So 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:
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.
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).
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 first oxycodone Tuesday night.
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.
But … 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.
I am four weeks post surgery and go to the Drs next week. I am having soreness when I pick things up with my right hand, ex my purse, a gallon of milk. It also hurts to write and open jars. Do you recall this post surgery? Also, my hand is still swollen where the surgery was, about the size of a big gumball. Has anyone experienced this too?
I don’t remember either of those things, no…
If you’re considering surgery, reconsider. I have had four. The first was to remove some soft tissue and the last three were attempts to remove the boss. I said attempts because I still have the boss and the scars that resluted from each of the surgeries. I understand you don’t like the look or feel of it, especially when the tendons snap across the boss, but as was stated to me before each of my surgeries there is a sixty-six percent chance that the boss will remain the same or get bigger. In my case it was one hundred percent. After reading some of the stories my case doesn’t seem that bad as I have almost no pain and I didn’t have to fuse anything together. If you don’t have any pain then as the first doctor stated, whom I ignored, just ignore it. I know it is ugly as hell and that snapping of the tendons is irritating and freaks some people out but you will probably never solve those problems. In fact you might make it look even worse by addings scars and scar tissue to it. I have been fighting mine for years and when I think of all of the time spent going to see doctors and recovering form surgeries and the aggravation and frustration of having to try to use my left hand for something that a very prodominately right handed person would normally use their right hand for, while recovering, it’s just not worth it, especially considering I still have it. If you’re wondering why you have it I wonder that all the time. I will say this after reading some of the other comments it looks as those it happens to the hand that most of us use most often, in my case almost all the time. Also there seems to be some athletic connection as well because if I recall correctly I first noticed the boss while riding my bike and feeling a sharp pain in the location of the boss. Maybe it’s the result of overuse or a fracture that heals into a lump, I just don’t know. I do know that the first Doctor that told me to ignore it kept asking me if I broke my hand and my response was to tell him the story of how I first noticed it. Ultimately, it is your decission of whether or not to have the surgey I just thought I would let you know about my fight with mine, which has not ended yet as I hope the cortisone shot will do something, though I don’t think it will, and then the fight will be over. Good luck with your’s, if you do decide to have surgery or ignore it.
I was just diagnosed with “boss” a few hours ago. I’m 65 and broke my right hand when I was about 16. I’ve had the occasional pain but nothing that precluded day to day activities. Now that I am not working, I have the chance to play golf much more often (my wife says golf isn’t my life but it ranks ahead of almost anything else I do). I’ve played for years (at the peak I played over 100 times a year but was down to 25 – 30 the last few years) and was never a pro but did get to about an 8 handicap. A few weeks ago, I was playing and felt a sharp pain in my right hand just as I started the downswing. It remained that way the rest of the round (needless to say I didn’t play too well). I played again 3 days later (the pain had basically gone away by then) but after about 11 holes the sharp pain hit me again.
I went to a hand surgeon who looked at some x-rays and did a pretty decent exam of the hand and said it was most likely arthritis pressing on a tendon or nerve and injected the hand with cortisone. The pain went away for all of three days (during which I played 2 pain free rounds). Then the next time I played the pain returned about halfway through the round. I went back to the same doc who basically said, you’ve got arthritis and you’re going to have to live with it. I applaud his conservative approach but decided I wanted another opinion and this time, from a doc who is a golfer and can appreciate the impact (pun not intended) this would have on my golf. So I got an appointment with another doc in the same group. I asked for a golfer and the nurse laughed but said she understood my strange request because she is married to a golfer. (So I can really relate to Zafar’s comments above about his love for cricket and the conundrum he faces.)
