Wednesday, August 13, 2008

Distal Biceps Tendon Rupture

Latest story update, here.

Back on July 2nd, I'd briefly mentioned in an entry on the main blog about dinner shopping with Robert Blake, that Mr. Sprocket had been recovering for the past two weeks from surgery on his right arm. ~ On a side note here, this story is not nearly as frightening as to what Kim of The Darwin Exception wrote about in her latest blog entry. I do hope Paul takes it easy and makes a full recovery. He was quite lucky and I bet the event just about gave Kim a heart attack.

I've been meaning to bring everyone up to date on what's been happening in the Sprocket household the past few months but I've barely had time to blog and no time to sew. The stack of Market Bags, Totes and Mini Market Purses remain unfinished.

I have to give all the credit to donchais, ritanita, and the other guest bloggers for keeping Trials & Tribulations going. They have all done a fantastic job while I've been dealing with RL.

I started to write this story about two months ago but I kept getting sidetracked with other things that took the majority of my time. That's because Mr. Sprocket's arm injury was misdiagnosed for about a month and a half. When he injured his arm, I had to put blogging on the back burner and concentrate my energies into going to doctor appointments with him as well as helping him do things he could no longer accomplish.

But let me back up a bit and start from the beginning. Back in late April, Mr. Sprocket lost his job and seriously injured his right arm, all on the same day. He remembers hearing a "snap" type sound when he sustained the injury. At first, he didn't realize how seriously he injured his arm. That same day, the company took him to the Kaiser emergency room, where his injury was misdiagnosed as just a severe muscle strain and sprain. He was then assigned a doctor at the hospital near our house. This doctor who treated him, also misdiagnosed his injury.

We filed a workman's compensation claim against the company which they promptly denied. We then had to find an attorney to represent him. The workman's comp attorney found him an orthopedic doctor to see outside the Kaiser system, and it was this doctor who first told us that Mr. Sprocket needed surgery. I was skeptical. Every other doctor told us that he did not need surgery. We didn't know who to believe and I told Mr. Sprocket we had to go through our own insurance (at Kaiser) and get a different opinion with an orthopedic. We finally were able to get into see an orthopedic surgeon at Kaiser, and this doctor was the third one who misdiagnosed his injury. At the time, he told us that if anyone were to operate on his arm, we could sue the doctor for malpractice. This injury did NOT need surgery. So we were stumped. A few days after that, the independent doctor was able to get Mr. Sprocket an appointment for three MRI's on his arm. They confirmed what the independent doctor first told us. Mr. Sprocket had a complete rupture of his distal biceps tendon, a very rare injury. Most injuries to the biceps consist of tears to the superior tendons that attach onto head of the humerus and the coracobrachialis of the scapula. Distal biceps tendon ruptures account for only 3% of injures to the biceps. He would need surgery.

We went back to the independent doctor to talk about Mr. Sprocket's options. He could not do the surgery since the company's insurance carrier was denying the workman's compensation claim, and there isn't a hospital that would let him operate on a contingency basis, until the claim was settled. We would have to go back to our private insurance carrier, Kaiser.

So, we wrote a detailed letter to the orthopedic doctor at Kaiser saw Mr. Sprocket in early June with copies of the MRI reports that his distal biceps tendon was torn specifically asking him that in light of this new information, it appears Mr. Sprocket needs an operation! After Mr. Sprocket dropped that letter off, we were notified that this doctor had taken a leave of absence, and that the earliest appointment he could get with another orthopedic surgeon was at the beginning of August. The only way he could get in to see one sooner, was to go to the walk in clinic and wait.

