By Jo Nova
It’s a fantastic piece of engineering
Henry Gray (1918) Anatomy of the Human Body
Last week my EPL tendon went snafu. For no reason, my left thumb just stopped doing what it always has. It didn’t hurt, but it didn’t work. It was rather disconcerting. I wondered if it was the first sign of some hideous degenerative nerve condition that would put me in a wheelchair. But after searching with the dreaded Dr Google, I figured out I’d just torn the EPL tendon. Who knew tendons can wear away painlessly and break? Who knew we can diagnose these things without an xray, just with an eyeball? So, I had surgery in hospital yesterday to fix it.
I looked at anatomy drawings and it dawned on me, we can see all the tendons on the back of our hands if we flex them the right way in the right light. And by golly, my right thumb had two tendons, but my left only had one. It was so obvious. Have a look at your own hand. We have two long tendons running down the back of your index finger and pickie* (though these look like one single tendon on our fingers, the two are obvious on our thumbs). Essentially, one tendon pulls on the top knuckle, and one pulls on the one below. These cords run down our hands through tunnels that keep them neat — like rolling over pulleys. They run right over our wrists and connect to muscles attached to the long bones of our forearm. Every time you wiggle your fingers, muscles are tugging from somewhere deep in your forearm, a long way from your hand.
Somehow as babies we all learn which muscle moves each knuckle to get full finger control. No wonder it takes months to learn fine motor skills…
Look at your tendons
The classic test for the torn long thumb tendon, apparently, is to place your hand on the desk and lift up your thumb. So this is me, trying to lift my left thumb. Nothing. No action. No cord under the skin. I’d never paid attention to the ridges that flowed before. But it’s so cool…
When the EPL Tendon is missing, the thumb can’t rise off the desk. | Click to enlarge.
Hardware, now gone.
Tendon breaks can occur with a long delay after a bone injury. I broke my arm two years ago iceskating. As the tendon stretched over the wrist, either the screws or bone scars abraded the tendon. Apparently they can’t be repaired easily after being shredded. Obviously, I needed to take out the metal hardware in my wrist too, lest it degrade the replacement.
On Monday I casually sent an email with my self-diagnosis to the surgeon who fixed my broken wrist two years ago. I must have been very convincing because 30 minutes later I got a phone call from his secretary saying I was booked in for surgery “Thursday”! That was a shock. Pandemonium hit my diary. So, yesterday I had the plate and screws removed, and a tendon graft and an overnight stay. The surgeon took one tendon from the index finger to restore control of the thumb. Apparently we don’t miss the extra extension on the finger as much as we do on the thumb — the ultimate prehensile tool — as I keep explaining to my cat. My arm is in a half cast. I’m typing slowly. I started this post a week ago.
And naturally after the secretary called, I sought second opinions. I was lucky enough, as a writer in the underworld of science, to get free advice from a GP, an orthopedic surgeon and an anesthetist. How rich am I?
For the next 3-6 weeks I’ll be typing less. Posts will be shorter. Sorry. I’ll do my best…
*Corrected. I thought we had two tendons on each finger, but it is not so — the middle two fingers only have one. For some reason we must need slightly more control with two tendons on the index and pinkie finger.
I hope you’re able to keep things from getting out of hand.
352
Boom! Tish!
140
Cruel!
30
You could have added – I hope you don’t drop the ball, lose a grip on things or have people describe you as all fingers and no thumbs 😉
30
Hope your recovery goes well, Jo.
Have you thought of using dictation on your computer? In your business it’s probably good to use something like that to protect from these types of injuries as time moves on.
260
Suggestions welcome. Please. Good tools to use? I have never tried one…
140
All the best Jo, tendons are much trickier to heal and develop strength over many months (better to heal a bone!). The windows operating system has voice dictation built in. Hell, your smart phone is prolly listening for the “safe word” that brings it to life (Siri/Bixby) so it can also eavesdrop for whoever controls the Operating System – It is trivial to transcribe the voice data and upload that to the “Cloud”. That is why smart phones have a processor >10 x the computing power of a Cray supercomputer of the 70’s.
