manipulation under anesthesia & release of MCP joint
 

Hi everyone.

As I have mentioned in previous posts, I developed CRPS following surgery to repair torn cartilage in my right wrist. My CRPS is limited to my right arm and seems to be fairly mild in comparison to the descriptions I have read of what many of you are experiencing. I am in constant pain which disrupts my sleep. I have burning, crushing and stabbing/spasm pain in varying combinations and intensity. I have abnormal hair growth around my wrist and I sometimes have very slight changes in color (sometimes a bit white, sometimes a bit red). My right arm is always a bit warmer than the my left, particularly the hand and wrist.

My hand and forearm are pretty swollen. I have limited range of motion in my hand and wrist. The knuckle of my little finger has particularly limited ROM.

My surgeon has proposed doing a manipulation under anesthesia and a release of the MCP joint. He said the tissue above the knuckle (MCP) joint in my little finger is stuck and preventing movement of the joint. He proposes to use a small needle to 'release' it. He will also inject steroid into my hand (you know, as long as he is sticking a needle in, he might as well). Finally, he is going to 'manipulate' my hand and wrist to basically force movement to increase my ROM.

Has anyone had anything like this done? If so, did it help?

Well you will need to go to PT 5x a week for ATLEAST a month in order to keep that new ROM. I was a PT tech and 1 of my paitents had it done, it was highly painful and its alot of work with PT. However it gave back her ROM and thats what was needed. Now the only thing I quistion about this is you have RSD and personally I wouldnt want to be manipulated like that because I do think it will cause the RSD to spread. In a sense it is a trauma done to your body, hence why they are doing it under anesthesia.

Hi KimA,

I'm not sure if this is the same thing, but I had complications with my right shoulder after rotator cuff surgery, and the shoulder froze. They put me under and basically "ripped" it open (they say it sounds like velcro ripping). I went to PT immediately afterwards (and I mean immediately - I was still loopy from the anesthesia) and they worked with it. I went to PT for 6 days straight, then went down to 4 days the next week, then 3 for the next quite a few weeks. It worked well for me, and I have good ROM in my shoulder. I'm not sure if this is what you're talking about exactly, but I think it's the same general thing. Best of luck!!

Thanks for the replies. I am, of course, worried that the procedure may cause my rsd/crps to spread. I guess I'm willing to take the chance. Yikes!

SloRian, what you had sounds fairly similar. I know I will be seeing the physiotherapist on the day of the procedure and then I will have more sessions for a while.

I am having a bone scan and a bone density scan on Wednesday. (I've never had those before.) Then I have the MUA and release of MCP joint on Friday.

I have been taking vitamin C and will continue to do so. Fingers crossed!

Good luck!! Please let us know how it goes :)

Home from procedure today
 

I had the procedure today. I have significantly improved ROM, mainly in my little finger. I met with the physiotherapist before I went home. We did some exercises, she gave me exercises and instructions for home and I booked my next session.

My hand is very numb from the local my doctor injected while I was under. It will be interesting to see how it feels in the coming days. I'm thinking a flare-up is likely but I have a freshly filled prescription of tramadol to see me through. And I have next week off work.

Oh, that's great! My manipulation worked really well, but my RSD wasn't active when I had it done. I'm so glad to hear yours went well! and especially that you have next week off of work. Reduced stress is really important for healing.

Keep up the exercises at home while the ROM is good - that will help a lot. I hope the extra rest will head off a flare-up.

Just a quick update. I have been working hard on my physio exercises and I am maintaining the increased ROM so far. It is pretty sore though.

Meanwhile, I am trying to keep a flare-up at bay. I have been taking Vitamin C...and tramadol. Strangely, my flare-ups seem to start in my shoulder and I can feel it starting. I have spent lots of time with a heat pack, though, and that seems to be helping. If I can maintain this ROM long term, it will be worth a flare-up.

:)

Yeah, I understand that whole fine balance thing between movement and flare-up. I'm glad it's going well :)

When my son had muscle release surgery for his Erb's Palsy, it did wonders as long as the PT continued. He had to have another after a couple of years because as the PT slowed down it tightened back up. He's probably looking at having another soon. My advice would be to never stop the PT. Use it or lose it, or words to that effect lol. Best of luck, hope the spasms/flare-ups stop soon. xxx

Back to work tomorrow
 

Well, I am going back to work tomorrow. I had last week off to recover from the procedure. I'm not sure how I'm going to do at work. I have had to take tramadol every day in order to do my physio exercises. Of course, I won't be able to take that at work but I need to keep up with my physio.

