Transcript
josh MacDonald: Hi, I'm Josh McDonald.
Miranda Materi: And I'm Miranda Matary and we are Hand Therapy Academy. So today's podcast, we're gonna do something slightly different and we're calling it On the Other Side of the Table and that's because we're going to be interviewing Josh and his experience as a patient after having a distal biceps tendon rupture. So first, Josh, why don't you share what happened to you or how your injury occurred and then kind of what it was like being on the other side and being the patient.
josh MacDonald: Yeah. Honestly, it was ah kind of a fluke thing. um i was playing hockey and was headed towards a puck and a guy went to just kind of push me off and the he the heel and the butt end of his stick brushed up against my forearm and just sheared it off.
josh MacDonald: And it hurt at the time, but it felt kind of like a stinger. And it like, like it must have hit the median nerve. And, and my arm kind of went that numbness, like, like I had laid on it, went to sleep. Didn't think any of me of it when sat on the bench, thought, oh, that stinger will go away, went back out of the bench and had lost, like the nerve had lost control of that hand. So, I knew I was done for the night, but didn't have any idea it was a bicep tendon rupture um to the point where, a you know, couple nights late, a couple days later, I was still working out and doing stuff and talk to a buddy who's a PT. And he's like, and we're just discussing is a guy. You should probably get that checked out. Like, it just doesn't seem quite right.
josh MacDonald: I went and got a consult with a surgeon and he said, we need to do surgery before the two week mark. And this was a little while ago, but he said, if you wait until after two weeks, it will have drawn up so significantly that I won't be able to pull it back down to do the surgery we need to do. well That was the the last day available for me to do that was the day before a camping trip that we had been planning.
josh MacDonald: So I had surgery on Friday and Saturday we packed up the truck and went on a two week camping trip. So I was, it was off like, right, right.
Miranda Materi: ah Advice we would not recommend for a patient.
josh MacDonald: And it was this like, well, I guess we all make adult choices. And, and I chose that we were still going to take this trip and it was fine. It was okay, but it it certainly made the therapy side of an adventure.
Miranda Materi: So how are you like driving and like how?
josh MacDonald: I, yeah, so I had an off the shelf hinged elbow on and I, I knew edema was going to be a concern for me because there was going to be times when we would go for hikes and it would be down by my side and there was going to be driving and there was going to be like, we had a little pop-up trailer. So I'd have to work to put that up. And my wife, the whole time was like, I'll take care of it. I'll take care I'm like, I can't let that happen. I can't just sit back and do nothing. While her and her two young kids at the time are setting up the campsite. So I took a boatload of kinesio tape.
josh MacDonald: I took compressive wrap garments and I would do like we'd be walking down this pathway out in the middle of Yosemite and I have my hinge double arm up in the air doing pumping fists and all that kind of stuff.
josh MacDonald: But I also had like, I was relatively new. And so I was talking with Cindy, our mentor, and she was giving me like, here's the stuff you should be doing. So I was, I would take breaks at night and lay on our mattress in the pop-up camper and be doing my active elbow extension and gravity assisted flexion. And I was doing active assisted range of motion. And so it was obviously super helpful to have that, that knowledge and that assistance, um,
josh MacDonald: to do it on my own, but I would definitely not recommend someone go off into the middle of the wilderness on a camping trip after injury. I could have had, ah you know, a dehiscence of the wound. I could have had a surgical infection. I get all kinds of complications. And I was literally out in the middle of nowhere. Like we had no cell phone reception. We had like, we were, we were like boondocking.
Miranda Materi: Yeah, do you ever share that with with patients?
josh MacDonald: Yeah, so every once in a while it'll come up. I usually bring it up. We've got a patient who has a distal bicep tear and I give him like a timeline, but I don't usually go into the whole like, yeah, don't do what i so do what I do, do what I say. I don't usually get into that whole story because it's a little bit more involved.
Miranda Materi: It's so funny. yeah but I think it's remarkable that you were able to do everything. and yes course i was his Yeah, probably.
josh MacDonald: and and i i probably got better And I probably got better in spite of myself.
