Hamstring Avulsion (complete tear from pelvis)

[Jackie E]

RehabAgain,

I am not sure about the incision. I was just told by family that it was up and down my thigh. It may be like Paul's but I had expected it would be like you described. The doctor had even described it that was to me on my initial and only visit when he explained the surgery to me.

[Jackie E]

I also had the further retraction from the time of the MRI to the time of surgery.

[dccoffman]

Hi Jackie,

It sounds like you are having a rough time right now; I'm really sorry to hear that! Unfortunately, I cannot help you with your specific concerns because I have not had surgery yet. From past surgeries, however, I can say that the first few days out are generally miserable. To echo Paul, it does get better ever day that goes by. Also, I remember when I first had my injury, I was having a hard time mentally/emotioally, but looking back it was related to the pain meds. I felt agitated and despondent at the same time. My husband suggested that it may be the pain meds and so I quit taking them and I felt so much better. I know that quitting your pain meds right now is probably not an option, but it's something to consider when you think about your emotional state, perhaps.
If you feel up to it, I was wondering if you'd mind sharing what you'd have changed about your house before hand?
I'm going to be offline all day as I have doctors appointments. I'll be back tonight and will be interested to hear what you say (if you are up to typing a response) and what Paul has to say to you. Take care and hang in there! Wishing you the best, Renee

[PWJJ]

Hi Jackie,
Yes, it is hard to be so unable to get around and dependent on others. And it is hard mentally. But I forced myself to focus on the long term benefits rather than the short term hardship, difficult as that is right now. I agree with Renee, the pain meds are a big contributing factor, they put you in a mental fog and make everything seem worse. That said, you can't leave yourself in pain if they are really really necessary. You should try and taper off probably by waiting longer between doses, then take one if you are currently taking 2, take 1/2 after that etc. There is such a thing as rebound pain if you cut them cold turkey all at once. Ask your Doctor. But I do agree that stopping them is key to getting back on track-and the improvement in the bathroom issues are dramatic and for me that was a great incentive.

I am glad you have a good support system. I had help for the 4 days after the surgery, Thurs, Fri and then the weekend, but after that I have been alone from 9-5 or so every day. The fact that I can get up and crutch to the kitchen is obviously key. Not fun at first but doable and actually easy by now. Obviously right now that's not possible for you, but should be a goal, you will feel much better mentally when you can start to have some control over, and decision making ability, over your movements. But you have to work at it.

From day one I have done isometric exercises on my good leg so as to not let it atrophy. (Asked my Doctor about it ahead of time). Flexing the ankle all the way up and down 25 times (calf muscle), doing circles with my foot both clockwise and counter clockwise 25 times each (flexibilty and ligaments), contracting my quad muscle and pressing against my heel 25 times (quads and hamstrings), even some leg lifts once my hip and groin muscles recovered from the fall. I do this when I wake up -careful to not give yourself a cramp if you are prone to- and at night before sleeping and at least several times more per day. My doctor also said I could do the ankle flexing and rotations on the injured leg while in the brace but NOT the quad or hamstring movements. I also do isometrics for both my arms to keep them somewhat strong. I know that this will be more difficult for you since I have always been very active, but probably even more important if you have low upper body strength to start with. Will pay off big time when you start walking with either crutches or the walker both in strength and balance. I know exercising isn't fun, especially if you are out of shape, but one certainly has the time right now and if you are miserable anyway.....

I don't understand your doctors prohibiting your lying on your side-but I am not your Doctor. I was told that as long as the brace was on and I didn't curl up and bend at the waist and put strain on the hamstring, I could lie on either side. That is a big help as my butt gets sore and numb from being on it so long-and you need to be careful about bed sores. I'd ask my doctor again, but you may have specific reasons he doesn't want you to. But that's just another reason to try and be able to get up as soon as you can, being vertical feels really good.

Do you have yourself supported with pillows when propped up in bed? Without question my neck got worn out real quick trying to hold it up. I ended up getting one of those bedrest pillows that angle up to support your lower back with small arms. (http://www.amazon.com/Bed-Rest-Pillo...2809307&sr=8-1) Not perfect but better than stacking a bunch of regular pillows like I did originally. Of course the limiting factor is how much pressure you can put on the butt cheek where the incision is. I was fortunate and didn't have too much incision pain so could get fairly upright.
And a reaching/grabbing tool is key, (http://www.amazon.com/gp/product/B00144L4LK) at least you can get magazines, adjust the bed covers etc. I have to use one to dress myself even now and no doubt will till the brace comes off. Another thing that is huge if you can afford it or can make up something similar is one one of those rolling hospital tables that extend over the bed. It has been a huge help in coping with being in bed.

My brace is set at 60 degrees, but everyone is different. I have found that the tightest it can be and still be comfortable is best, but I did also have it too tight once or twice and had to loosen it. I can take it off by myself in a pinch but can't reach the bottom strap well enough to put it on all the way. I have never found it to be "lop sided" while lying down, sounds like yours is not adjusted well. One other big thing is I had my wife go to a medical supply store and buy some "sleeving" which is tubular cloth sold by the foot. I slide that up high on my leg to prevent chafing from the brace straps. Until I got that I would wrap an ace bandage around the upper part pf my leg to serve the same purpose. Women may have some leggings or stretch pants that you can cannibalize and cut off a leg to do the same.