The second doc did a good exam of the x-rays and then moved my hand every way he could to find a source of the pain. Then he took me to a flouroscan unit to get more views. He said it appeared to be a carpal boss but wanted to have a better idea before he made any recommendations. (I had no pain at all during the exams)Then came the cool part of the visit. He said – I want you to hit golf balls until the pain returns so we can get a better idea of where the pain emanates. He walked me to the back of the clinic past multiple rooms to a room with a golf mat, a net and clubs and balls. He said – take your time and hit balls until you feel the pain. So I did, for about 35 minutes. I had some pain but nothing like when I was on the course. I was frustrated because I hoped that by duplicating the activity that seems to cause the pain, there might be a better chance of getting a better diagnosis. I went back to his office and told him the results – that I had some minor pain and a couple of shooting pains that went away after 1 swing. He then said that he believed it was a boss and that he could operate. He immediately said that he thought that would fix the problem and that it is a relatively simple operation to shave the boss. He also said, to his credit, that while it easy for him to say, it was not going to be easy for me to agree since there is no 100% guarantee that surgery would be the fix. The way we left it is that I will see him again if the pain continues. I should say here that, so far, golf is the one thing that causes the pain. For some people, it would be easy to say – OK no more golf. For people like me with golf and Zafar with his cricket and Marco with his tennis, the decision is not that easy to make.
So here I sit, reading all the stories about this malady and finding what I thought I would, a mixed bag of results. For me, there is not yet a clear path. Hand surgery is not a walk in the park. I knew that before my problem appeared. Now that I have at least some sort of diagnosis, I’m trying to weigh the pros and cons and so far, am not even close to being convinced that surgery is the way to go.
I don’t know that this tale will be terribly useful to those who read it (and I’m not one to post on the internet but I thought it might at least help some understand that making a decision isn’t that simple and that the results are just not assured.) I want to thank Derek for this blog and also thank the people who have shared their experiences here. Knowing your experiences helps me to understand more about this condition and the ramifications of a surgical procedure.
This has been a wonderful blog to hear of others’ stories of carpal boss. I had surgery on my left hand back in May. It was a fairly simple procedure, and I went back to work in 4 days (had surgery on a Thurs. and went back on Monday). My left hand is so much better now. I have better strength in it now without pain. There is still a little tenderness and stiffness at the incision, but it has only been 6 weeks since the surgery. Unfortunately, my right hand is suffering from the same thing. I am going back to the surgeon to see about surgery this summer before I go back to work (I’m a teacher). My right hand isn’t as painful yet, but I know how quickly my left hand deteriorated and was painful each day. If I can get it done soon, I’m going in for my right hand. I am a true believer that this surgery helps. My doctor didn’t seem to think it would grow back. That’s my only concern since my first surgery was so recent. God willing, I will have a successful second surgery and they won’t grow back! Good luck with your decision, Anthony!
Thanks for this blog. It really help me. I have this same problem on my right hand. I’ve noticed this a week ago. So, I do a searching over the web this time and found this blog. It is not painful. But if i flex my hand downward, it will appear. I have already informed my medical friend about this concern but have not received any reply. But I think this blog really served the best answer for me. I have to undergo surgery if possible. I haven’t experienced that my hand broke but I experienced being smashed in the corner while i am walking. may this is the beginning. just a sort. Thanks guys on this.
By the way, I would say my hand is continuing to improve… very slowly. It’s now been what, 10 months since I had the surgery? I only notice it while doing the “full wheel” pose in yoga. Push-ups are fine now.
Hello, thank you for putting your experiences down, very enlightening. Having taken several hammer blows to the hand during the reworking of my garden. I would appear to have grown one of these little lovelies. Fortunately it runs slightly to the right of the tendon between thumb and forefinger so I don’t get any annoying tendon popping and no pain to speak of.
Having gotten over my original thoughts of “what the **** is that!” I’m really growing quite attached to it (no pun intended). Although cosmetically it looks a bit odd (like I’m growing a spare knuckle) it’s an acceptable 3-4th decade injury to me, apparently that’s when these things start being more common in relation to hand trauma. It just don’t heal like it used to eh?
Admittedly I do have a habit of wearing scars as badges of “work done”. I’m glad to hear that your surgery went well however and any problem that could cause more damage in the future should always be addressed. That said I think I’ll keep mine.
Thank you for taking the time to write this, reassuringly illuminating.
Hey Derek. I hope this message finds you soon as I’m scheduled to have my carpal boss removed this Friday. I’m having second thoughts after reading your blog and other people’s posts.
I’m 28 years old, and I gave up playing golf about two years ago because pain began in my left hand after playing a round. The pain stayed for 6 months. My orthopedic clinic doctor looked at me a few weeks ago for maybe two minutes before mentioning surgery. He said it wasn’t going away and a cortisone shot wouldn’t help, though I’ve read that it could.
