Thursday, November 20, 2008

Surgery Day for Ulnar Nerve Transposistion - Warning: Graphic Pictures

I've added my surgery pictures below. If innards make you queasy, then don't scroll down.






First let me say the one good thing is I will no longer have a funny bone. It will be moved under the muscle so I can no longer nail it a few times a year : )


Surgery Time 9 am
We arrive at 8:15 to the surgery center in Newport Beach.
They take me in within minutes to go over my information and change into a sexy open back gown. grrrrr. That with the hair cap (ie non waterproof shower cap) and I'm unstoppable.

I walk back to my bed where they anesthesiologist comes over to talk with me. I tell the nurse Im not fond of needles, beware, so the anesthesiologist talks to me while they give me the iv in the middle of the arm. Its easier there in my opinion although if the arm is bent it can cause an issue they tell me. My last surgery they put iv in the middle of my arm (ie where you get blood taken) and it feels better not stuck in your hand.

My Wife comes back then just for a minute as the doctor comes over to talk. I asked if I was getting a nerve block and they said no.. just 'mac' ie a local and sedation rather than full general. No complaints here.. it is intesting though that in Louisvile for an easier surgery the gave me the block and general anesthesia.

Next thing I know.. Im waking up. It was that fast.. I didnt even know they were bringing me back.. I just woke and was in recovery. I looked at my hand and my first thought was check that I can still move and feel my fingers ie... still play guitar : )
I could.. but they were very tingly.. ie pins and needles.

Pain was about a 4 but quickly rose to about a 7... no problem.. they gave me two perkaset and something in my IV... I felt better very fast. They kept me 30-45 min longer because of this though.
Finally they got me in a wheelchair and brought me out to my car that my Wife pulled around.
I went home and went to bed for a while. My arm was raised on two pillows next to me.

What did I feel? Well, more tingliing (ie pins and needles) than I ever did in that hand. The doctor had told my Wife after surgery that some people will feel that. Had he not said that I prob wouldve been more concerned since I read reports of symptoms immediately better after surgery, although they were probably in a worse place than I was with the nerve. My thumb kept twitching and the muscle in the webbing of thumb and index finger kept twitching/pulsing. Pain wasnt bad and I tried to keep flex my arm and fingers every 30 min or so although motion is very limited in flexing arm by the thick bandage.

When I was getting ready to go to sleep I barrreeellly hit my middle and ring fingers on my leg and it hurt....bad, really the first 'pain' since I got home. I took one vicodin (hydrocodone) and went right to sleep..hoping the dog wouldn't decide to plop down on my arm. He kept wanting to sniff the elbow...quite amazing what a dog can smell that we cant. Needless to say I didn't let him...wanting to of course keep everything clean.

I went to sleep and woke up three to four hours later and all the tingling was gone and no pain. weird.

I requested pictures of my procedure...they are pretty graphic.

Here you can see the white string - ie my nerve. The muscle is cut open in preparation to move the nerve. If you look to the right it seems another smaller nerve is crossing my muscle. These are smaller nerves they try to preserve and not cut if possible while performing the operation. Sometimes they have to be cut if they have formed in a way that prevents the ulnar nerve from being moved. Notice how my nerve looks thicker at the bend of the elbow. You will see once it is moved how much larger it was there - possibly from being aggravated - so it thickened.

You can click on these pictures to see them in more detail.
















here the nerve has been moved under the muscle. Note where the nerve used to be you can see the path. You can see where the nerve was near the elbow the pathway looks much thicker. This seems to be the source of the problem.













In these pics besides looking like chicken, it seems the muscle or at least some of it has been closed. Now you are probably asking yourself "why is there a hole in the muscle".
The muscle is cut in a "Z" pattern. That hole is the middle line in a "Z" shape. The left portion is then attached not back in the same place, but bent a little bit upwards and reattached. This makes the muscle a little bit longer and thus has less tension on the muscle during the healing process. The doctor said this makes the muscle roughly a half inch longer. Since this muscle controls wrist movement, you would think it may affect it a little, but it does not actually seem to be affected by the procedure at all according to the doctor. I also asked if cutting the muscle made it any slower and was told I believe about 5%, which would seem to not even be noticeable.




















And finally back home!
Its weird.. the day doesn't feel any different .. its gone by quite fast and here I am now... coming up on three years later...finally done with this surgery (at least on the left.. since my 'in situ' procedure didn't work on the right, I'll need to do this procedure if it works on my left arm)



41 comments:

Adam said...