181
Simon,
Nothing gives me the creeps more than bixby, all of a sudden, comming to life and babbling about whatever I was talking about. There is no doubt phones do an awful lot more than we imagine and certain have the ability to transmit that information to whoever! Worse than that I do not think there is any way to stop phones listening or transmitting.:-(
151
Safe word?
That reminds me of this amusing arrest video. Funny comments by the guy being pursued and apprehended.
https://youtu.be/iVAZL7zzzqI?si=yXtsIFAMYVG0QgFw
20
Yes subscribe to the dictation add on in MSWord it works a treat. Little different process than from ‘head to fingers’. I had to do this last year when I had my right hand rebuilt after nearly slicing it off with a powered paraglider prop, but still had to produce reports. Get the thumb moving as soon as you can Jo.
120
I use the dictation – voice to text – that comes with my old iMac ….it’s part of the standard tools that come with Mac computers these days too.
https://support.apple.com/en-au/guide/mac-help/mh40584/mac
Friends have used Dragon in the past. It’s still going strong and apparently is especially good with PCs.
https://www.voicerecognition.com.au/collections/dragon-professional?gclid=CjwKCAjwysipBhBXEiwApJOcu65qbDhL-kSSMx_eOuxY2ROtZawuSEoBbKAn_-yK95DDZuBUQ-9hWhoCarwQAvD_BwE
I’ll leave Linux voice to text to others.
Good luck with it …btw with mobile app versions as well it can help with “on the go” working situations.
80
One option is to use “speech note” on Linux. If you run an Ubuntu based distribution of Linux it is already in the app repository which is all free software.
https://www.linuxlinks.com/machine-learning-linux-speech-note/
40
Hope you have a speedy recovery Jo.
The MS speech typing works pretty well. I found it helps if you speak with a slight American accent! Don’t get in the habit though we like your WA accent as it is🥴.
130
https://www.happyscribe.com/free-transcription-software
https://www.techradar.com/news/best-speech-to-text-app
Probably Dragon Pro if you want to part with a few bucks.
60
At the end of each comment is seen,
A left hand thumbs-up coloured green,
A positive sign,
That your hand soon be fine,
And your old keyboard skills be routine.
210
Thumbs up to you Ruairi…that’s brilliant!
40
And I’m a sports and exercise doctor, also happy to advise.
No help on computer issues I’m afraid.
Tendon ruptures do occur more often as we age.
The process of tendon degeneration, or tendinosis, is common, and reflects the poor ability of tendons to heal.
Strangely, painful tendons rarely rupture, though painless degenerative tendons do.
[Email coming. Thanks Doc! – Jo]
80
Need to work on your bedside manner doc, so you don’t publicly diagnose a lady as old. 😉
.
So, as a sports medical expert. What do you think someone’s chances are of playing elite level soccer once they’ve done an EPL tendon?
30
Notice I said “as we age”, carefully avoiding the “O” word!
EPL rupture should have no effect on soccer, unless the thumb is a necessary accoutrement!
10
Yes, I noticed.
Just a bit of whimsy by me (for both aspects of my comment) that could have been ignored. 🙂
10
Jo, I have “Dragon Naturally Speaking”, V10 , that I’ve never loaded or registered, still in its original box with headset. Happy to pass it across to you if you want it.
[Email coming Graeme!. Thanks – Jo]
60
Jo, sorry for your distress, hope it heals quickly and you have minimum pain. I can recommend Dragon Speaking , it is a great tool. Your patience will be tested as it trains you to do it’s will. A great solution for your problems.
20
Microsoft calls it “voice typing” and it is embedded in Win 10, 11.
https://support.microsoft.com/en-us/windows/use-voice-typing-to-talk-instead-of-type-on-your-pc-fec94565-c4bd-329d-e59a-af033fa5689f
Free speech-to-text software (Win) https://www.makeuseof.com/tag/best-free-speech-text-software/
Speech Texter: https://www.speechtexter.com/ (requires latest version of Google Chrome browser).
