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About this blog

A Wisconsin Golfer's Blog

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cipher

March-July, 2016 - I did not know exactly what to expect when starting physical therapy.  I have been lucky enough in the past not to need it due to any other injuries or procedures.  One of the first things we tried to do was to check the range of motion.  I simply held my arm on the table and tried to rotate the wrist back and forth, palm up and palm down.  I was very surprised, as I think the PT was as well, that I only had about 10 degrees of wrist rotation available to me at first. 

I continued to do the therapy over the next couple months and the wrist very slowly began to regain the mobility that it had before the surgery.  What the Physical Therapist told me is that everyone is different when it comes to getting mobility back after having something immobilized for a while post-surgery.  Unfortunately I turned out to be one of those patients who struggles to regain the full range of motion quickly again.  It further delayed my attempts at getting back out on the course.

Around July I finally felt like I would be able to try some light swings. I had been doing the PT on my own at that point and my first range session went pretty well.  I was able to make some very light swings with an eight iron and I was pretty excited to start swinging again.  The next time that I went out I decided to try a few longer irons.  Even though I was again trying some very light and easy swings, this time with the longer irons I felt some instability in the wrist and immediately stopped swinging. There was not a lot of pain, but I decided to shut it down and wait until the spring or 2017 to start swinging again. Trying to get to a point of playing in the late season was just not worth the risk re-injuring the wrist again if it was not quite ready. 

At this point in my life, I honestly was not very bothered by the situation.  In the early part of June I attended an intensive four day leadership program down in Houston Texas which was possibly the most difficult thing I have ever done, but it changed the way I look at and approach all of life’s challenges(long story).  I was having a lot of fun playing disc golf, traveling, fishing and hunting with my family at the time.  There was and is just so much to be thankful for and golf is only one of many things I enjoy to keep myself active.  I was not about to allow the setback of not being able play golf to still to affect me negatively.  Heading into the late part of summer, I was about to have an incredible rest of the year.

cipher

February, 2016 - The first afternoon home from the surgery was not too bad.  The meds were kicked in pretty strong and I had very little pain.  The toughest thing that day was just the annoyance of having to hold my arm up in the air to keep the swelling down.  I did not walk around much as the weight of the cast was enough that I decided to lie down and elevate the arm for the most part.  The next day however, things were much different. The wrist area was not really in much pain, but my left shoulder was in some pretty terrible pain.  I think it may have been a combination of the way my arm was positioned for the surgery and having to hold the arm and weight of the cast chest high whenever I moved.   I had to deal with this for about two weeks until I had the cast removed.  It was not the most enjoyable two weeks I have had.

When they removed the large cast, they put me in a much lighter weight splint and that was a huge relief to me.  I was a bit surprised at the size of the incision in the wrist and that the doctor also had two smaller ones.  Looking at it gave me the sense that I was going to be in for a long road to recovery from there.  The wrist felt incredibly stiff, I was really not expecting it to feel quite that tight.  The good news is that unless I was trying to take the splint off for showering the surgery itself had relatively low levels of pain. 

View only at your own discretion.  This is how the surgery looked and was a little shocking to me when they took the big cast off.  Also the second picture shows the lighter splint that they initially put me in as well.

Spoiler

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IMG_8386.JPG

 

Another two weeks later which was one month post-surgery they reduced the size of the splint so that I could bend my elbow.  That was another step forward at that point and we also scheduled some physical therapy.  I was very excited to start rehabbing the wrist and to get the mobility back.    

 

cipher

February 2nd of 2016 came quickly and I was ready to get the surgery over with.  I was a bit nervous about the procedure as this was my first real surgery.  I really did not know what was going to happen when I woke up and how difficult recovery was going to be.

The doctor had explained to me what was going to happen.  He was going to do an endoscopy procedure in the wrist first to look at the damage, as the MRI results did not really show everything that he wanted to know before beginning the actual surgery.  The worst case scenario was that would have to replace the sheath that cover and holds the ECU tendon in place, and at the same time would need to essentially deepen the groove in the Ulna bone that the ECU tendon itself sits in.  This would allow the tendon to become a little more secure against the bone as well.  

