed ulna scar was reopened to take out the K-wire. The scar is now slightly raised and thick. My surgeon said it's a hypertrophic scar, and the tiny knot of dissolvable surture used to close the wound that's popped out from it is a reaction to the surture. I can now lift the kettle to make coffee and recently went back to lifting my 2kg dumbell, thanks to exercises prescribed to regain wrist stability and strength. 

After nearly 20 outpatient visits and therapy sessions and an ongoing wrist strengthening home exercise programme, my recovery is on track, although I still have some way to go. I still sleep and wake up to a right wrist and fingers that stiffen up when when not used. My grip is weak and there's still some ulna-sided tightness, tingling in the base of my palm near the thumb and the odd ache after the grip and weight exercises. 

My heroes

Although my husband would walk over hot embers for me, the real heroes are the men and women at Ng Teng Fong General Hospital. I'm lucky I have the right doctor. My dear friend Joanne Yap (COO) and Dr Gamaliel Tan (Head, Orthopaedic Department; Senior Consultant, Orthopaedics and Chief Medical Officer) of Jurong Health have been instrumental in introducing my surgeon Dr Mark Puhaindran who did a first-rate job fixing my wrist. Occupational therapists Tui Sze Sze and Cait Maire Chroinin as well as Dr Renita Sirisena also worked hand in hand helping me get my mojo back. 

Cait, my therapist, holding the
handgrip dynamometer for 

measuring hand grip strength.  

My surgeon Dr Mark Puhaindran
whom I'd recommend in a heartbeat
to anyone in need of hand surgery. 
He also specialises in treating tumours 
of the bone and the connective soft tissues

Coping with my non-dominant hand, I came face-to-face with my own Everest and a mountain of challenges.

As unwelcome as my fractures, I'd developed an unhealthy paranoia of crowded places and wet surfaces. For now I don't travel far on anything that moves if I can't get a seat, as my grip strength is half that of my left hand, and I've to avoid straining my wrist from sudden or jerky movements that could potentially undo my healing bones. Wet surfaces, slopes and rainy days give me the shivers. For fear of slipping and refracturing, I wait it out until the streets and pavements are at least dry before venturing outside. Crowds scare me as they hurry past, as I worry what a bump would do to my still fragile hand.

A fracture tests your patience and forces you to adjust your daily routine. In the first three months post-op, everything slowed down, from eating to cleaning up and dressing. Even walking. 

I had to adapt fast. You will too. We have no choice. 

When eating out and queueing for food, grab something you can handle with one hand, or ask the staff to help carry it to your tableIn the first three months (when eating alone) I ate mostly food I could pick up with one hand, like soups, sandwiches and fruits that needed no cutting or slicing

Wear loose or sleeveless tops as they're easy enough to slip on. If you're a woman living alone, wear lycra or slip-on sports bras as it's impossible to manage the conventional (hook) bras with one hand. Avoid drawstring shorts or pants and opt for the adjustable belts you can pull with one hand. Bottoms with pockets are handy since you needn't bother carry a bag or purse and you'll need your uninjured hand to steady yourself when riding the escalator or train, or to pay for things when you shop. 

I've often wondered how people living on their own cope under the circumstances. When you're vulnerable and unable, humility is a constant companion. You'll need help with wrapping the fractured arm in plastic,  shampooing your hair, scrubbing and drying the spots you can't reach. At first I used wet wipes bought from the hospital pharmacy, gradually taking more frequent showers 3 months post-op with help from the husband.  

While brushing my teeth was the most awkard adjustment I had to make, bedtime was especially rough in the first three months post-op. Feeling vulnerable, I drifted in and out of sleep, always on my right side with my right hand in the splint and propped between cushions. As a consequence, the muscles on the right side of my neck, shoulder and upper arm grew tense and stiff. 

Rehabilitation therapy
The hardest part about therapy is repeating the same routine exercises day in, day out. It's tedious yet critical to the healing process. Make it less dreary by turning on your iPod, laptop, TV or radio as you work out that hand. I did it to music and my favourite TV shows and sitcom reruns. CNN, HGTV and The Dr Oz Show kept me company many boring afternoons and evenings!  Incidentally, don't just work out your fractured hand. I exercised both the left and right in front of a mirror, using my non-injured hand to compare if I'm moving naturally or making headway.

After regaining range of motion
You need to oil the machine to prevent rust. Train your fractured hand to gradually take over. I used mine whenever I can, at first for light tasks like picking up a pack of tissues and a pen. With more range of motion and strength I "trained" it to do more, like holding a coffee cup, operating the TV remote, buckling my belt and so on. Not letting my non-dominant hand do all the work has brought me closer to my Everest peak.

Fracture healing is demanding, so be prepared

Make no bones about it. It's a long-drawn process so don't expect a quick fix.wrist facture can take up to a year before the bone is cast-iron strong, figuratively speaking.  It's not as if you go in for surgery, take some painkillers and it's life as usual before you know it.