70
There is also somewhat the reverse, TTM, Text to Movie, where your script is associated with characters to create a short video. Used to be free, but now it is $5/month to use.
An example is “Liberal Universities Explained” https://www.youtube.com/watch?v=EffEaMXQAbc
It uses xtranormal, http://www.xtranormal.com/
70
Very good video. “Liberal” in the US sense meaning anti-conservative or Leftist-oriented. Come to think of it, much the same as the modern Australian Liberal Party.
41
https://upload.wikimedia.org/wikipedia/commons/thumb/1/1a/Thumb_up_icon.svg/1024px-Thumb_up_icon.svg.png
70
15 years ago I had a workplace mishap and did my back in , after a few months I lost the use of my right foot due to nerve damage .
4 months ago I lost the use of my left foot for no apparent reason the MRI showed there was no problem and the diagnosis was Chronic Regional Pain Syndrome or CRPS , strange how the body works .
90
Robert — So sorry to hear of your struggles! Have you looked at B12. ALA. ALCAR. may help?
B12 deficiency causes peripheral nerve damage. We need b12 to make myelin, the insulation on nerves. Injectable B12 is $5 ea From Chemist warehouse. No script required though you may want a nurse to do the IM injctn in the thigh. Dont trust simple blood test results too much — it’s hard to diagnose active B12 levels without several tests of downstream markers etc. There are only a couple of rare contraindications to B12 doses, but look them up of course to make sure you don’t have them. B12 is v hard to absorb orally — like 1%. Also cyanocobalamin — synthetic b12 — is bad form for some ppl. Hydroxy/methyl/aden… form of b12, so much better. take a B group forte combo so you get the b3 b6 as well.
Then search for info on ALA — Alpha Lipoic Acid and ALCAR — Acetyl L Carnitine. Some US podiatrists are advising people use these for perif nerve damage. They help mitochondria work properly so repair can be done.
80
Thanks for the info Jo .
20
It’s best you stay indoors and recuperate, Jo – luckily you’re not trying to hitch-hike anywhere with that gammy thumb – there’s isobars and temperatures and meteorite showers everywhere, as well as a long-distance pulse of cold Antarctic air heading north for the Great Southern Land… frost and snow in October? Still waiting on that mythical ‘warming’…
220
Best wishes for a speedy recovery.
200
Last year I completely ruptured the quadriceps tendon in my left knee (the tendon that joins the four thigh muscles to the kneecap). My lower leg could not be controlled. After an operation to stitch the remains of the tendon back to the knee-cap, followed by use of a brace and crutches, and then lots of physiotherapy, I am slowly getting back full use of the leg. It’s a long slow recovery.
140
Wow Phillip. That must be one of the biggest tendons we have … wow
60
On Jan 26 I ruptured my Achilles tendon wow that hurts so much and recovery takes so long. 10 months later recovery is ongoing. I stupidly participated in the annual village gift race over 7 and 3/4 yards after being on the fire truck as a volunteer for 5 hours previous. The noise and pain was incrediblle.
30
Oof, sorry to hear that Phillip! (And Jo!) A couple of months ago I was working my way through a Spartan twisting monkey bar obstacle and managed to tear off the brachialis bicep tendon in my left arm. It didn’t hurt at all, but the arm got a lot weaker all of a sudden! Then my forearm bruised up pretty badly too. (I still had the other two bicep muscles and tendons to work with, so the arm wasn’t totally useless, but not very strong.) I got the tendon surgically reattached last week and am now going through a slow healing process, which will be followed by some equally slow and careful physiotherapy to try to restore more or less full function. They said the repair is a suturing process, probably the same as the stitching you mentioned, so now I am curious how it is possible to “stitch” or “sew” something onto a bone. ???
20
Jo I’m sorry to read about your L/H thumb problems and I can remember someone telling me about a similar problem years ago.
Please take your time and perhaps try one of the voice typing programs mentioned above?