They got me ready for the surgery, the anesthesiologist came in and got me set with the IV.  The last thing that I remember is being wheeled into the surgical room and being put on the surgery table.  The next thing I realize is that I am waking up.  

I regained consciousness in the recovery room.  It was a bit strange as I was expecting to feel very groggy and pretty weird but I woke up surprising clear.  Those drugs were a bit disappointing. :-P  The nurse came over and asked me how I was doing and I said I was fine, except for the GIANT cast on my left arm.  I was a bit shocked at the size of it.  I was expecting something that ended before the elbow, but it was well past the elbow and was very thick and heavy(twss).  It turned out that the thickness of the cast was for allowing some swelling and the length was to eliminate any forearm rotation. 

Spoiler

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The doctor explained that he did have to fix the TFCC and the ECU was actually not quite as bad as he feared.  It did have a bit of a tear in the actual ECU tendon itself, which was something the MRI did not pick up.  He cut the torn portion out.  The subsheath that holds the ECU tendon in place was not torn as originally thought, but it was stretched out so he just had to tighten that back down.  He also decided that he did not need to deepen the groove in the Ulna bone as he saw that the biggest problem was just all the damaged and irritated scar tissue in that area.  Other than the 20lb weight attached to my left arm I was happy that everything seemed to go very well.

 

cipher

I had a lot of fun playing disc golf, but the fall of 2015 came quickly and I started to prepare for an attempt at swinging the sticks again.  I went to the range in the middle part of September and tried some very light swinging.  I was not hitting the ball far at all, but it seemed to go pretty well.  I was just taking half swings with some wedges and a 7 iron.  I was happy with the results and so the next week that I went out I decided to try and use a couple long irons.  As soon as I started trying to swing the longer clubs, even with the half swings, I immediately started having problems with the ECU tendon snapping out of place again.  In my mind I knew I was probably not going to get better without the surgery.  It was time to schedule the surgery at this point. 

The only remaining issue with the decision was really a financial one.  My health insurance is a Health Savings Account (HSA).  Usually there is a reduced premium with this but it comes with a sizable out of pocket deductible.  It was $4500 in my case for the family.  We had not really used much of our deductible up for that year.  I decided to wait until January 2016 to have the MRI done for the surgery so we could have it all taken care of at the beginning of the year.  That way any additional medical bills for my family and all my additional physical therapy would be taken care of for that year.  It delayed things a few more months, but I was good with the decision based on the financial practicality of it. 

I never had an MRI done before and have to say that was quite the awkward experience.  I did not really think I would have a problem with it, but there were a couple moments I had to find a “happy place” in my mind, so to speak.  The MRI technician was also getting a bit frustrated trying to get me to lay still for 5-7 minutes at a time.  I had to re-do a couple of the scans. :-)  We managed to get it done though and my follow up with the doctor to tell me the results was a couple weeks later. 

The meeting with the doctor was quick.  He basically told me the MRI results showed I had two problems.  There was a problem with the ECU as we already knew.  There was also a tear in the TFCC in the wrist as well.  I was not really sure what this was, but it was in the same area as the ECU and also possibly why the injured area was not healing naturally.  I was glad to have the MRI results and we scheduled the surgery for February 2nd.  I was very much looking forward to getting this over with. 

 

cipher

The struggle of not being able to play anymore was tough during the summer of 2015.  I felt pretty helpless about the situation and was not really sure what to do.  I began to slowly unplug golf from my life.  I stopped watching and talking about golf as much as possible. Basically I tried to eliminate anything that would cause me to think about not being able to play golf.  I took a necessary break from posting on this site for a while as well.  There are a few people from TST that continually checked in with me during this time, and I am grateful for that.  They know who they are, and probably don’t feel it necessary for me to mention them by name.  But they should and I hope do know how much I appreciated it.  