After surgery, be prepared to set aside time for your wrist exercises and scar massage. If you're working full-time, do it before you go to work or after dinner before you sleep. Find ways to cut your lunch hour short or do it when you take a pee, during your coffee break or between meetings. I've done mine at the library, cafe and mall between meals and appointments. Take a shortcut and your fracture will take longer to heal.  An acquaintance regrets neglecting his exercises due to a busy work schedule which slowed down his recovery. 

Setting goals has also worked for me.

I made it a point to track my progress and asked my therapist to share the numbers. When she started me on clenching exercises, my fingers curled ever slightly. After two weeks of daily practice up to 4 or 5 times a day, I did it. Once I could clench my fist fully, I did it harder and longer. 

When I started wrist flexion exercises, my right wrist could only flex 20 deg. At last measurement it went up to 64 deg (left wrist: 67 deg). When extended,  it was 66 deg (left wrist: 74 deg), supination (palm up) was 75 deg (left wrist: 85 deg). Despite both my surgeon and therapist telling me I've more than regained my hand function, I'm working to narrow the gap even more. That's one more goal for the road.

Get involved in your treatment. Being naturally inquisitive, I've found it useful to be actively involved in mine. Imagine going on a trip to prepare for the unknown and to discover new perspectives. Familiarising myself with my fracture gave me some measure of control. It should be the first step you take to help you cope.

The internet has been my reliable companion. The more informed I am, the more enlightened I get and I'm able to engage my surgeon and therapists. I lost no time absorbing about wrist fractures, the treatment options, pre- and post-operative procedures, surgical processes involved, dressing and wound care, X-rays and their side effects, types of scars and surtures, fracture healing and rehabilitation.  

I found information offering both medical professionals' findings and patients' experiences. I fed my insatiable hunger for material on  bone health, bone disease and bone food. I read numerous accounts by people who experienced and recovered from similar fractures. I scoured YouTube videos of tutorials of surgical procedures by othorpaedic surgeons, wrist exercises and scar massages by occupational therapists. I even read stuff on potential complications that could pop up after 6 months or longer.

You'll also find there are many clinical studies, published findings and useful information on the websites of hand clinics, hospitals and orthopaedic organisations. mayoclinic.orgNational Health Service and in particular offer useful insights and information on wrist fractures and treatment. So do sites such as International Osteoporosis FoundationAmerican Academy of Orthopaedic Surgeons and Singapore's Health Promotion Board.

1 month post-op

Five days post-op, my plaster cast was replaced with a lighter, up-to-the-elbow thermoplastic splint to prevent wrist rotation. I'd expected throbbing pain in my hand but instead felt a dull ache in the palm and general tightening and squeezing sensation along my forearm. My fingers were stiff, swollen, discoloured and tingled as if poked with pins-and-needles

To reduce swelling, I dutifully followed doctor's orders to elevate my hand. I ate, slept, showered, peed, exercised, walked, sat and stood up with my hand always raised, elbow locked 90 degrees.  I couldn't put my hand down even briefly without feeling pressure bubbling up in my wrist like a giant rubber band gripping it tightly.  A slight jerk of the hand produced an uncomfortable feeling, like very strong pressure on a deep bruise. 

After two weeks, the stitches came off. Quick, painless and felt like ant bites as the nurse snipped and pulled on the surtures. I had the splint on at all times to keep my wrist from moving. The fist clenching exercises began. So did my personal battle of Mind Over Matter. I was fighting my own demons aka Fear Factor (the TV game where contestants must face their fears to win, like jumping from a height, eating bugs or lying in a tank of cockroaches).  Fear was my constant opponent, lurking in my mind like an unwanted guest. I was  having to deal with the fear of pain, fear of further injuring my hand and fear  that something could go wrong. 

6 weeks post-op, right wrist flexed 20 deg
(left wrist: 67 deg)
As your fracture heals, it's natural to feel frustrated and bothered. Your hand and fingers will feel sore, numb, stiff, tight and achy. My fingers were as stiff as chopsticks and bending them even half way was hard at first. I persisted because the tendon gliding exercises were stretching scar tissue formed around my hand's tendons. It's like learning to ride a bike again after a long time, just tougher. The back of my aching hand and fingers was sensitive to touch even the slightest brush of anything against it made me recoil involuntarily. 

Three weeks post-op, the scar massages began. Tedious and boring, it was necessary to prevent scar tissue from sticking to the tendons and joint and from restricting my hand and wrist movement. The first time, you'll be anxious as your scar will still be fresh and sensitive to touch. My therapist applied a heat pad and towel on my wrist and did a demo, applying pressure as she massaged. It wasn't easy to do it myself as my scars were still raw and new. The ulna-sided scar was especially hard to reach as I couldn't rotate my wrist, so I had to massage it in front of a mirror.  