Sweeet pictures dood! Hope it's a speedy recovery

Kristina said...

I like the 'fork' holding your skin back in the pictures!

kerleyQ said...

i really enjoyed those pics.. i left a comment on cubital-tunnel, but wasn't sure if you would check it any more..

i wish my surgeon had taken pics of mine!

rock on!

Anonymous said...

thanks for posting this
i had mine done on weds i was wide awake and no gas or sedation..nothing,i seriously would not advise anyone else be as stupid as me though !! it was the most horrific thing ever,i felt all of it and im normally really tough for a girl
next time i will listen and be knocked out !!
its amazing how surgeons differ with their advice,here in U.K we keep the bandage on only one day and all we are told not to do is lift anything heavy for a few weeks
the only painkillers given to me are paracetamol pills,the worst bit for me is having to sleep on my back since i used to sleep on my tummy with that arm bent under me (probably half the cause of my problems !!) good luck to you

Adam Tuliper said...

wow.. no sedation. I was given that option.. but nooooooooooooo way.

silly girl : )

actually its amazing the differences in doctors even in usa from doctor to doctor. My surgeon was at a conference and every doctor at the dinner table had a different way (8+ doctors) of how they did this surgery. Also I've heard other doctors using immobile casts.. which seems silly. I do recommend keeping it raised.... I believe the medical evidence is out there for keeping swelling reduced and 'junk' from staying in the arm (as you can see in my healing pictures). This is obvious in people after knee surgery and the junk that forms in the lower leg as well.
best of luck!

Anonymous said...

I had transposition of my left ulnar done last week! I'm not understanding the no sedation?? I had no choice in the matter and was put right out! I'm heavily bandaged now with a enormous blue foam sling on :-) Pain is not too bad so far.... have been given very strong pain killers when needed. I found the pictures on here really interesting - thanks for sharing!
x

jan said...

hi ya, i had my op yesturday, at the moment not really feelin much, bit think its still numb. but im findin it hard to keep my arm raised and straight. but pics were interesting thankyou
jan x

Anonymous said...

Mine was done almost 16 years ago. Both transplantation and repair of MCL (using vestigal tendon from forearm). Total recovery time one year. Extent of recovery, excellent. How long it lasted ... well, I'm reading this site, right? But 15 years pain-free was worth it. Not nearly as bad yet as it had been before, but I know it's slipped away from transplant location and is getting pinched again. Likely that it finally moved back because I used it more and in more ways that I should have been over the years. So my recommendation to anyone having this done is (1) don't overdo it after the surgery, be patient and follow orders, then (2) work really diligently at your therapy and you'll see great results - and finally,(3) though it's hard to remember after time passes, you really should avoid movements/positions/activities they recommend you don't do or else you could end up back where you started. Well worth doing the surgery - assuming you have an experienced surgeon.

Anonymous said...

I have this surgery done the 21st of this month. I'm really scared. I've had several surgical procedures done, but for some reason this one is rattling me a little. How long was it before you had full 100% normal use of your arm again? Fill me in on anything I need 2 know!

Adam Tuliper said...

In three months I was cleared for full activity. I had full use of the hand within two months where it felt great.. but needed to let muscles heal more. I was typing with the hand inside of two weeks or so.

Anonymous said...

Thanks Adam.

Could you post a picture of your scar now that it is 3 years?

Linda Claire said...

Thanks...just got word on Tuesday of this week that my dominant arm will need an Ulna Nerve Transposition- already had this on my other arm 2 years ago. I asked the doctor what the chances were of having this in both arms and he said -"pretty good!" Good grief. I am a secretary so this is horrible for me!

stephen said...

Hi Adam,

Great detail in your pics,i have been suffering with the same condition for 10yrs in my right arm and 3 1/2 yrs on my left, i was wondering if you could tell me the sympons you had in your arms other than the pins and needles, did you have the shooting pains down your arms as if you just hit your funny bone? im also 99% sure i have carpul tunnel at my wrists as well,also i have constant pain in my back where the ulnar nerve meets my spine, i think. this didnt develop until about a yr ago, have you any advice for me in relation to pain relief, i could do with as much advice as possible.Thank you

kevin said...

