While I was on the train home, the doctor called. We chatted for a bit and he’s going to give me a call the week after next when he is able to schedule my surgery for sometime after October 16th.

I’m going to be having a proximal row carpectomy. “What,” you may say, “is a proximal row carpectomy??” Allow me to explain. Rather, let me paste in what an orthopedic journal online had to say, including information on the post-op treatment, recovery time, etc., and then write up my layperson’s view.

Proximal row carpectomy(PRC)- The surgeon’s purpose in removing the bones in the proximal row is in attempt to eliminate pain but maintain ROM that wouldn’t be present with a wrist fusion. A PRC is indicated for diagnoses such as scaphoid non-union, radioscaphoid arthritis, scapholunate instability, and AVN of the lunate or scaphoid.

The primary therapy goals are to eliminate pain, maximize function and prepare for productive activity at home and work. It is likely there will be eventual decreases in ROM and strength (approx. 30%) compared to the uninjured hand.

Weeks 1- 4: The patient is immobilized in a thermoplastic splint which is removed only during therapy. Edema and pain control are achieved with appropriate techniques such as edema massage, TENS, NMES, fluidotherapy, or cryotherapy. Full active thumb and digital ROM is initiated on the first post-op visit. Digital flexion may be limited because of the decrease in carpal height and the altered length-tension relationship of the flexors post-op. The exercises should be performed 3-5 times a day within the splint.

Week 4: Gentle AROM of the wrist is initiated. ROM should progress slowly and according to pain tolerance. Throughout the rehab process, some minor increase in ROM might need to be sacrificed for a less painful, more stable wrist. The wrist splint is normally continued for protection, but may be removed for bathing and exercise. The patient will likely spend approximately 8 weeks in a protective splint before discontinuation.

Week 6: As AROM begins to plateau and reach functional levels, gentle isometric strengthening exercises are initiated as well as light functional activities at home.

Week 8: Progressive resistive exercises using weights to strenghten the wrist and forearm can be initiated if the expected ROM has been attained and the patient is without pain. Grip strengthening can begin using theraputty with progression to a spring gripper as tolerated.

OK. So, in your wrist there are eight little bones. Those are the carpals. They each have a special name; there’s hamate, capitate, pisiform, triquetral, lunate, scaphoid, trapezoid and trapezium. They’re divided into two rows in your wrist - the distal row and the proximal row. The distal row is the row of bones that’s attached to your finger bones; there are five bones in the distal row. Below the distal row, connected to your ulna and radius, is the proximal row. The proximal row is composed of the scaphoid, lunate and triquetral bones. The disease/condition I am suffering from is Kienbock’s disease, which is otherwise known as avascular necrosis of the lunate. My lunate - the middle bone in the proximal row - is dead, fracture, and turning to mush. This causes great pain, arthritis, loss of strength and loss of range of motion (the ROM referred to above).

Since my lunate bone is essentially mush, there are limited procedures that can be done. It is what my doctor called, “a salvage mission.” We want to decrease my pain and get back my range of motion. Thus, what my surgeon is going to do is a proximal row (the entire row of three bones including the lunate) carpectomy.

Now it’s time for some Fun With Roots!

-ectomy: a combining form meaning “excision” of the part specified by the initial element, used in the formation of compound words

Carpals = carpectomy.
Appendix = appendectomy.
Tonsils = tonsillectomy.
Hystera = hysterectomy. (hystéra means womb or uterus in Greek)

So… he’s going to remove or excise that second row of bones closest to my ulna and radius. Rather than becoming bionic and having metal implanted in my wrist, my body will now have only 203 bones compared to the 206 in normal, healthy adults.

I’m sort of OK with this. Less chance of infection since they’re not putting anything IN, just taking bones out. I’ll need physical therapy , but that’s OK, too.

Ah. My mother is home. I haven’t had the chance to talk to her since she got back yesterday, so I’m going to go do that now. Perhaps I’ll write more later.