Frustrated out of our minds to no end, that's what we did. Around 4:00 pm on June 17th, we decided to go to a different Kaiser hospital than the one we had been dealing with. After waiting for about an hour, we finally get into see a doctor and we tell her the long sad story. She then goes to contact the orthopedic on call for the hospital that day, and comes back to tell us that he will see Mr. Sprocket, but he can't come down to the clinic for about an hour. We go to the cafeteria and get dinner. Around 6:00 pm we finally get to see the orthopedic surgeon on call. And this is where Mr. Sprocket's luck turns. The orthopedic on call is a very young looking, Assistant Director of the orthopedic department for the S. Cali. area. He looked like a young John Carter, but we later find out he has been with the department for over 18 years. "Young John Carter" ( JC) examined Mr. Sprocket's arm, listened to his entire story of mis-diagnosis and read the MRI reports. We then asked him, "So, can Mr. Sprocket get the surgery?" And young JC responded, "How about tomorrow afternoon?"

Success! Mr. Sprocket later said that no doctor before had examined his arm quite as thoroughly as young JC did. Our main concern with a distal biceps tendon rupture was the fact that the longer he went without the surgery, the less likely any surgery would result in a positive outcome. All the information we had about this injury stated that Mr. Sprocket needed to have the surgery within weeks. The longer he went without it, the more likely it would be that he would need a graft of a tendon from another part of his body to re-anchor the tendon. A graft would mean that he would be more prone to re-injure his arm. The graft would mean his arm would not be as strong as if he had the surgery and did not need a graft. It would all depend on whether or not JC could retrieve the distal tendon that had snapped back up his arm, and get it to stretch back to the point where it needed to be anchored. He wouldn't know that until he opened up his arm. JC talked about where he would take the graft; from one of his many hamstrings in the back of his leg. I asked JC how many of these operations has he performed in his career. "About twelve," he said. The independent doctor, an older Mideastern man in his early 60's had told us he had performed "hundreds" of these operations. JC just smiled when we told him that and said, "That's doubtful."

The following morning we did as many things around the house that we needed to get done that we knew Mr. Sprocket would not be able to do for six months. One of them was to fix the pump in the patio fountain. The finches and humming birds had been missing it. Here it is, all fixed.

JC had asked us if we could to get a copy of the actual MRI films so that he could see them before the operation. We were able to pick them up on the way to the hospital and dropped them off at office in the orthopedic clinic and then headed to the hospital admissions department. Afterwards, we went straight to surgery pre-op. In pre-op, Mr. Sprocket is his usual self, telling the anesthesiologist which drugs he will let her administer and which drugs he doesn't want. This is from a surgery experience he had when he was 18. I'm sure the anesthesiologist "loved" that. We are in this waiting area for about two hours. Right before the surgery is to scheduled to start, JC tells us some more good news. He had consulted with some other surgeons and they suggested that if he needs a graft, an extra tendon could be taken from his wrist area. This is a graft that was used on a well known sports figure (a baseball player I believe) but I can't remember the name. This is a better option than taking a graft from the hamstring. We wait some more, and then Mr. Sprocket is wheeled into surgery.

Two and a half hours later JC comes to the waiting room to tell me that the surgery went perfectly and he didn't need to do a graft. That was great news. Since it is so late, he really wants Mr. Sprocket to stay in the hospital overnight. I was not allowed to stay in his room with him so I went home after a few hours. I'm sure the nurses thought he was just the "most favorite" patient on the floor. I bet he buzzed them a gazillion times for "get me this" and "get me that." When he asked the nurses if he could get some "tums" (and they only would give him a single tum), that caused a fit of complaints because they would not give him more than the single tum. Then there was the drama about the suppository. Mr. Sprocket wanted a "glycerin" suppository and evidently the hospital didn't have any. They only had a type that ". . . burned his butt. . .it was terrible!" I didn't hear the end of that story for days. You could see the relief on their faces when I came to collect him the next morning. For most of that day, Mr. Sprocket was a happy camper. That's because he was still in morphine heaven. He was invincible and thought the worst was over. His arm felt great! Then the morphine started to wear off.

The first two weeks of Mr. Sprocket's recovery were the most miserable I have ever experienced of taking care of someone. He parked himself on the sofa and wouldn't budge.