Thanks for the story. I had this done on my left elbow 4 weeks ago. But he didn't put it under muscle. He said recovery time is longer so they've begun to cut a patch of the fascia around the muscle, creating a flap, then stiching up the nerve under the flap. My pain was pretty low...0 or 1. But on week 3 I noticed my elbow skin is numb...where it's still swollen. Is this normal?

Thanks! Great report and pics.

Kevin

Debbie said...

Thank you so much for your story and the photos! I am having mine done on November 30th and I'm nervous as heck...lol Im worried about being able to do resistance training afterward and of course the pain. Thanks Again and good Luck. How did your dog do?

Anonymous said...

THANKS SO MUCH FOR SHARING ADAM.
Excellent explanation and detail.

Anonymous said...

I am having my surgery on Thursday! I am very nervous, as my last standard procedure surgery "Appendix" went horribly wrong and I was left in hospital for 20 days with severe poisonous material in my body. Now this surgery which I know I need to have is freaking me out...I have damage to the nerve so I am not expecting a full recovery but would like it to go flawlessly.

Adam Tuliper said...

thanks! best of luck to you! Wow, seems theres some old posts I didn't reply to. Unfortunately I can't seem to reply on here even though its my blog : )

alamuddin said...
This comment has been removed by the author.
alamuddin said...

I had the surgery last Thursday. and I hate to post this, because I don't like contributing to negative posts about this surgery, but it had many complications and facts are facts.

1st. The Anesthesia didn't work, they gave me block anesthesia at first with 3 injections of Dormicum (Midazolam) and all I kept telling the two Dr's Anesthesia and Orthopedic surgeon was that I could still feel everything. I wouldn't sleep either. Probably because I take Ambien everyday for the past 3 years. But it didn't work. So I was given a second dose of block anesthetic. IT DIDN'T work.

So finally the DR. gave the instructions to do General. I didn't feel anything after that.

2nd. I woke up fine, but the Dr. came to visit me and told me the operation was complicated due to the nerve damage and the "entanglement" of the nerves and muscles in the area, so he needed to make a second incision. To place the ulnar nerve there.

So now I have 2 15 centimeters (6 inches) incisions. My arm is in a sling and the pain is okay. The 2nd finger's sensation is back! but the small pinkie is even worse then before! Doctor said it was normal for about 2 weeks to 3 months. Till the nerve regenerates.

My biggest concern however is the tenderness of the elbow, I don't know if it is too early too judge but I can't feel the bone of my elbow, and the area is extremely sensitive.

Another concern is that my hand is cramping from time to time, with pain.

I don't know what to make of this surgery as I have read so many negative posts in this blog and others about this surgery. Right now my focus is to avoid this in my other hand. and hope and pray that my other hand gets better with no need for further surgeries.

Lorrie said...

Hi everyone~ Havig this surgery in about a month. It's a little premature since I don't have tingling/ numbness in the fingers, but pain in the elbow, fingers and palm. Timing is what it is and the doc said to do it now before nerve damage. I work in an office on a computer. Do you think I'll be able to go back in a little over a week? I can do my work with my other hand and make it through the day. Thoughts>

e60e9282-99bf-11e1-b46f-000bcdcb5194 said...

I had the surgery 27th April under general anesthetic, this was not optional as the surgeon stated that the patient needs to be totally immobile which seems reasonable when slicing around delicate nerves. Sugery was on my inner elbow as the ulnar nerve had been bulging out of the tunnel each time I bent my arm which caused me to hit hit on every concievable object causing that awfull sensation we all know and hate! This could not continue, as I firefighter, I was rendered useless whilst turning out to emergencies. Anyway, the anesthetic was great, I felt it travel up my arm, I thought " when that reaches my neck, I'll be out cold" and thats exactly what happened. Having never experienced general anesthetic before, I can only say, I was very impressed! I had my stitches removed yesterday, the scar it incredibly neat and only 3.5 inches in length. The elbow is tender with limited movement. There is limited sensation in my two smallest fingers, pins and needles (similar two what is experienced from extreme cold). I hope this with decrease over time. I have nop idea when I will be fit for operational duties, but Its feeling ok considering sugery was only 12 days ago.

Martynne Edney said...

Hi Adam,

Thank you for sharing. I am potentially facing this surgery and was wandering if you have pics of scar a few years on. Thanks again.

Martynne

Adam Tuliper said...

