By Michael Jablon, MD, FAAOS

The prompt in this month’s “Perspectives” invitation is “Are there any recent changes to the field of hand surgery of which you are not a fan?…”  While I am in the fifth year of an extremely enjoyable retirement, I have not been as concerned with the newest developments as when I was in practice. Reading selected articles in the JHS and participating in a weekly hand conference with residents (when in my Illinois home) has been rewarding and has enabled me to contribute, occasionally recounting my clinical experiences relevant to the topics under discussion.

My response for “ASSH Perspectives” recounts the recent experience of crossing over from care provider to care recipient. Last September, one week after receiving a “double dose” flu shot immunization, I developed severe and intense left upper back and scapular pain. This occurred during a round of golf, and I assumed I had somehow strained my upper back.  The next morning when I awoke with unremitting pain and numbness in my left hand I knew more was amiss.

While visiting a colleague a few days later, physical examination revealed a weak left hand as well as a sensory abnormality through the radial and the ulnar nerve distributions. Shoulder and neck x-rays were negative. However, reflexes and all muscle groups were functioning, though weak. Spurling test was negative.

Experiencing electrophysiological testing first-hand as a patient was eye-opening. Over my 36 years of practice, I had referred thousands of patients for EMG/NCVs with incomplete appreciation of how the test is actually experienced by the patient.

I was also sent for MRIs, with and without, contrast for the brachial plexus and cervical spine. Spending an hour and a half immobilized for imaging while “strapped-in” gave me a better understanding of a patient’s perspective for what we routinely order for evaluation.

Fortunately, the diagnosis of Parsonage-Turner Syndrome was supported by the findings, and I was reassured that full function was likely to return.  I was thrilled that surgical treatment was not called for, and a good prognosis expected. Were I still in practice, performing surgery would not have been possible. 

This experience has brought into focus what it is like to have a hand that is not fully functioning and its impact, as well as the pre-diagnosis anxieties one may experience. While I believed I was an empathetic practitioner, my first-hand experience was enlightening.  

The takeaway message is to be mindful that our tests and treatments are often painful to our patients.

Now six months later, while considerably better, I am still not fully recovered. Localized paresthesia in the ring finger and hand weakness persist. More complete recovery is still possible with more time.  Fortunately, I have the ability to do all I wish to, especially evidenced by improvement in my golf game – now that swinging too hard is a thing of the past.