All the best Jo and a full recovery soon.
170
Wishing you a speedy and complete recovery Jo.
Incidentally, some people think humans are the only ones with opposable thumbs.
Bonobos, chimps, drivers, gorillas, orangutans and some other primates have opposable thumbs.
Also koalas (the most stupid mammal), opossums and pandas have them.
But human thumbs are unique.
About the human thumb:
140
As for voice programs as suggested, I’d be using one that works locally, not on the cloud, to slightly minimise Big Brother and Big Tech spying on you.
I don’t have a suggestion for specific software however.
140
Science, politics, and now Anatomy!
190
And all sensibly presented.
00
Hope you have a full recovery. We are wonderfully designed but our bodies don’t appreciate being damaged.
Give your cat a hug for me. Regards G
160
I am sure we all wish you a speedy recovery. Presumably you will need some physiotherapy to ensure a full recovery.
150
Thanks, Jo and may you experience a speedy return to digital good health. Just protect the ‘middle’ finger and keep it ready to raise in defiance of elitism and cynicism.
180
Get well Jo!
130
Hi Jo I did my wrists in by falling down stairs
Right wrist was repaired with a metal plate which they now want to replace
Hopefully ASAP
The other wrist feels constrained and will not move its full extent in any. Direction
I keep trying to extend the mobility but it is slow in responding
Fortunately all digits are ok
Hope you recover soon
Alastair
10
There’s one-handed keyboards but they are difficult to learn to use.
https://www.ergoport.com.au/products/tippy
Also a bit expensive for something that is just a keyboard … which just goes to show how much high volume manufacturing brings down prices for standard items.
How about you start a podcast? Everyone else is doing it, and you have a good starting point to launch from.
120
I am very sorry to hear about your thumb problem. I wish you a rapid recovery. We will miss your great output being handicapped and reduced.
110
Creation.com for more information on how remarkable everything really is.
90
A thumbs up for this post!
Take it easy and recover Jo, and welcome to the world of mere mortals. Not a nice place is it. 😉
As the saying goes, “your body is the most amazing piece of performance engineering you’ll ever own”, to which I added “until it goes wrong”.
Around 650 muscles, 900 ligaments and 4,000 tendons in the human body.
I reckon I’ve tormented every muscle, tendon, and ligament I have in the gym, and ironically only ever torn one ligament – the medial ligament in my right knee. Slipped on gravel, came down at a bad angle. I heard a loud r-i-p sound and thought I’d torn my trousers. 5 seconds later, the pain said otherwise. 2 months to recover.
Never mind Jo, the mods are looking after things, but there was a slight hiccup with the concept of Friday…
110
Very best wishes from sunny Queensland Jo.
70
Take your time Jo. Allow the body to heal. Good luck
On a side note my father had a truck tyre split rim fly off a tyre that was being pumped up I think in the late 1940’s. It smashed the bones and elbow joint. He went to 99 doctors and surgeons in Brisbane and all but 1 said amputate nothing could be done. My Grandmother was having none of it. However 1, a doctor mein said he could take part of the leg muscle out of his leg and fix the elbow. All the other doctors said it wouldnt work. He did it anyway and led a full life driving trucks and loading them by hand. He would load a truck of 40 kg cement bags in record time and unload them. I wonder if it was Dr Meins ground breaking surgery that has led to some of the solutions used today. Unfortunately Dr Mein was bombed only weeks after he did my fathers surgery. He called out a workers comp bludger who subsequently bombed him. Dr Mein was a Charley Teo of today
150
That’s quite a story! Such determination. Amazing it worked out.
70
All the best for a speedy recovery, Jo.
Do you remember that scene in the first ‘Terminator’ movie, where the cyborg had sustained damage to its arm in a car crash? It cut open the fleshy outer coating on the arm to reveal the damaged metal ‘tendons’ inside, and then did its own repairs.
I suppose the human system of tendons and articulated joints is basically a biological solution to a universal engineering problem. Except we need someone else to do the repairs for us!
