carpal boss surgery

Carpal bossSo I thought I would resurrect this long-dormant blog to describe my recent experience recovering from surgery to remove a bone spur in my right hand called a metacarpal boss … a bony protrusion often confused with a ganglion cyst. See picture of my hand at left or the X-rays below:

Hand x-rays

Anyway, so I had the surgery a week and a half ago, Oct. 10, 2011, at the Hand Surgery Center in Manhattan with Dr. Steven Beldner. (I thought Dr. Beldner was a good surgeon who took time to answer my questions.) I couldn’t find much information online about people’s post-surgical experiences so I thought I’d blog about it afterward.

To back up a bit. So basically I had this bump on the back of my hand … and had, for years. Dr. Beldner said I was basically born with a bony “pebble” between the joints that caused bone to rub on bone, forming the boss. It was unsightly, but not really something that irritated me on a day-to-day basis … except when I was flexing my hand backwards (dorsiflexion), something I really only did in yoga. But the tendons did have a tendency to “snap” over the bone spur, and Dr. Beldner said that that could eventually cause problems, like a rope rubbing over a bump.

Surgical gown So about a year after I was initially diagnosed I bit the bullet and scheduled surgery. It did not initially seem like a big thing but by that night prior to the surgery I was kinda anxious about it and didn’t get much sleep. I had to report to the surgery center, Phillips Ambulatory Care Center, at 6:30 a.m. on Monday for the surgery. (No eating or drinking past midnight the day of the surgery, although I messed up and had some water in the morning).

Soft cast Getting the injection for local anesthesia in my wrist was fairly painful. The anesthesiologist thanked me for not swearing. And then he put me under. The next thing I remember, I was waking up with my hand and forearm in a soft cast (pictured at left) and a throbbing pain in my right hand. The anesthetic had already worn off! Thankfully they had Percocet.

I arrived at the hospital at 6:30 a.m., had the surgery at 8:30, and had my friend meet me to take me home at around 11:30 … but I actually wasn’t quite ready to leave when she got there. Was still going over things with one of the nurses. And I was maybe a little loopy. But I think we left at around 12:15-ish. We made the right decision to get my pain medicine filled at a local pharmacy rather than waiting in line by the one at the surgical center.

I’m not going to lie: The next 24 hours were kind of rough. Even tho I was on oxycodone, that just sort-of dulled the pain; it didn’t take it away entirely. Even though it was a small incision, I guess anytime you mess with bone it hurts quite a bit. Thankfully Dr. Beldner called me the morning after the surgery and told me that by the afternoon, the pain would have really diminished… and he was right. I actually work evenings and felt well enough that I went into work that night, although I left early and was maybe a little loopy from the oxycodone. I quickly switched over to regular Tylenol, taking my last oxycodone Tuesday night.

Foam thing
Also: I had this big bulky foam thing to rest my hand in! Because I had to keep it elevated at all times to reduce swelling. It was a little more conspicuous than I wanted to be. But I guess it was nice to have something to rest my hand in.

During this time wearing the soft cast I had to wrap my hand in a plastic bag and seal it with tape so I could take a shower.

Removable splintBut … as of Wednesday, Oct. 17, I am out of the soft cast and into a removable splint. It still hurts to make a fist or flex my wrist. Even though the skin has healed, Dr. Beldner says he had to displace ligaments from the bone in order to remove arthritis that had developed in the joint. The ligament is currently sutured down to the bone, but it will take four to six weeks to heal. I have to be careful with it, otherwise I could bust the sutures and need more surgery. Eek! But as long as I keep my wrist immobilized, it is really not THAT uncomfortable. Still, no yoga for awhile, alas.

Hopefully I will look back from this in a few months and be like, it was all worth it!!

Anyway, I guess everyone’s experience with surgery is different… but that has been mine, so far.

UPDATE 2/21/2012: I’m happy to answer any questions people might have about my own experience in the comments… but keep in mind, I’m not a doctor, just a dude that had the surgery. I can’t predict what your experience will be like if you end up having the surgery, or give you any medical advice.

