The Snowshoe Brace

Ah, the snowshoe brace!

The snowshoe brace got its name from one of my coworkers, PR, who shows up in other posts on this blog. Because of the metal loop going around my hand, she described it as looking like my arm was trapped inside of a snowshoe.

This was a custom-made brace my OT (occupational therapist) made for me so that I could regain my palm supination and pronation (palm up, palm down motion).

After six weeks of only moving my elbow like a hinge, with extension and flexion, I started working on trying to get palm supination and pronation back. After surgery, my arm had been "frozen" in the position of thumb pointing up. I could turn my palm down a little bit but could barely move the other direction so that my palm was facing up. It took about 4-5 weeks for me to be able to get my palm down enough to begin to use my hand for typing, although my hand was still at an angle, just barely turned down enough to reach the keypad with my fingertips. I became fluent at one-handed typing since I do quite a bit of writing for my job.

So the snowshoe brace was a uniquely grueling stage of the process. I was told by several hand therapists, "Don't expect to get back all of your range. You'll probably never be able to turn your palm all the way up again."

I'll never forget my first appointment with my OT, a peppy middle-aged woman whom I really came to adore. She asked me to set some goals for myself for regaining movement. Granted, this was after I'd spent a month being on a CPM machine ("continuous passive motion", explained in another post) and now was going to be given more exercises for extension and flexion, before the snowshoe brace came into being.

When asked what I'd like my goals to be, I started throwing out things like, "I'm going to sea kayak again, I'm going to climb again." She gave a boisterous laugh and said, "how about, for now, something like being able to put your earrings in?" I chuckled back, "Okay..." feeling a little embarrassed. It was true- at this point, I had so little range of motion, I could not reach my ears to put earrings in, nor could I wash my hair, feed myself or brush my teeth with my left hand because I simply couldn't bend (flexion) my elbow enough to bring my hand up to my face or head. For a long time, I could only get my elbow at 90 degrees down to about 45 degrees.

But yes, my mindset going in was not simply to one day be able to put earrings in again; I was going to set my sights as far as possible.

In terms of numbers, it had been guessed or estimated by my OT that at most, I might only get back about half my range, meaning that my palm would never turn completely up, but only half way between thumb pointing towards the sky and palm all the way up. As a pianist, drummer, climber and aspiring sea kayaker, this would pose a problem.

As I understand it, these sorts of custom braces are rare. Few OTs know how to make them. Most people in my position, with serious reconstructive surgery, end up struggling on their own to regain range of motion (ROM). Being blessed (or cursed) with a trusty stubborn streak, when a particular OT told me that I would probably only regain half my ROM, *if* I was lucky, I looked him in the eye and literally said, "You don't know me very well, do you?" He smiled and walked away.

While I understand that there's a point where a PT or OT is trying to prepare a patient for the worst and not build up false expectations, I deeply wanted a more positive outlook, something closer to, "we'll do everything we can to get you back as much range as possible!" So I became that cheerleader for myself, once again. It's really the only way it works, though- you've got to believe it yourself, that you can do it, no matter how many people are cheering you on.

Here's how the snowshoe brace worked, since the photo is from only one angle: There was a hard pocket which my elbow sat in. Attached to the hard pocket was the metal looped shape bar. Then I had a separate hard "sleeve' which I slipped over my hand and which went up my forearm. Attached to this sleeve were velcro straps which could then attach to the outside of that curved metal bar. Using the velcro straps, I could slowly twist my thumb outwards, forcing my palm to turn up. I could tighten and loosen the tension with the velcro straps within my pain tolerance. I tried to sleep with this thing on but it was too uncomfortable so I committed myself to wearing it 5-8 hours a day.

To recap from other posts, the reason I needed the snowhoe brace was because I'd had complete ligament reconstruction surgery on all the ligaments that surround the radial head. I also had a prosthetic radial head inserted into my radius bone because I'd crushed my own. Since I had a prosthetic radial head as well as all of the ligaments constructed around that, the palm movement was extremely stiff. My surgeon did not want me working at this range of motion for the first 6 weeks after surgery because working on it would stretch out the ligaments he had recontructed and we needed to make sure everything was healed well before working the arm that way. That meant that after 6 weeks of really hard work at extension and flexion, exhausting in and of itself, now I had an entirely new challenge starting from ground zero.

Within the first month to six weeks, as I recall, I think I was gaining about 10 degrees a week with the snowshoe brace. After that, progressed dropped dramatically and it was very challenging to stay positive, especially when I kept hearing each week, "yep, that's probably about all you're going to get." It took 5-6 months to get back the majority of my range; after the initial spike in progress, I think I was averaging only 5 degrees of gain every 2-3 weeks. I remember the regular, sinking feeling when I would go in for my appointments, be measured and find that even in wearing my brace 5--8 hours a day, I'd gained nothing.

I used the snowshoe brace for about 3 and a half months, total. At the time I stopped using it, I believe I still had about 15-20 degrees to go in each direction, both on the supination and pronation end. Eventually, using my arm in everyday activities helped me gain more and more.

As of January 2008, about 9 months from my fall, I had regained all but 5-7 degrees of range on both palm supination and pronation, depending on the day, how cold it was outside, etc.. This was extremely exciting, since again, all the "experts" warned me I would probably lose about 20-30 degrees on both sides. I just can't capture through words how grueling the process was... the emotional highs and lows, wearing this ridiculous-looking, awkward thing around town, trying night after night to sleep with it on, knowing that the more I could tolerate it and keep it on, the better long-term results I would have. But wearing it was fairly uncomfortable and when I really worked hard at it and really cranked down on those velcro straps, it could be unbearable.

This is one of the places in my journey where my patience was tested over and over. I wanted to excel, to be an overachieving patient, to prove them all wrong, to work my butt off- and I did. And at the same time, I had to be patient with my body and be careful not to cause further injury by pushing it too hard.

As uncomfortable as strange as it was, the snowshoe brace was crucial to my recovery. It did me well in the end. After months of using it, the therapy and exercises didn't end there. Right about the time I was finishing up using the brace (mostly because I just couldn't take it anymore and because I couldn't get enough tension on it to really stretch my arm), I started hearing more of, "that's probably going to be it for your progress." So I found another PT and then another OT and then after that, a final PT whom I really felt like gave me the right combination of hope and practicality....