Saturday
Differences: Garbage on arm (brusing) is very visible still, purple lines, etc.... but I guess it is supposed to look like that as everything is supposed to flow like that. Last night my hand was tingling a bit. Today it felt better though. Each day a bit better - the fingers are moving faster and possibly less numbness. Something dangerous is occurring though - since my arm is feeling a lot better since the surgery (in terms of surgery caused pain/swelling/slowness in hand) I find I'm automatically almost using it in daily activites, opening the door, etc. I have to consciously make sure I don't use it, even though I feel I could to say..open a door. I can't use it for anything yet though according to the doctor. Tonight going to lift laptop on lap I suddenly put the other ghand on it and just started to use it to move it and caught myself and stopped. close call.
Today my middle finger started buzzing off and on. It feels like someone hooked up the smallest amount of voltage to the finger and it was clicking.
Now I am giving a little amount of force in stretching arm, I dont allow it to become painful though.. just enough to slowly trying to touch my thumb to the same side shoulder. If you try the same, slowly lift the arm away rather than fast.
Saturday, November 29, 2008
Thursday, November 27, 2008
Eight days post-op for ulnar nerve transposistion - more flexibility/new minor pains
Thanksgiving Thurdsay!
Great day - dinner with family at my Sister's and my Mom is in town too.
We ate so muchgood food today. yummy.
Lets get right to it with a more 'to the point' format. I'll prob change older posts at some point to reflect this too.
Differences: Last night my hand was burny/tingly when I went to sleep. I have not been using it, but it is not elevated all the time just most of the time. When I woke up my hand was burning. I thought maybe its some hypersensitivity fom everything healing, its hard to say though. Today my arm hurt in one specific spot in front of my elbow when I put my arm down. It has not done this before today. Also yesterday around the point of my elbow I would feel a minor sting, prob the incision healing, Overall the arm is becoming a little more mobile (ie flexible) each day. The arm is still stiff feeling. It is by no means very painful - it actually hasnt been at all - just annoying at times. The brusing under my arm is smoothing out and the whole area is a diffused yellow now with the purple lines essentially gone. However new 'garbage' as they call it (all those dark bruises/spots) has appeared more to the backside of the arm near the armpit. I gather its the stuff 'flowing' out of my arm. It's typical too see this after surgeries. When I had torn meniscus/acl repair done on my knee in 1999, the same thing appeared in my foot a bit after surgery.
I can bend my arm almost straight to about 105 degrees (ie slightly more bent than half way).
It is easier to hold your arm straight up, start slowly bending it over in front of your face and let gravity slowly pull it further. After a few seconds it will flex further as the arm gets used to it. I do not force it - I do give maybe an extra slight slight push (like one finger from the other hand hardly pushing)
Happy Turkey Day!
Great day - dinner with family at my Sister's and my Mom is in town too.
We ate so muchgood food today. yummy.
Lets get right to it with a more 'to the point' format. I'll prob change older posts at some point to reflect this too.
Differences: Last night my hand was burny/tingly when I went to sleep. I have not been using it, but it is not elevated all the time just most of the time. When I woke up my hand was burning. I thought maybe its some hypersensitivity fom everything healing, its hard to say though. Today my arm hurt in one specific spot in front of my elbow when I put my arm down. It has not done this before today. Also yesterday around the point of my elbow I would feel a minor sting, prob the incision healing, Overall the arm is becoming a little more mobile (ie flexible) each day. The arm is still stiff feeling. It is by no means very painful - it actually hasnt been at all - just annoying at times. The brusing under my arm is smoothing out and the whole area is a diffused yellow now with the purple lines essentially gone. However new 'garbage' as they call it (all those dark bruises/spots) has appeared more to the backside of the arm near the armpit. I gather its the stuff 'flowing' out of my arm. It's typical too see this after surgeries. When I had torn meniscus/acl repair done on my knee in 1999, the same thing appeared in my foot a bit after surgery.