UPDATE 3/18/2014: So it’s been 2 1/2 years since I had the surgery! And I’m certainly glad I did. I would say it took about a month or so for my hand to get back mostly to normal, a few more months until a firm handshake or a rap on the knuckles wouldn’t make me wince, and a year until I didn’t notice any real difference between my hands doing yoga. Read some of my comments to this post from the beginning to get the various updates as I gave them.

104 comments to carpal boss surgery

  • Anthony

    Ron,

    I’ve played for almost 2 years since being diagnosed. No surgery. Pharmaceuticals only. I played about 60 times in 2013 with hardly any pain. I take Ibuprofen the night before I play and then take more about an hour before tee time. I fiddled with Aleve and decided that it worked but I wanted to start slower with meds since I don’t know what the future holds and didn’t want to start building up a tolerance. Since the Midwest winter was so bad, I didn’t hit a ball from Nov until about 2 weeks ago.

    Unfortunately, the Ibuprophen isn’t doing as much good so far (I’ve played 5 times in the last 2 weeks.)I’ve found that I start having some pain after about 6 or 7 holes and then the rest of the round I try to manufacture a swing and grip that doesn’t hurt as much. I also discovered that shaking hands with people does not help so I’m avoiding that – awkwardly at best. I’m contemplating going back to the doc for a new look with Xrays or fluorscan to see if the thing has grown. However, I decided after yesterday’s round to increase the Ibuprophen dosage and see if that helps. The good news (everything is relative) is that I haven’t had the intense shooting pains that I did before seeing the doc 2 years ago. As far as my own case goes, the drug seems to work. I haven’t changed my grip (I tried that when I first noticed the knife in the back of my hand. It didn’t really help at all. The pain was bad no matter what grip I tried.)

    I don’t know if this is of any use to you. I’ve read enough about the boss issue that it seems that everyone has a little bit different issue. When I told a surgeon friend about this originally, he was surprised that I had managed to develop such an obscure malady and even more surprised that I had found a doc who had dealt with it before. The one thing I would suggest to you is make sure your doc knows the subject. You saw in my other post that the guy I saw first didn’t. They do not all know everything and your best advocate is you. Ask questions and don’t hesitate to get another opinion if you aren’t comfortable with the first or even second. Regarding your course of treatment – re read my first post. My cortisone shot only worked for days. The Ibuprophen worked better. I’m not suggesting that you do what I did – I’m only saying that conservative treatment worked for me for almost 2 years.

    I’ll stop there. I hope it helps a little. I’ll check back here in a few days in case you have any questions.

  • Jay-C

    I’ve noticed a carpal boss on my right wrist about 3 years ago. I suspect it was caused from doing handstand push-ups…

    After reading several comments on this blog, I’ve realized that this surgery is very risky. Since my carpal boss isn’t causing me too much pain, I had decided I wouldn’t go for the surgery. However, lately I have been weight training seriously in the gym and noticed that my grip strength on my right hand is a lot weaker that on my left hand. I’m suspecting that my carpal boss is partially blocking the signal sent from my nervous system which would result in a weaker grip strength.

    Anybody else noticed the same thing?

  • Claire

    Hi I just wanted to check with you that you would out way the risks in favor of the surgery? I have the same metacarpal boss you had on my right hand and it’s bothering me everyday. Did you get informed about scarring and infection risks involved?? Do you get stiffness in your hand? And lastly, would you know how much the surgery costs? I have seen a surgeon about this, he did say it is unusual in someone who is 26 which is how old I am (had it since 18 though) but if it is causing me problems would perform the operation. I am worried about function afterwards.

    Thanks very much

  • Hey Claire. I don’t recall ever talking to my doctor about scarring or infection risks. There is a scar where he made the incision, but it’s pretty minimal. It’s certainly less unsightly than the boss was. I would read through everything I wrote at the time for more details about what I went through; it’s more accurate than me trying to remember it all three years later. I mention in the comments somewhere how much the surgery cost my insurance company.

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