Wow realized theres quite a fe posts I never received notifications on. I'm going to post a pic of what it looks like now. To the above, yes there was tenderness after the surgery - of course there is : ) It's a major surgery either way. Mine was successful (although one year in I doubted it but since that issue several years ago its been good knock on wood)

Martynne Edney said...

Thanks Adam. Current pic would be great as I am worried about scarring also.

Sanjay Kumar said...
This comment has been removed by a blog administrator.
Anonymous said...

Scar pic Adam???? If you really had the surgery.

Brenda said...


Hi I had surgery in March 2012.
Every thing went well and im regaining strengh all the time.
My fingers are still tingly at times but much improved. At times my elbow is sensitive!
Great surgeon in Hexham England would recommend.

Brenda said...


Just read a comment about the scar, only a thin line after 12 mths, great job!

Anonymous said...

I have been suffering from weakness and loss of sensation in my dominent hand for almost 9 months , 2 doctors I saw had limited experience with this type of conditions. .could you provide me with the name of the surgeon. .thanks

Jeff said...

Having ulnar surgery tomorrow at Lahey Clinic in Boston. I believe Dr Ghogawala is the best there is and I hope to get my 'guitar hand' playing chords again soon.
Jeff
Stamford ct

Adam Tuliper said...

For diagnostics dr Jeffrey Cole at Kessler institute in NJ. He's quite good and has written 12 books or so on the subject.
My surgeon was Dr. John Cook in Newport beach, CA
The endoscopic procedure that didn't work for me but may for others - was Dr Tsu-min Tsai in KY

Mette said...

Hi - did they try loosening the nerve before transposing it? I've had the nerve loosened twice and now a doc is suggesting tranposition but I am leaning toward a no....

Adam Tuliper said...

I had that done on my other arm but it didn't work well for me but they told me it worked for like 95%+ of the people that had it done. That is if we are talking about the same type of procedure which for me was endoscopic. It cleared up a bit literally years later but if I push it I feel it so I still consider getting it done but with minor symptoms and two young children it can wait :)

Anonymous said...

I had this done on my L elbow knowing the right was still to come. Strange, on July 17th 2013 I thought there would be nothing to this after 2 C-sections and other abdominal surgeries. I was mistaken. My entire nerve became inflamed post op and after 8 weeks of antibiotics my incision is healed over. It was like someone turned the nerve on in the pain position and it would not turn off. Now, 3mo later I still have pain and numbness in my hand and pinky. Needless to say, research your physician and have him explain ALL the possible complications. I was not reassured when he stated, "I have never seen this happen before. " He has now handed me off to a hand specialist since I also have carpal tunnel in both hands and still need surgery that "he didn't feel comfortable doing." Lol!!! Long and short....no procedure is minor if it involves you. Please research your physician and know the possibilities. Best wishes to all who set out on this journey. Yours may be straight forward.

Tara said...

I had a my left arm done-ulnar nerve and carpal on 8/28/2013 and my right done on 10/16/2013. My left arm and all fingers of my hand go numb more than before. Waking me up from sleep at night. They put me on steriods, nerve meds,sleeping aids w. nerve meds etc.. nothing has worked. They are now sending me back again for another EMG. It appears it didnt work. Has this happened to anyone? My scars are pretty nasty still.

Anonymous said...

Thanks. Just had my left done last week. Still recovering then will determine if I will have the right done.

Mark said...

I had my left arm done 4 weeks ago. It is healing well I had feeling back in my palm , ring and little finger right out of surgery. I had full Anatasia and the surgery was a little more than 1 hour. I was given pain Meds but never took anything, not even aspirin. I still have some funny sensations near the surgery site and my elbow is completely numb. But I am told this will get better in 3 to 6 months.

Anonymous said...

Next Wednesday (19th Feb) I could attend my Anterior Ulnar nerve transposition.
I was very scared and nervous.

Anonymous said...

I have mine done in 6 days. I'm very nervous. I'm a hairdresser with two small children...5 months and 2.5 years....husband is only able to take off day of the surgery. ..it will be me and kids after that and back to work March 11.

NĂ©meth Marcell said...

I've had mine done three days ago. It was my left arm, and the numbness is still there in my little and ring finger, but I guess my motor skills are already better. Pain is bearable. The doc wrapped my elbow with a not-too-tight bandage, I'm even able to move my hand from 0 to 30 degrees. And I can type. Doc told me to do gentle exercises with my palm and fingers. Interesting how different the advised recovery process is for each people.