Wish me luck getting through the week!

Pulling for you KimA.

Hi Kim,

I am new here and saw your post. I can't sleep because the rsd pain woke me up so I decided to log on. I know that this is after the fact for you, but when I first broke my wrist over 2 years ago and was diagnosed with RSD my orthothpedic dr told me to ask my pm dr about manipulation. He didn't seem to think it was a good idea because of fear of spread. So I didn't do it. He did nerveblocks and meds and pt. I also was given prednisone from my neurologist for a few months which helped too. Though I still have constant pain and limited movement, the appearance looks better and swelling went down a little. Two years later I have spread because of abdominal surgeries for endometriosis and what I think is because of accupuncture. I hope you are doing okay and don't have any spread or flare ups anymore. I have learned to get second and sometimes third opinions on my rsd questions from doctors to make sure I make the best decision possible. I was told to try neurostimulator from my pm doctor but my neurologist and gp said they didn't agree, so I didn't do it. I don't know what the right answer is all the time, because sometimes I get conflicting opinions from my drs which adds to the frustration of this disease. But I am doing the best I can and I hope I can help others out too.
I wish I had known about this website too when I first had this disease to get opinions and support from others going through this too.
I accidentally came across this website, and am so glad I did. I think an angel was guiding me. The people on this website angels too! They are so nice and helpful.
I really hope you are better now and hopefully in remission. I'm here if you ever need to talk and wish you well. Soft hugs from another RSD wrist survivor.

P.S. I don't know if this happened to you, but I noticee after my swelling went down a bit on my wrist, (It took over a year to see it) that it was not lined up straight with my hand. I asked my neurologist about this and she thought it might be from the closed reduction I had on it (in the ER with my orthopedic dr) when I first broke it. I have had another doctor who thought I should have maybe had an open reduction with pins put in because I had multiple fractures in my wrist and one bone was almost sticking out of the skin, but they checked into it and said that they couldn't be sure if that's what a contributing factor to getting RSD. Anyway, I was just curious if this happened to you too. If it did, you may want to check with you doctor about whether or not they can fix than too. Take Care and Hang In There.

P.S.S. My dr didn't want to do a manipulation on my crooked wrist either for fear of spread, but I just wanted to let you know about it in case it applies to you too. Bye for now. Take care.

Sorry, don't know how I missed this thread!

Kim and Renee, I'm an arm, hand & wrist CRPS patient as well.
I'm not sure I completely understand what was done to you Kim back in June.

My P.M. Dr. is proposing a "suprascapular" nerve block in a couple of weeks.
I guess it's like the one I had done for my original surgery for broken wrist "repair". They completely numbed my entire arm AND put me under general anethesia.

In addition to the RSD/CRPS -
My hand and wrist originally had NO range of motion, now after 9 months and over 60 P.T. visits I can make a partial fist, partial grasp, but still cannot straighten fingers or rotate my wrist.


My P.M. Dr. has already done 13 regular nerve blocks (at 2 wk. intervals).
Now she wants to try this total numbing one and of course I go directly to P.T.

Please tell me if this is similar to what they did to you - I'm very scared.

Hey Kim,

I have not done this, but if you decide to proceed, I wish you the best. I really hope that it will bring you some relief. :hug:

