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)