I can bend my arm almost straight to about 105 degrees (ie slightly more bent than half way).
It is easier to hold your arm straight up, start slowly bending it over in front of your face and let gravity slowly pull it further. After a few seconds it will flex further as the arm gets used to it. I do not force it - I do give maybe an extra slight slight push (like one finger from the other hand hardly pushing)
Happy Turkey Day!
Tuesday, November 25, 2008
Six days post-op for ulnar nerve transposistion
Tuesday - almost a week.
Slept bad last night. Arm didn't hurt but shoulder was sore again only while sleeping (I am sleeping basically flat). Suddenly I'm wondering if all the iced green tea I was drinking is keeping me up at night.. hmmm.
Had my first post-op appointment today.
The bandage was changed. I still need to keep the arm elevated for one more week. doh. At work Im talking with people holding my arm up while sitting like Im in school and have a question.. I find it funny. Most of the time I'm not in my office so its about the buildings talking with others on projects.
Today the top of the arm near the armpit is definitely more sore. The bruising has been going away, but for some reason it is much more sore today in that region. When I raise my arm up it is sore. The doctor said it is good the bruising is showing up there, as that was is hoped for by elevating the arm. I was surprised at how clean the incision looked. ie not much scabbing, etc around it.. just the skin almost perfectly sealed together in a fine line. Sometimes sutures pull the skin up one one side more than the other. I have to give Dr. John Cook in Newport Beach credit here (besides being a cool doctor who will take the time to explain things in more detail if you want to know - he has also been more cautious with rushing to judgement I needed surgery until was has a solid case for it).
We did some minor strength tests - for ex. I hold my fingers together and he tries to get them apart. I was instructed though not to use the arm for really anything yet.. not even flossing - although I can't reach that close to my mouth with that arm yet, so I'm to keep working at increasing range of motion. It seems I may be losing a little size in the arm already even with the swelling.. the definition isn't the same in some spots.. my Wife disagrees though.
I asked if during surgery the problem was identified. He said the nerve appeared to be thickened at one spot of compression . This can happen from aggravation of the nerve.
That being said.. here is an interesting abstract from a study
http://www.neurology.org/cgi/content/abstract/63/9/1675
"Conclusion: More pronounced ulnar nerve thickening at the time of the diagnosis is associated with poor outcome at follow-up, especially in conservatively treated cases, while "electrodiagnostic signs of demyelination on testing indicate favorable outcome"
Slept bad last night. Arm didn't hurt but shoulder was sore again only while sleeping (I am sleeping basically flat). Suddenly I'm wondering if all the iced green tea I was drinking is keeping me up at night.. hmmm.
Had my first post-op appointment today.
The bandage was changed. I still need to keep the arm elevated for one more week. doh. At work Im talking with people holding my arm up while sitting like Im in school and have a question.. I find it funny. Most of the time I'm not in my office so its about the buildings talking with others on projects.
Today the top of the arm near the armpit is definitely more sore. The bruising has been going away, but for some reason it is much more sore today in that region. When I raise my arm up it is sore. The doctor said it is good the bruising is showing up there, as that was is hoped for by elevating the arm. I was surprised at how clean the incision looked. ie not much scabbing, etc around it.. just the skin almost perfectly sealed together in a fine line. Sometimes sutures pull the skin up one one side more than the other. I have to give Dr. John Cook in Newport Beach credit here (besides being a cool doctor who will take the time to explain things in more detail if you want to know - he has also been more cautious with rushing to judgement I needed surgery until was has a solid case for it).
We did some minor strength tests - for ex. I hold my fingers together and he tries to get them apart. I was instructed though not to use the arm for really anything yet.. not even flossing - although I can't reach that close to my mouth with that arm yet, so I'm to keep working at increasing range of motion. It seems I may be losing a little size in the arm already even with the swelling.. the definition isn't the same in some spots.. my Wife disagrees though.