I guess my question would be how bad your or anyone’s carpal boss was hurting prior to surgery? I’ve never had pain during yoga. After not playing golf, the pain has only come back after weight lifting. Probably benching. Did your doctor say that extraction would also prevent other complications or arthritis?
Hey Jarred,
Re-read my third paragraph, I don’t really have anything to add to it…
It’s been about 30 hours since my surgery. The first 24 hours were not painful at all due to the anesthesia (they put me completely out because they said it was safer that way). Now, it hurts to pick up stuff and move my hand while in this soft cast. My doctor said it could be removed after 3 days and that there were no restrictions after that. I was not given a brace like you, Derek.
I’m staying positive that I will recover quickly. I was wondering, Derek, since results for this surgery are mixed, would you mind if I periodically submitted an entry on this blog stating my recovery? I don’t blog, but it’s good that you have yours set up and get a few people with the surgery responding on it.
-Jarred
How long did it take you to start doing yoga again?
Jarred,
Sure, go ahead.
Ashley: read this comment.
It’s now been about 3 weeks since my surgery. Not even a week after, I could do a push up, but my hands hand to be slightly in front of me because I couldn’t bend my hand to a 90 degree position. I’ve already done road cycling, yoga, push ups, curls, and pull ups. My doc recommended light weight and high reps. There is some slight discomfort with pushups, but it’s not painful. Everyone heals differently, and I feel fortunate to be healing faster than some. Turning keys and holding things at odd angles creates a little pain, but nothing lingers. I will still wait for golf since that’s impact stuff. My tendons had to be pulled aside to get at the boss, and because of this, scar tissue has formed on the tendons. Sharp pain around the knuckles of a few fingers when making a fist, and it’s only now getting better.
I will say, the bump is actually lager now than it was before. My doc said it was blood build up. It feels almost like bone. I went to a physical therapy session to learn some exercises to get full movement back since the tendons are still “tight” feeling. They gave me these moisturizing strips to put over the bump/incision at night to reduce the swelling and recommended vitamin E oil. The every day pain is gone, so that improvement already! The only complaint I have is that they shaved half my forearm. I have an arm hair style like no other.
Derek, did you have the localized swelling bump over the incision / old boss area, and if so, how long did it take to go flat?
Nevermind. I see now that your swelling was gone in a month.
Hi Derek thanks a million for sharing this with us, it is exactly what i needed to know i have the same thing (i think/im certain), just have to book appointment with the doc. I was just wondering if I could ask you how much this surgery costs? I live in Ireland and our currency is probably different but i was just hoping I could get a rough idea of what the surgery might cost. any help welcome, thanks, Craig.
Hey Craig,
As I said earlier in the comments, the hospital and surgeon charged my insurance company nearly $10,000 for the operation. I don’t think that I paid for anything out-of-pocket though, as I had already met my deductible for the year.
cheers for the reply, i guess il have to wait until i strike oil, but this is at least the first step in the right direction, thanks Derek, best of luck.
Derek,
Thanks for your blog post– really informative. Today I saw a hand surgeon for what I assumed was a ganglion cyst but what turns out to be a carpal boss. I do have pain (scale of 1-10, only a 3 or 4 at its worst) however I am a gymnastics coach and live a very active lifestyle with both Crossfit and yoga, like you. The pain is annoying enough to have me out of Crossfit completely and limits my yoga. My work life is effected considering I spot and occasionally demonstrate.
Using a brace during my non-working hours to “rest” the tendons that are effected and that have pain and am debating the surgery. Sounds quite invasive (going under anethesia and those heavy pain meds… yikes) and like a long recovery to be back to an active “normal”.
Hmmm…
I had thé surgery in August of this year along with carpal tunnel, just like. Susan above, I am still not able to open à jar or bend my hand back, my Dr. Says it is soft tissue but thé boss bigger than or was, no continuous pain but still hurts on occasion, I am not sure how long it will continue. Any. suggestions ?
Hi Derek!
I am planning to have my carpal boss removed soon… I just wanted to know how your hand is doing now?
Thanks!
It’s doing well. I would say maybe that maybe it’s a still not as flexible as my other hand when it comes to doing yoga certain yoga poses (plank and full wheel), but other than that it is fine. I really haven’t had any issues with it in months.
