Hand surgery - a personal account

Eileen Garcia, B.C., Canada writes:
Look within yourself – talk to your hands and decide.

Watching the slow deterioration of the muscles, especially of my right hand, was frightening. I worried about losing my career working with people who are visually impaired because they depend so much on touch. I did adapt to some activities. For example, at 35, I could not use nail scissors but, with practise, I learned to slide the scissors low on my index finger and use this finger for control.

After attending the CMT International conference in Vancouver in 1991 and listening to Dr. Patterson, I considered hand surgery. CMT International kindly advertised my desire to hear from others who had hand surgery, and after hearing from three others, I decided to go ahead in spite of discouragement from a neurologist. He was concerned about compression damage to the nerves because of a tourniquet which would be necessary on the upper arm to control bleeding during surgery. Such a tourniquet was used during the operation (for 67 minutes).

The plastic surgeon I saw had done many operations designed to restore opposition between the thumb and forefinger (opponensplasty) but had no experience with CMT. I dreamed of being able to do up buttons on my shirt, turn a key with ease, etc. The literature I received from CMT International told me that the loss of strength occurs within the first five to seven years of upper extremity involvement. After that there seems to be a tendency toward stabilization. I was past the five to seven year period and hoped that my hand strength was stable.

The plastic surgeon explained that a tendon would be transferred from my middle finger, rerouted through my wrist and attached to the thumb. He listened carefully to my concerns about prolonged casting and anesthesia.

This operation was day surgery. The anesthesiologist insisted on a general but used propofol and assured me that this drug was more expensive so not generally used but that it was well tolerated. In fact, I recovered easily from the anesthetic and had no side effects. I suggest that anyone with CMT talk to the surgeon about this drug. I was just as happy not to have to be awake and the surgeon was definitely happier.

My hand was put in a plaster cast up to my elbow. I was advised to keep it elevated. After ten days, this was replaced by a removable plastic cast. I was told to keep the wrist flexed at about 30 degrees since there would be danger to the tendon if it was straightened. It was a huge relief to be rid of the weight of plaster and to be able to take the cast off in the hot weather. I used it for about four weeks.

The cast kept all my fingers flexed, and after a few days, I noticed that the donor finger was healing in a bent position. The surgeon was away on vacation but I took the chance of ripping the stitches open to straighten the finger. Unfortunately, keeping the finger bent in the splint still allowed the finger to heal bent. It had been the only finger I could straighten independently before surgery. The finger would have been worse if I had not tried to straighten it but I was nervous, with no proper advice, so was not persistent enough. No amount of physiotherapy after healing helped me to straighten that finger after surgery and it is still flexed. However, this is better than frozen straight. I have been advised to leave well enough alone, though not by a plastic surgeon.
My dream of doing buttons without a hook was never realized.

Although I can bring index finger and thumb together, they remain too weak to pinch hard enough. However, I can pick up a glass or larger item more easily with the right hand, and I think function is improved.

Would I advise someone else to take the risks of surgery. I think they need to look within themselves, talk to their hands, and decide. By risking the operation, I felt that I had done all that I could do to help myself. My self-esteem improved and I have greater self acceptance. This allows me to take risks with my hands. I have lost the shame that used to haunt me when others watched my hands working, and I ask for help if I need it. This change in attitude has improved my life immeasurably. I am grateful to the surgeon and his compassionate treatment and would only suggest that anyone considering surgery check on the doctor's vacation times!