Hi again. I initially had 8 nerveblocks with one week intervals and then straight to pt that day or day after. I asked to be be under for them because the thought of a needle in my neck made me want to pass out. They helped a little along with prednisone which I took alot of for two month and six months of pt. Also tried tens unit, but that did not help much. When they stopped helping my pm was pushing a neurostimulator, but my neurologist and gp were afraid of infection and more complications with RSD, so I didn't do it. Then I tried accupuncture and that was a disaster. More spread. Even though I explained that i had rsd, i don't think the dr really knew what it was. She said she did, but i just don't think so. So now I'm just told to exercise and keep taking meds. They said if I don't take meds while I'm in pain with RSD it could aggravate it. I was also told by my pm and rheumatologist and neurologist that after 2 years of RSD, there is not much else they can do for it except meds and prescribe exercise. So I am just going to keep exercising and taking my meds and pray that this doesn't get any worse. I was never told of of this suprascapular procedure and because I'm not a dr I can only tell you my experiences and what my drs said. I can also say that when I was first diagnosed with rsd I was more worried about upsetting my drs by questioning them and getting second and third snd fourth opinions. I now two years later am not the same person. Though I'm in constant pain and feel like I've been throung hell and back, I speak up more to my drs because I'm afraid if I don't I will become a guinea pig. I've had drs tell me not to do certain procedures because they were just money makers for other drs (like the neurostimulator). I don't know if this is true or not and don't want to scare you to not do a procedure because of this. I'm just telling you so that you may want to consider getting more than one drs opinion on this procedure and it's side effects. Maybe get 3 or 4 opinions. I've lost some drs because they didn't like me questioning or disagreeing with them, and I have no regrets. I don't want drs like that anyway. Just be prepared for that too being that there are not many drs who don't know about rsd, so try to always have backups. I haven't had many do this, but there were a couple. They don't come right out and say it, but all of a sudden they are either booked up or on vacation all the time or want you to see nurse practioners. (Nothing personal but I prefer to see a dr.) You have to do what's right for you. And what works for one rsd person, may not work for another. And talk to your loved ones who you know for sure really care about you. I was very scared too. I still get scared from time to time. I don't know what the future holds but I do know that I am stronger because I have a loving family, faith in God and a wonderful bunch of friends from this website now. I hope I helped. Please just remember that I'm not a dr but hope my experiences help guide you to the right dr. And find a dr you trust alot. My neurologist and gp are my guiding stars. They cares so much. You can just tell in your gut who really does and who sees you as a lab rat. Well Good luck with your decision and I'm here if you need a friend. Take care and get some rest. Stressing about it is going to make you feel worse so try to relax. I know it's hard. There are alot of new shows on tonight so maybe that will give your mind a break for a while. Get several opinions and check online for info about it too. Also remember to check healthgrades on drs backgrounds before seeing them. That's online too. Bye for now and please know that you are not alone. The people on this website care so much and understand what you're going through. Think positive and keep the faith.

[ Well Good luck with your decision and I'm here if you need a friend. Take care and get some rest. Stressing about it is going to make you feel worse so try to relax. I know it's hard. There are alot of new shows on tonight so maybe that will give your mind a break for a while. Get several opinions and check online for info about it too. Also remember to check healthgrades on drs backgrounds before seeing them. That's online too. Bye for now and please know that you are not alone. The people on this website care so much and understand what you're going through. Think positive and keep the faith.[/QUOTE]

Renee,
Many thanks for the reply and the good advice, much appreciated! I know everyone here IS great. I feel connected with a community here.
:hug:

Hi Ladies

As I said, I had the joint release and manipulation in June. I was, of course, aware of the risks.

The knuckle in my little finger had very limited ROM and physio wasn't improving it. The surgeon basically used a small needle to nick tissue above the knuckle which had become stuck and was preventing movement. The manipulation was a matter of fairly forcefully moving the joints; that is, more forcefully than more forcefully than could be done while I was awake.

I did experience additional pain for a few weeks following the procedure. Luckily, however, I have had no spread or long-term worsening of the CRPS.

I have greatly improved ROM following the release. I don't have nearly the ROM of a healthy hand but it is very much improved and am now able to make some slow progress in physio. As for the manipulation of the wrist, there was less immediate improvement but I have been able to make progress with it in physio since the procedure.

Renee, as far as I can tell I do not have a crooked wrist. My hand, wrist and forearm are still a bit swollen and the level of swelling varies. Oddly, my forearm just above my wrist is the most noticeable area of swelling.

I did have a stellate ganglion block but it did not help me at all. In fact, I had my worst flare-up following that. I think the nerve blocks only work for some people. Unfortunately, I was not one of them.

Az-Di, I wish you the best of luck with whatever you decide. Ultimately, you have to do what you think is best for you. There is so little known about CRPS and we each seem to have such different experiences with various treatments that it is really difficult to know what to do. I was worried about the procedure but after speaking with multiple doctors and weighing up the pros and cons myself, I decided to go for it. I know I was lucky and it could have gone the other way. If you decide to have the procedures, I hope you will be lucky too.

Kim