Take care!
80
Jo,
You Left Out Acupuncture
I am into around my 30th Netflix Korean Series and probably one of the best, up there with “Amazing Attorney Woo” & “What’s Wrong with Secretary Kim”, is the Series I have just finished watching covering Acupuncture
The Series – Live Up to Your Name
Korean No. of episodes 16
Live Up to Your Name (Korean: 명불허전) is a 2017 historical time travel South Korean television series. It brings Heo Im (a medical scientist from the Joseon Dynasty portrayed by Kim Nam-gil) to present day Seoul, where he meets the surgeon, Choi Yeon-kyung (Kim Ah-joong). The series marks Kim Nam-gil’s small screen comeback after four years. It aired on tvN from August 12 to October 1, 2017.]
Its final episode recorded a 6.907% nationwide audience share according to Nielsen paid platform, making the episode one of the highest rated in Korean cable television history.
Synopsis
Heo Im (Kim Nam-gil) is a Joseon doctor of Traditional Korean medicine, specializing in acupuncture. He worked at the clinic for the poor during daytime and earned a fortune by making secret visits to nobles and high-ranking officials’ houses at night. After gaining notoriety for his great skills, he was tasked to help treat the king’s migraines. Unfortunately, his anxiety got the best of him and he was charged with treason. Unwilling to accept jail, he escaped capture but was chased by soldiers. He was eventually cornered into a river and fatally shot by arrows and fell to his supposed death.
Death never came and he awakened in modern Seoul-Korea and realizes he has somehow time traveled. Dazed, lost and confused, he runs into Choi Yeon-kyung (Kim Ah-joong), a cardiothoracic fellow surgeon at Shinhae Hospital and began an unlikely relationship between time and space.
Get Well Soon
60
I watched a Korean food series on Netflix all about Kimchi. For some reason, I was hooked. They’re certainly a weird mob those Koreans.
60
Sending this article to my footballing son. Last match of season he busted the little pinky on his right hand. Initially went to emergency at a suburban hospital and they put it in plaster. But he wasn’t fully happy and went to a specialist and ended up with pins in it. Thousands of $ later. Pins came out last week. Would the original plaster job been successful- probably? But there was a slight chance something may not have “knitted” properly. Certainly as soon as go to a specialist, they love to tell you all the horror stories they’ve seen.
70
I’m pretty sure my bones would not have lined up correctly without the hardware. So misaligned joins could mean a lifetime of aches, and quite possibly the loss of tendons anyhow, worn away on rough edges. So I don’t regret getting the hardware, but I would have preferred — in hindsight — if I had taken it out sooner.
40
Best wishes for a full recovery Jo. Look after yourself and don’t overdo things!
90
Best wishes for a full recovery, Jo.
70
I have heard “I know ___ like I know the back of my hands” all of my life. Several years ago I looked at the back of my hands and realized I likely could not pick them out of a comparable line up. Today,even with that awareness, I might be hard pressed. From observing the wife’s at least weekly nail trimming and polishing ritual, I woukd imagine it is something women would be more adept at doing.
Best wishes for a swift recovery!
60
The space between those two tendons is known as the ‘anatomical snuffbox’. No kidding!
40
Oh Jo wonderful
50
Whilst we chat, I fixed my dilemma about withdrawing superannuation at age 59, I can help if anyone needs advice but only through Jo
[I am happy to forward messages so ppl can get in touch. – Jo]
40
Best wishes for a fast recovery Jo!
Ken S
50
I’ve put a little in your tip jar that might help soothe your recovery.
80
Thanks so much Graeme!
50
Jo, getting old sucks. My right thumb got trigger finger, the shot is wearing off. ( Not to mention it hurt like hell.)
Just got hearing aids, and left hip surgery is coming up soon.
Despite all the ailments, the alternative is worse. Prayers for a speedy recovery, we need you in this battle!❤️❤️❤️
100
Thanks Brad.