I started to look for new ways to keep my mind off golf, stay active and be challenged.  I knew that @iacas played some disc golf, so I started asking him some questions about it.  He recommended a few discs, I picked a couple of them up and took them out to a field to throw.  It was pretty awkward at first but seemed like it could be fun.  I headed to the course about a week later to try and play for the first time.  It was a lot of fun playing disc golf that day, so it was something that I started doing many mornings before work.  I even played in a recreational tournament a couple months into playing and I enjoyed doing that.  It was fun watching how other more experienced players played the game.  As I got better throughout that summer it was fun to learn about all the different ways a disc can be thrown and how they act differently in flight based on the disc design.  Disc golf is very much multi-dimensional and there are so many types of shots you can play.  You can literally have a disc curve in two different directions left and right.  You can sidearm or backhand the same disc for different throws, play skip shots, throw the disc upside down, and you can even get some to flip over enough that it will roll a long way.  It is a lot of fun to watch.

Should I be back on a golf course this spring, I don’t see disc golf ever going away as I have come to enjoy it so much.  It is less frustrating to play in general for me, the rounds are quick, watching a disc fly on a good throw is so cool, it is cheap because most courses are free to play and the average cost of the best discs is only around $15 each(unless you become addicted to buying discs like I am).  J

If you don't know much about disc golf here are some great shots that were caught on film in 2016:

 

cipher

I was pretty convinced that my problem was a rare and poorly documented sports injury called ECU subluxation.  The ECU tendon is the tendon that sits in a groove on the outside of the Ulna bone and is covered by a thin sheath that holds it in place.  ECU subluxation or dislocation of the tendon happens when that sheath tears or stretches and the tendon itself becomes dislocated from the bone.

 

Here are a couple resources on the injury. 

http://radsource.us/extensor-carpi-ulnaris-subsheath-injury/

http://bjsm.bmj.com/content/47/17/1105.full

 

When I went back to the doctor I showed him how the tendon would dislocate itself by picking up an object of some weight in a position of ulnar deviation to the wrist.  It was pretty clear to him that the problem was the ECU tendon at that time.  He gave me two options, I could have surgery right away or I could continue to immobilize the wrist and it is possible that it could settle and I would be able to get rid of the irritation and pain associated with the injury.  The problem was not as much about the tendon popping out itself as it was the pain and irritation that goes with it.  I decided to give it one more shot at healing through rest and immobilization.  He also gave me a cortisone shot at this time to try and settle the irritation in the area of the injury.  I was hoping to avoid surgery if at all possible.  

As a potential candidate for a spot in the 2015 TST Newport Cup, it was a very difficult decision for me.  I reluctantly put the clubs away, removed my name from consideration for the tournament and decided that I was going to wait until the early fall to try and swing again.  The sinking feeling began to fully set in at this point.  I did my best to keep my spirits up, but I would be lying if I said I did not struggle some during this time.  I was really looking forward to 2015 and everything that was happening with the golf swing and the Newport Cup.  I did not fully understand at the time, how that one swing had already changed my life. 

cipher

After returning home I made an appointment with an orthopedic doctor who specialized in hand and wrist treatment.  He did an x-ray to rule out the possibility of any broken bones in the hand or near the wrist.  The x-ray showed that there were no bone problems in the wrist.  The doctor thought I likely had some kind of tendon problem near the wrist.  He really did not know or maybe want to say what at that time.  He thought I should first try to immobilize the wrist and put it in a custom splint for about a month.  I was asked to check back with him a couple weeks after taking the splint off.  

He originally thought I would be back playing golf very quickly.  This was one of those situations however, where you just kind of know the outcome may be different based on what your body is telling you.  I had a sense that this was not going to be a simple rest and recover fix.  After taking the splint off, it still did not feel right.  I would continue to have the popping near the wrist with various movements.  It was not particularly enjoyable, and the wrist was in a constant state of irritation.  I decided I was not going to make it any worse by trying to swing a golf club at that time.  I also started to notice that the tendon on the outside of the wrist near the Ulna bone would often visibly appear to pull away from the bone itself and stick out.  I started to figure out which type of wrist movement was bothersome to the injury.  The two main movements that bothered the area were Supination and Ulnar Deviation.  Two movements that are also very much used in the golf swing. 

