I have not had hand surgery, but do hope things go well for you.

I hope to learn from this post also... Thanks for posting.
I have had carpal tunnel surgery years ago.... but my hands are a mess now from the RA... I have the same problem you have... " the rope is not in the groove of the pulley". Some of my fingers are starting to twist and have trigger fingers too. Hope someone here has some answers as to what might be next.

Nightshades, a friend of mine had the same problem. He consulted a surgeon about it who uttered something that ought to be inscribed above the door of every room in an orthopedics office: "You know, there isn't a hand in the world we can't make worse with surgery."

Hands are highly complex and delicate. If you are going to look at surgery, find the best hand surgeon within driving distance. Talk to them for as long as you can beforehand. Ask about success rates, failures, possible complications. Be wary if anyone tells you it's simple, it's a piece of cake, and none of their patients have ever failed to do well. Ask about non-surgical options.

I had a trigger finger "fixed" a few years ago. The surgery caused some sort of inflammatory reaction and I ended up with a case of Dupuytren's on steroids, only it's maybe not actually Dupuytren's. In any case, a mess. A second surgery to remove the nodules and ease the constriction worked, for about three months or so. Trigger finger release surgery is supposedly about as fool-proof as it gets. Guess that makes me the fool. Moral of the story: %$#@ happens.

If you do proceed, you'll probably need therapy after. Hand therapy is usually done by an OT rather than a PT. Again, do some digging to find the best one you can.

I don't know what or how much you do with your hands. I'm a string player, and if what has happened to my right hand had occurred in my left, I'd be dead in the water. Weigh the risks and benefits, look into complication rates, then make the best decision you can with the information you have. Good luck.

Serious consideration to be sure. My post is a real downer but I do want to provide you some feedback and know from your posts you prefer to keep it real so here goes.
I had surgery on the CMC joint, not the same as what you're considering but hand surgery nonetheless. I couldn't use my right hand for anything so the surgery was a must. Altoclef makes a valid point-I was given the positive spin & in reality the recovery was very rough and painful. I was out of work for 2 months-use my hands constantly-and after returning lasted 7 days before a flare started, tried to manage but ended up lasting 2 weeks only at work before going out again on leave. Flare was worse than ones before, went for the tendons in my hands and wrists among other things & am now on permanent disability. I'm not familiar with the procedure you mention but get the gist from your description. My feeling now for myself is that I would have to weigh out any benefits from surgery with a flare, going off biologics, and I would need to be in the worst/unable to function shape to do it.

I had surgery on my right ring finger last September (severe boutonniere deformity). The nurses told me that my doc was the best - that even other surgeons went to him. So, not surprisingly, I had absolutely no complications and virtually no pain afterwards.

I secretly wished that he could have done something about my huge knuckles, but, I wasn't there for that.

My RA doc never, ever, ever said a thing suggesting any type of surgery for my finger or anything else on my deformed hand. I had to pursue finding a surgeon myself about that.

My finger is now full of metal (screws and wires), but I don't notice that. At least my finger is in a more "normal" position, so I don't bang it on everything like I used to. It also looks a lot better, although, if you look closely, you can sure see the (long) scar on top of my finger. It will never be "good as new." I lost all use of the tendon in that finger (I had already lost that with the deformity). I cannot bend (flex) that finger at all any more. He fused my second joint completely.

Hope you have a good surgeon (the best) and hope your outcome is very positive.

I might add that the worst part of the surgery experience was the 10 days prior, going without any type of blood thinning NSAID. At the time, I wasn't even on a biologic, so I thought I was going to die. I missed two days of work because I was in so much pain, I could barely move. But after the surgery, the doc gave me some pain meds that were like milk from heaven. I only used that Rx about twice, but it was fantastic. After that, I could go back on ibuprofen, and then later, I got on Enbrel and have been doing great ever since.

Good point, Trooper. I had reconstructive surgery on my foot that turned out to be a total mess.

But the first thing that happened was I got an RA nodule on my throat when I was off my meds, lost my voice for months, and then my singing voice pretty much forever. Lucky I still have flute, unless the hands continue to go downhill on this what is shaping up to be a year long med failure.

I went to the best foot surgeon around. I was told not to do it, because these foot surgeries do not end well, but my foot was such an incredible mess. I had to wear hand made ugly shoes that cost $2300 because I could not wear regular shoes.

Well, the surgeon ran into trouble with the second toe. Because my joints were so rotten from RA, he could not reattach it in the right place, because the toe kept dying. So 6 years of unending nerve pain, plus I have a painful subluxed bone on the outside of the foot, because the outside joint never reconnected.

Now I don't know what procedure you are having, just that hands are so much more delicate than feet. I would really grill the ortho about nerve pain, which is a HUGE deal. And keep talking to people. And if you are on mthx, you can stay on it, now. Lots of studies showing it does not make the risk of infection higher. Plus, weight how long you have had this disease. I think when you get past a certain point, these surgeries do not go well for RA people.

I hope you find some answers that work for your condition.

nightshades

good luck with your research part.

i think your answer will live in your restrictions and limitations.

by the time I got my left wrist and left thumb done I was dropping everything and stopping in shearing pain as the tendons got tied up. I had a sling put in the wrist and the ortho removed bone particles and bone powder (his words) in my wrist as he picked it all out.

first off: the recovery was pitched as planned to be bucolic (you know 2 months) and it was more like a FULL YEAR

when I hit the 11 month mark I knew I was getting close to pain free in that hand and wrist.

Occupational Therapy was tedious but I was a POOR patient in the strengthening area (I did not do the wrist exercises and the hand exercises, imagine, I did not follow protocol? oh gasp gasp gasp)

today: my strength is fifty percent less in that wrist - BUT I have 100 percent less limitation from PAIN and I feel I could bring my strength back, somewhat, if I worked nightly on my strengthening exercises - well at least I could improve 20 percent. you know what I use? I use those ole YMCA weight lifting hand and wrist straps on that left hand (so I have my fingers) if I have an hour or two where I need to call for strength in that hand.

BUT gone are the lightening strikes in trader joes where the glass bottles drop from my hand or I bolt from the register holding the bag of frozen veggies to my left wrist whimpering like a baby.

it was a MUCH MUCH MUCH longer recovery. the immediate was gross. I had them cut off 3 casts and was in plaster much less time than I should have been. it was 50 times more painful than the neurosurgery on my neck.

the right wrist and hand is doing the same thing - so on that one I use hard splint at night and soft splint in the day. i'm not bolting towards surgery again, my plan is to re-evaluate outcome again on my left wrist and hand at two years.

you know, you can go to JUST Occupational Therapy for a while and the OT will do strips on you and exercises and modalities and voo doo bullshit to see if he can coast you a while until you make your decision.

remember that asking about specific surgery outcomes is like asking about pregnancy (I know you know about that) you are going to get everyone's horror story. well mine is the story about giving birth in the baby pool, more or less. I had to be patient, which I suck at.

pm if you want

depot

Thank you all very much for your input!