Miranda Materi: And then like, what was your, what are your outcomes? Like any long, like, do you notice, is it your dominant arm, you know?
josh MacDonald: Yeah, it is my dominant arm and I'm still very active, still playing hockey and working out and being very active. There are a couple of movements that when I do them, I can tell there's still tension in there, right? So in talking to the surgeon on follow-up, I had one follow-up with him, right? And I was doing great afterwards and he said, he's a great doctor. I'm super happy I went with him and he said, you're doing great. You're have great blood flow. He's you had so much blood flow. I had to like clamp off an artery for good. So don't you won't be able to get blood from that arm just it's gonna be hard to find anything.
josh MacDonald: He said you had great outcomes, you know, the therapy to do. I don't think i need to see again unless you have any complications. But he did say that, you know, it's it's a very tight system in there. Now they did a button. So they did, you know, they drill through the radial tuberosity, and they take that distal under the bicep, which is now shorter and pass it through to the backside to the posterior aspect of the radius with that button mechanism that kind of flares open after it's through. And then they drop an extra set screw in that hole to hold the tendon. So a shorter tendon now has to pass further.
josh MacDonald: So the anchor is incredibly sturdy. That anchor is not going anywhere. And he really kind of gave me the confidence to say, you'd have to do something really stupid like deadlifting at week two.
josh MacDonald: to to pull that anchor loose. he said, that's not what would give first. It would be the musculotendinous juncture.
Miranda Materi: All right.
josh MacDonald: He's like, that's where the weakest point in that system is. So he said, you just have to get it like moving well, but not too aggressively. And how much can that musculotendinous juncture withstand?
josh MacDonald: An awful lot, right? Like that's your weak point. And so it really changed my perspective on other patients I see coming in to say, if I know the surgery you did is secure and it's not like an osteoporosis situation or something like that,
josh MacDonald: Like that system is incredibly strong. And while I'm not going to crank for passive extension on an early patient, I also know that I don't have to worry like a flexor tendon about this being a tenuous situation. There's no flexor tendon sheet. There's great circulation. These are big, thick muscles and very broad tendons and strong super strong suture anchors. So I knew i had the...
josh MacDonald: the opportunity to be a little bit more assertive and proactive with my therapy and not just kind of sit back and like so many of our cautious doctors would prefer like, okay, we can work on stiffness later.
josh MacDonald: Like, I don't feel like we need to let that happen because we can be proactive and not have to worry about some obscure thing happening. It's, it's so unlikely with these patients.
Miranda Materi: Yeah. So did you miss any work?
josh MacDonald: So I was gone for two weeks on vacation. That was already planned. And when I came back, he said, just wear the elbow splint for when you're doing any active stuff.
josh MacDonald: And so I was working at at a local hospital at the time and a pediatric neuro patient neuro rehab inpatient. And I had a student. So when I got back, I was still in this splint, so i didn't so I didn't have to be accountable for transfers.
josh MacDonald: But I had a student, so I dumb lucked out that when I got back, my level two student was doing well enough. he was i mean, he was pediatric, but sometimes you have to lift these kiddos into their wheelchair.
Miranda Materi: Oh,
josh MacDonald: He was doing all the transfers. He was doing all the floor play. And I just kind of like signed off on things. I got dumb lucky on the timing of it.
Miranda Materi: wow. It sounds like you had overall had a great experience.
josh MacDonald: Yeah.
josh MacDonald: I did, and it was – you know Sometimes we learn from the other side of the table about the dysfunctions of the medical system, right? Like, oh, this doctor didn't listen to me or I had these problems.
Miranda Materi: Yeah.
josh MacDonald: And in this situation, the medical system worked out really well. I do think a large part of how well I was able to do after was how healthy I was on the front end.
Miranda Materi: Yeah.
josh MacDonald: I was I was still in but a very active person at the time and I did a ton of stuff and a great vascularity and I, you know healthy lifestyle. I think that is something that can set you off on a much better footing when patients do have these kind of injuries. um and And then knowing that having the confidence to not be afraid to kind of push ourselves a little bit.
josh MacDonald: i like I tell our flexor tendon patients sometimes when they say, oh, I kind of took my splint off. It's week five, but I took my splint off and was like eating with that hand. I'm like, hey, you're probably okay.
Miranda Materi: Yeah.
josh MacDonald: Yeah, yeah. You're a little scarred in. It's probably okay.
Miranda Materi: That was probably good for you.
josh MacDonald: Yeah, yeah. So it kind of helped me kind of adjust like, yes, we have precautions and I have to you know stick to things both for liability purposes and to protect patients who are going to go too far. But sometimes it's OK, those patients that kind of toe the line a little bit and and push themselves. It's not necessarily always a bad thing.
Miranda Materi: Yeah, they sometimes get better. Well, thank you for sharing your story. We would love to hear other stories. If you've been on the other side of the table, maybe as a hand therapy patient or just as a patient in general, we'd love to hear those. Reach out to us, info at handtherapyacademy.