Hello. Thanks for all the insight. I am 12 days post-op. I was very surprised how much pain there was after surgery (yowza!) I opted for the surgery because I work in accounting and the repetitive motion between data entry, writing, and my 10-key was causing a chronic ache in that hand. I was in a soft cast for a week and will utilize a split for 4-6 weeks around the clock except for the at-home PT instructed by my doc. I am pleased so far with the progress because when the cast came off my hand was so weak I could hardly lift it. The cast has been off 5 days and the recovery is moving right along. So far so good.
I am 5 weeks post op and still in a lot of pain. My carpal boss is still be much present as well. My surgeons medical asst has not returned my 2 voicemails. Did you Derek, or anyone else aside from the person advising against the surgery still have a bone spur after the removal?
I was first diagnosed with ganglion cyst and just found out I have a Boss instead on Thursday. I have surgery on Tuesday because I feel as if not trying at least one surgical attempt would be a bad idea. My boss bothers me a lot. I have my tendons constant snapping and popping and it hurts to do almost any daily activity. I’m only 19 years old and I’ve never had surgery before (not to mention a phobia of needles) so I’m extremely nervous. I just hope everything goes smoothly…
hello,
thanks for this blog! did you see another doctor before consulting with dr. beldner?
thanks again!
Hi, everyone! It’s really nice to read the stories of so many people who have been dealling with the same wrist “boss” problem. I have had my both writs effected by this issue for years. I think one on my left hand is getting bigger… There is very obvious underlying factor and bumps that stick out accidently and then they hurt. I heard from few doctors years ago the same idea of just accepting the problem and learing to live with it. Sergery does not guarantee neither good result of removing boss(es) nor the fact that I will EVER PLAY VIOLIN AGAIN!!! This last statementpossibly reason why boss started to develop on my hands. I am a professional violinist and do use my hands a lot as you can imagine. I don’t really feel much pain while playing, no discomfort or restriction to my fast and vigorous finger and hand motions as I play or practice for hours. Some days I feel pain or stiffness when I am not playing. I hit those makes it really scarry for me: what if I won’t be able to move and twist my wrist and play violin that I have been playing for 27 years since I was 5 years old and have two degrees in. However, if I don’t do anything and live with it, how long is it before I will have to stop playing due to boss problem becomes worse and causes me to stop playing?! So, guys, what would you suggest here? Do I live with it and be ready to stop violin playing in few years or d sergery and stop play right after it?
:(
Any opinions are welcome!
By the way, are there any alternative methods of preventing the boss from growing?
Thanks
Anna
Wow! My comment was modified automatically. Some things were missing from what I wrote.
I was trying to say that I am a professional violinist and I have boss problem on each hand. I know that it’s better to live with them than to do sergery. I am 32 years old. I have been studying music and playing for 27 years. I want to know how long aproximately my hands are going to allow me to play violin? Anyone has ideas how can I prevent the boss from growing and growing on my left writs?
thanks
Andrea,
I have what you are describing. It’s not carpal boss. It’s hard scar tissue. You, like myself, are one of the unfortunate few who don’t heal well. My surgeon told me that massaging the area and using heat can reduce or break up the tissue, but I haven’t found that to work for me. He also told me not to worry about it. There is more of a bump from the scar tissue than the initial boss, though there isn’t the same pain from it.
Just to expound on my last few posts, I had my right hand’s boss extracted back in late December 2012, a few months after having my left hand done. It was less invasive and smaller than the left’s surgery, but the healing has actually been worse. There is more scar tissue around the bone now that is hard. I’m having pain still from it. I will try some golf to see if it hurts. I feel like that’s the ultimate test for me. Two months after I had my left hand worked on, I was able to hit golf balls without pain or post golf pain. We’ll see how the right does after 3.5 months.
Some people heal better than others. My surgeon told me I heal poorly. I scar easier than others. It’s either genetics or something I’m forming. I’m 28 years old. After seeing how badly my first surgery scarred my hand, my surgeon used dissoluble stitches on my right hand. The scar is much flatter than the right hand’s. People still ask what I did to my hands. I joke about a stigmata.
Post op advice: after you get the soft cast off, start doing your stretches! It will help with the healing process a lot.