The excuse for why he couldn't move or do anything was, "My arm hurts." He also didn't understand why I wouldn't let him use the plastic urinal jug he got at the hospital to go to the bathroom in while he was lying on the sofa. I was a terrible wife because I made him get up and use the bathroom just to go pee. My reasoning was, he didn't have surgery on his legs. Those still worked, and I wasn't going to have a container of pee on my coffee table all day until he had eventually had to go poop. I was lucky to get him up every few days to bathe. (After a month of this, I had to wash all the pillows and covers on the sofa since they started to have an aroma about them.) His most stellar moment was when he threw a tantrum ~ literally got up off the sofa and threw a ton of stuff on the floor, all over the living room ranting and raving the entire time ~ because I would not put a small trash can in his left hand so he could put his boogers he'd just picked and laid on his chest in it. His arm hurt too much for him to move and 'reach for the trash can.' I kid you not. That's what the first month was like.

Two weeks later, the plaster cast he received in the OR was removed and we got to see his incisions for the first time. The top incision is how far up his arm the distal tendon retreated to, and the lower incision is where they anchored it.

Stay tuned for the next episode of Mr. Sprocket and sofa king living.

Distal Biceps Tendon Rupture Update


Anonymous said...

Interesting story. Nice to hear the spouse's point of view. I had my Distal Biceps repaired in July.

I haven't seen two incisions on the same side of the arm like that.

Most everyone (we have a dedicated forum for distal biceps surgery) either had a one incision procedure, or two incision. The two incision procedure have one incision on the anterior side and one on the posterior side.

I linked your blog to our Distal Biceps Tendon Surgery forum here:

I'm sure the forum members will find your story very intersting - thank you for posting it.

We would love to hear from you there!


Anonymous said...

I also find this interesting. Distal rupture is extremely easy to diagnose since the biceps contract up the humerus and it is obvious to anyone. I tore mine in 2005 while on "holiday" on my old farm in Iceland. I was diagnosed by the local doctor and was in surgery 4 days later. Nobody bothered with MRI or even Xray as the symptoms are so easily diagnosed. They performed the Anderson-Boyd operation on me and after about 3 weeks I was back in the US where post-cast;) care was performed. I did some physical therapy (which hurt like heck!) but I regained full power in the arm and I feel no different than before the accident. Best of all I only had to pay $920 for the operation plus a night in the hospital for excellent care and world class surgical team. The "post care" here was almost as expensive and they didn't really do anything;)

I have also never seen an this type of surgery for distal rupture. I did quite a bit of research on this when I had the accident but have never seen this type. It somehow looks more invasive than mine as my lower cut is on the other side and along the ulna so the scar is pretty much invisible. Hope you are doing well:)

Arnor Baldvinsson, Port Angeles.

Anonymous said...

and of course there is no need to actually have the surgery and get it fixed. I had the same injury and opted to not have it repaired. Bicep looks funny of course and about 50% strength in that arm, but other than that no worries

Sprocket said...

Unless of course, you can not earn a living with only 50% strength in your dominant arm.

Snapper said...

Interesting story. I incurred the same injury almost a month ago. Extremely painful! The orthopedic surgeon, who says he's done many surgeries for this- always on men who do moving and storage or athletes - told me he'd never heard of a woman getting this injury. In fact, he said when he was called in to deal with it, he was sure the medical assistant had made a mistake in diagnosis, because it just doesn't happen to women. Of course, the diagnosis was correct. I opted not to have surgery, and I'm glad I made this choice. The phsycial therapist I was sent to says my other muscles are extremely storng and will take up a big part of the slack. I can feel some disconfort and have some limits but nothing to warrant surgery.

Sprocket said...

I believe the reason for the two incisions was because the tendon had snapped so far back up the arm. Maybe it was easier for the surgeon to grab it by making an incision where he had to dig for it.