Right hand pronation & supination 
 with water bottle,
 6 weeks post-op 
After four weeks of wrist immobilisation, the pronation (palm down) and supination (palm up) exercises started. Pronation was much easier than supination which caused ulna-sided pain. My wrist joint was so rusty it took a while before I could supinate without moving my right shoulder at the same time.  By this time I could weakly clench my fist, sign my name and type with my two index fingers on my iPad. I'd tried typing on the computer keyboard but gave up after a few minutes. My wrist felt strained, I was typing at an awkward angle with the splint on and it took forever to move the mouse or finish a sentence. My thumb and fingers also felt like sandpaper when I tried rubbing them together. 

2 months post-op 

Flexion and extension 
with 500ml filled 
water bottle 
By the end of the second month, I'd put away the sling as I couldn't stand the discomfort any longer. I was always up and about with arm in splint pointing skyward.  The purple- and yellow-coloured bruises and forearm discoloration started to fade away. Each week as my fingers regained some flexibility, I could flex and extend my right hand, work the TV remote, flick a light switch, hold my iPhone 6 and an empty glass, grip a pen more firmly and write short sentences. The hardest part was handling my computer mouse, brushing and flossing my teeth. I still couldn't shower or dress without help nor tie a shoelace, buckle my belt, hook my bra or lift a soup bowl.

With daily flexion, extension, pronation and supination exercises, I could gradually lift a spoon at an awkward angle to feed myself, button my blouse, touch the opposite side of my face, apply hand cream and clip the nails of my other hand. I did these gently and slowly, still feeling ulna-sided tightness. As my grip was still weak, my husband helped to open canned foods and the coffee jar and cut solid food items on my plate like meat, tomatoes and avocados into bite size pieces.

3 months post-op

The week immediately after the K-wire was taken out, I had to tolerate a very tight, uncomfortable grip around the ulna. It was impossible to turn my wrist palm up - until my surgeon "manipulated"  and did it at a follow-up visit. After that, I could turn my wrist more easily, feeling less ulna pain. Week after week I drew motivation from little victories and each time my Everest appears smaller.

I use a stress ball and
alternate it with a gripper
to build grip strength

Using  hand gripper to build 
grip strength 
With grip strength slowly coming back, my healing hand also stopped shaking. By now I could shower and dress without help, although it was still dreadfully slow as I had to be gentle and careful. I could also "cup" and splash water onto my face, rinse my mouth, shampoo my hair, reach the left side of my body and arm, brush my teeth and cut fruits and vegetables, powder my face and tie a shoelace. The ache in my palm disappeared and the back of my hand no longer felt "sensitive" to touch. The tingling pins-and-needles in my fingers went down by about 60% to 70% although I still felt it in my palm near the thumb

4 months post-op

About two weeks after the K-wire was out, I was quick-as-lightning back in the swimming pool. I was eating, cleaning and dressing myself without help and did light household chores like ironing, slicing food and dishwashing. I could also lightly wring a face towel. 

Each morning before and after breakfast, I'd rotate my wrist sometimes holding a full 600ml bottle of water, at other times holding my 2kg dumbbell. And, to increase grip strength I'd switch between the hand gripper and stress ball. 
With gripper in my right hand,
working out my left with a stress ball
for strength comparison  
Right hand holding 2kg dumbbell, 
5 months post-op

Even though I've made big strides, today my wrist and fingers continue to stiffen up when they're not in motion. I'd wriggle and clench my fingers and rotate my wrist when I feel the stiffness coming back - at my desk, in the toilet,  cinema, reading, watching TV, waiting for someone, brisk walking or grocery shopping. 

As my fracture goes through different stages of healing, I'm relishing each step no matter how small my progress. I want to crawl and slide, push and pull, twist and turn or jump up and down  tomorrow, which I know is idealistic. If only Criss Angel or David Copperfield could make the stiffness and the on-and-off aches vanish with their magic! 

Still, the human body and mind can be amazingly adaptable. When the right hand's broken the left takes over. It's been said that when we use our non-dominant hand, both hemispheres of our brain are activated and it makes us think differently. We also become more creative. This has been my experience as I improvised ways to cope. 

As my broken wrist heals, my scars (I have one each on both sides of my wrist) remind me of that fateful day I came face to face with my own Everest. When I look at them I think of the lessons I take away from my broken wrist - of resilience, perseverance, patience, discipline, positive thinking, love and life. 


  1. Thank you so much for this - I fractured my left wrist in May (Distal Radius fracture) and it's almost 8 weeks since my K wire surgery, and 2 weeks since my plaster cast was taken off and they were removed. I've started physiotherapy but am finding each day extremely challenging so reading this really helped!

    1. Hi Anna. Don't let up on the physio and you'll get there in no time. Some discomfort is to be expected when exercising as your wrist and fingers will feel stiff and tingly.
      There are lots of stuff on the internet so whatever you do, make sure your therapist and surgeon are ok with it, as what's good for others may not be for you depending on the nature of your fracture.

      It's been 6 months and 1 week and I've since travelled to Indonesia and Malaysia. Last week I started going out without my splint and I'm less paranoid about crowds and wet surfaces. I can now handle doorknobs and up to 3kg in weight. Other than a lingering stiffness I feel nearly as good as before. You will too!

  2. Thank you for the reply! I will let you know how I get on - week 9 now!