Wrist-Movement-Pic.gif

After doing some more research I started to get a sense for what might be wrong with the wrist.  The problem was somewhat rare, both as a sports injury and in general.  I made another appointment with the specialist to try and see if he would give me the actual diagnosis and confirm my thoughts on what the injury was.  I started to become very worried about whether or not I would play golf again that year.

cipher

The popping sound I heard was quite loud and the pain was strong enough that my initial reaction was to think I actually broke the ulna bone(the outside arm bone) near the wrist.  I tried to pick my club back up and the nerves in my arm near the wrist were on fire.  I could not even grip the club at all with the left hand.  I had actually hit the ball a bit thin and the shot flared out to the right about 40 yards right and short of the green and I missed the water.  When I made it up to the ball I tried to one arm about a 40 yard chip up onto the green.   I bladed the ball into an embankment in front of the green luckily and it slowed the ball down enough that it hopped up onto the green and left me with a long putt.  I made two right hand only putts for a par somehow and we headed to the clubhouse at the turn. 

At the turn we grabbed some ice and I began to ice the injury.   My round was most definitely over.  I decided to ride along in the cart so my Dad could finish his round.   I had no idea what was actually wrong with my wrist but as the afternoon went on I was fairly convinced that the wrist or the arm bone was likely not broken.   I had a sinking feeling that something else was very wrong and that I was not going to be playing golf for a long time.   

Sleeping through that night did not go very well.  Anytime I moved my arm in my sleep I would irritate the wrist and the pain would wake me up.  The next day I went to an urgent care office to see if there would be an easy diagnosis.  The doctor came in and said that he had no idea what injury I had exactly but that it was likely some kind of tendon problem. He also mentioned that an x-ray would probably not find the issue either.  He gave me a brace to try and immobilize the wrist until I got back home and could have further tests done.  The brace also helped me to be able to sleep at night as well.  I did my best to enjoy the rest of that 2015 spring vacation and I looked forward to heading home to see a specialist who could try to figure out my issue. 

cipher

I have always enjoyed golf, but in 2010 at the age of 30 I discovered a passion for it.  I moved to the Milwaukee area that year from Minneapolis and golf became much more affordable to me at the same time. I started playing a little more and at the end of the year I set out to see how much I could improve my play during my 30s.  I started the journey in 2011 at around a 15 handicap.  It may have been a bit late in life to try something like this, but it was a way to challenge myself and also enjoy the outdoors.  I started playing early morning 9 hole rounds before work 3-4 times a week and I would go to the range a few times per week on my lunch break. 

I faced my share of challenges along the way.  I would say I have a pretty natural ability to make changes and improve my swing, but I often struggled with that intangible ability to just make consistent shots off the tee.  I did make some nice improvements early and entered the single digits pretty quickly.  Not long after however, I endured a major bout with the shanks.  I had them on and off for over a year.  In the fall of 2011 I found the TST community and became a member in the search for a better swing.  Ultimately signing up for some online lessons with evolvr.com proved to be the game changing help I needed at that time. I continued to improve over the next few years.  In 2014 as 3.8 handicap, I somehow started battling the hooks.  There were even a few weeks when I exclusively used a 4 hybrid off the tee, and did not carry a driver or fairway wood in the bag.  I continued to work on the driver and woods at the range during this time.   Ultimately a trip to visit @iacas ended up helping me make the changes that were needed to fix the problem more permanently.  I ended 2014 with a 3.6 index and felt ready for 2015.

Fast forward to April 9th 2015.  I was playing a round of golf with my Dad in Florida.  I had a decent front nine going considering I was coming off a long winter break.  I was on the 9th hole which was a par 5 and I hit a nice drive down the left side.  I was looking at about a 200 yard shot to get the front edge of the green for a good chance at making par or better.  I had to clear some water at about 185 yards in left front portion of the green but it was not really an issue.  I took out a long iron to try and place a shot to the open area just to the right and in front of the green.  I addressed the ball and quickly felt comfortable with the shot.  I had no idea what that swing was going to cost me.  I began my swing and on the downswing near the point of contact, I both felt and heard a loud pop.  The club went flying in the follow through and I immediately hunched over grabbing my left arm near the wrist.  The pain was excruciating.