Quite likely this was not age but a case of a screw that was slightly too long. X-ray added to the article. See long screw? That could abrade the EPL maybe — tendon is near that bony outcrop on radius.
I feel good about losing the hardware. Mostly I didn’t notice it, but under load something was not the same in forearm. Ached differently to r-arm after gym workout. I suspect weights stress bone with screws and plate embedded.
60
Back in the day when I was looking for reliably painful surgeries on relatively healthy people for pain control experiments, I considered “hardware removal” as a good candidate.
Those were the days when the stress and sleep disturbance produced by pain were regarded as highly detrimental to recovery. Then a bunch of people over prescribed Oxycontin, and pain control has gone back to secondary consideration.
In fact, the typical pattern of for addiction associated with Oxycontin was a young adult who had experimented with street drugs since he/she was 12. Give such a person the opportunity to obtain lots of free drug and you have a disaster. Of course the OD’s that followed were from poorly processed fentanyl (possible 100-fold difference in dose from one hit to another) when street fentanyl became cheaper than diverted Oxy.
20
Oh, Joanne!
As one who plays both the piano and the organ (sort of!) I can relate most particularly to your disaster. Happily, we are living in this day and age where such things can be fixed.
Needless to say: All the very best!
60
I forgot to add that Maurice Ravel wrote his Concerto for the Left Hand especially for German concert pianist Paul Wittgenstein who lost right arm in the First World War. And, a brilliant piece of music it is too. So: Good things can come from bad things!
Once again: All the very best!
80
An excellent andinformative post
80
We do tend to forget our bodies…until something goes wrong. I fractured several bones in my left foot late last year. A slow recovery but by August it was finally completely back to normal.
Unfortunately two have refractured, so back on with the boot…
I hope your surgery goes well.
60
prophet! thats no good. Can I suggest collagen supp or at least bone broth? Also Boron, maybe Strontium. Amino acids in bone are different blend to steak. Need glycine, proline much more.
70
Best wishes for a good recovery Jo.
60
excuses, excuses…
your really on an all ‘oil expenses paid’ vacation to Kellerberrin… we know how it works!
Get well soon Joanne.
PS ‘oil expenses paid’ means you paid for your own fuel.
40
Praying the operation goes well and your hand is completely healed. God bless.
50
Oh boy, and you know all about healing hands wrists and tendons… what I’ve had is nothing
30
Hand surgeons, plastics guys. We have some of the best in the world. I think Australia may have even been one of the first if not the first to country to perform a successful hand transplant.
50
Hope you recover well!
30
I hope you recover well. On January 26 this year I ruptured my Achilles tendon what a noise and what incredible pain. I stupidly participated in our village gift race which is over 7 and 3/4 yards and has been run annually for the past 40 years. I had been on the fire truck as a volunteer for the previous 5 hours and was convinced to have a go in my yellows and work boots. Recovery is ongoing still.
10
Something similar happened to me about 40 years ago. Paranoia said ‘mini-stroke’. I saw the company doctor who said to see my doctor. I didn’t and it recovered. Main thing was not being able to grasp a fork!
00
Gods design is incredible, and the power to miraculously heal is still in operation thanks to His Son Jesus.
20
?
00
I’m hoping you have a speedy recovery. The only advice l will offer is for you to avoid hitchhiking in the upcoming months. And audience participation if watching Wiggles videos
10
Could the fantastic engineering of your hand be the result of random evolution or is it rational design?
10
That’s a very “modern” question Bucky.
00
Hi Jo I did my wrists in by falling down stairs
Right wrist was repaired with a metal plate which they now want to replace
Hopefully ASAP
The other wrist feels constrained and will not move its full extent in any. Direction
I keep trying to extend the mobility but it is slow in responding
Fortunately all digits are ok
Hope you recover soon
Alastair
10
The hand is one of the marvels of the body hilighted in Bill Bryson’s “The Body”.
I guess recovery is like for knee replacement – do no more and no less than your physio recommends.
00
more left leaning literature.
00
We share something in common. Be diligent with not putting any load on it.
00