The brace is to keep your knee bent to relieve pressure on the hamstring, not specifically to keep the foot off the ground. In fact, even at 60 degrees I can put my foot down on the ground quite easily. I touch my toe to help with balance but have to be careful as I find myself unconciously putting weight on it which it is too soon to do. So I have to be alert to hold it off the ground when crutching around. I expect after seeing the doctor I will be able to start putting some weight on it gradually.

Yes, the goal is to not put pressure on the hamstrings and pull them. The last thing you want to do is pull the anchors out or the re-attached hamstrings off. But I have found that I can still partially sit up in bed with the knee bent in the brace and supported underneath the knee area by 2 pillows. Everyone will be different but I have always been very tightly strung and I would think soneone more naturally flexible would find it even easier? Id id ask my Doctor about this specifically by asking if I made a mistake and reached too far or something would the pain stop me and when it did would I have already done damage? He said the pain would let me know I was going too far and that it would take more than that to do damage, something like a fall etc.

Interesting about your bandage, mine is absolutely NOT to be changed for 2 weeks until I get the stitches out. And what do you mean your stitches aren't removeable? Are they the dissolving kind?

Going tomorrow to get the stitches out, assuming it has healed well enough. And yes, then I can take it off to shower- but need to be really careful while it is off, for obvious reasons.

So again the mental part is very tough, just look to the future benefits and remind yourself it will be worth it and pay off for the rest of your life, and that there is an ending point. It's just day by day, not easy but you can do it.

hang in there,
Paul

[jgillson]

Paul,

The brace pictured in the article was the brace I was given, almost exactly the same. Since 1 day post op it has been sitting over in my closet!!

Mike

Thank God I was able to have a straight-leg immobilization instead. I had a hamstring avulsion as a result of a fall on 5/1/11 and was lucky enough to have it reattached at NYC's Hospital for Special Surgery on 5/6. My surgeon says this is a really time-critical injury, in terms of the quality of the long-term outcome based on how quickly surgical intervention occurs. My surgery was, I'm told, very uncomplicated, due to good muscle tone ("it unrolled like paper towels"), absence of scar tissue and non-involvement of the sciatic nerve - all, I'm told, a result of rapid intervention. My surgeon says that surgical complications that can result from potential nerve involvement, scar tissue build-up and inflexible muscle tone - triggering the need for a bent-knee immobilization - can set in as quickly as two weeks post-injury. I'm now three months and one week out, ambulating normally without crutches, finally beginning to see the edema in my lower leg diminish (thanks to a compression sock), and realizing that it will probably be three more months before I can run. This is the best it can get, it seems, given that I'm 59 years old (although I have worked out consistently since my early 20s).

[RehabAgain]

Paul, Jackie - I think you are correct about the retraction. Mine was only 2-3cm according to the surgeon (it was 1.5cm at the MRI) so that is probably why the incisions differ.

[h2oriding]

Reading these posts has been very helpful. I just saw a surgeon yesturday I am almost 3 weeks post avulsion and need to decide about surgery this week so It can be done ASAP. I had an initial tear injury at this spot 4 years ago (watersking) did the PT took it easy but my leg was always weak and I would have pain if I worked it too hard. So 3 weeks ago playing softball I suffered the complete avlusion. My MRI says it is distracted 10-15mm but it now feels like my muscle is ina big bunch in the back of my leg. The surgeon is willing to do the procedure but also stated he wouldn't do it if it was him. Although he admits to limited physical activity. I myself am 43 and have been active but less since the initial tear 4 years ago. Prior to the first injury I was doing some short triathalons/ half marathon but have never been able to regain the strength i use to have. I guess my question is: Has anyone had a tear prior to the avulsion? I am concerned that there is already scar tissue there. I am not how successful the surgey will be with this history....

[Jackie E]

Hi Renee,

How are you doing? What was your outcome from you appointments yesterday? I am making mental notes as I go through this process and think I may be able to help you like Paul has been helping me. As far as the house I will let you know more later but I am unable to get to things that I need and hard to explain to others where somethings are.
I am searching on-line now for a table or night stand to go beside my bed that would have plenty of shelf room below that I could store things close to my bed.
You take care and I will get back to you soon.
Jackie

[PWJJ]

H20, The important thing is this: Has your surgeon done this surgery before and if so how recently and how many? And if he thinks it will be successful what is his rational for saying he wouldn't do it himself, just the difficulty of the surgery and recovery vs. the future benefits since he is inactive? If you are active then you have different reasons and goals and his personal choice has no relevance.
Have you asked about complications from scar tissue after all these years since the initial injury? Sciatica nerve complications? I would strongly suggest another opinion from another surgeon experoenced in the surgery.

[dccoffman]

Hi Jackie,

How are you doing now? I've been thing of you and hoping things have gotten better for you. I'd love to hear your list of household tips, when you feel like it.

I'm doing ok. The doctor who knew a lot about this type of injury said that I absolutely need this surgery. He thinks I should plan on having a long brace (waist to ankle) after surgery. This is so, so hard to think about. I think that you cannot even sit in one. What does one do all day for 6 weeks lying in bed staring at the ceiling? I guess I could read for as long as my arms would stay up. And I could talk to my husband and kids, but it still seems like the stuff of nightmares. The Dr's name is Dr. Benjamin Schaffer and he was very, very nice. He seemed to think that I'd require a cadaver tendon, due to the age of the injury and the length of my retraction. There is always the chance that my own muscle/tendon would co-operate and stretch the distance and I'd avoid the "borrowed" tendon and wake up in a knee brace. That's what I'll be praying for anyway. My surgery is scheduled for Aug. 31 right now.

Has anyone else on here endured the body brace? Any tips would be much appreciated!
Renee