I asked if during surgery the problem was identified. He said the nerve appeared to be thickened at one spot of compression . This can happen from aggravation of the nerve.
That being said.. here is an interesting abstract from a study
http://www.neurology.org/cgi/content/abstract/63/9/1675
"Conclusion: More pronounced ulnar nerve thickening at the time of the diagnosis is associated with poor outcome at follow-up, especially in conservatively treated cases, while "electrodiagnostic signs of demyelination on testing indicate favorable outcome"
and... in my case conservative treatment didn't work.
Why didn't my "in situ" procedure work? The doctor explained a possible case - in the "in situ decompression" procedure the tunnel itself is opened up. Think of your nerve going through a hose. If the nerve gets too big for the 'hose' it will have pressure on it. The tunnel is cut open to release that pressure. If the cause is not the tunnel being too tight and the nerve is being pressed on my other structures (muscle) then in situ decompression doesn't seem to be the right choice to resolve it. Unfortunately it doesn't seem there is a check ahead of time to determine which is the choice to use.. although in my case nothing was lost by trying in situ, I feel zero effects from that procedure and have just a small Z shaped scar on my elbow from it.
The doc also didn't feel numbness in hand was a big deal.. since it is on the whole hand and seems to be pretty minor, prob because of swelling. He did the roller point test which is a wheel with spikes on it they roll across fingers to check if you feel the same sesitivity in each finger/hand. It was pretty close between left and right.. but not as 'sharp' feeling on the surgery arm (even close to the incision it felt more like a long scratch than individual points).
Here are pics today after bandage was removed before the smaller one was put on.
A lot of the yellow is brusing, but also a lot is from the ointment they use before surgery.
It looks all like there are raised lines because the bandage was just on pretty tight.
The new bandage is now much smaller and easier to move.
Monday, November 24, 2008
Five days post-op for ulnar nerve transposistion
Monday
First day back at work. I was trying to use my arm without putting pressure on it to tie my shoes - not successful as it became untied three times today.. so I pulled my move from when I was a youngster and didn't know how to tie my shoe - I tucked it in : )
I didn't have it up as much as I could as I was running around a lot at work today. It was about a 10 hour day there .. a lot of the time I tried to hold my arm up.. other times I didn't and let it down and get more circulation as I moved it. I can move it almost 90 degrees today. The bruise is yellowing a lot more. Working didn't seem to have a terrible effect on it.... but still wish I could've rested it today more... at least I flexed it a lot as I was walking around. I want to keep my elbow as extended as reasonably possible (it doesnt hurt when I try..just feels tight and Im not going to force it straight until it is more healed unless doc tells me otherwise)
Last night I woke up a lot again... definitely from having my arm on the side on a pillow. When I put the pillow slightly on me and had my hand lying on me it was a bit better. For a bit I let it just lay directly on me and that felt much better.. cant wait - two more nights until I dont have to keep it elevated.
My hand still has a lack of sensation in all fingers. I can only attribute this to trauma/swlelling. I would think if it was only the ulnar nerve being affected then only the pinky and ring fingers would feel that way - but the whole hand does.
Also if I put my hand straight above my head I feel a slight pain right at the start of the armpit. I felt this in the 'in situ' procedure but that was because my nerve was blocked by injecting it several times and as such hurt a lot. For this procedure it is just sensitive.
My right arm is acting up some because it is now the only arm being used.
No twitching/flexing spontaneously is happening anymore.
First day back at work. I was trying to use my arm without putting pressure on it to tie my shoes - not successful as it became untied three times today.. so I pulled my move from when I was a youngster and didn't know how to tie my shoe - I tucked it in : )
I didn't have it up as much as I could as I was running around a lot at work today. It was about a 10 hour day there .. a lot of the time I tried to hold my arm up.. other times I didn't and let it down and get more circulation as I moved it. I can move it almost 90 degrees today. The bruise is yellowing a lot more. Working didn't seem to have a terrible effect on it.... but still wish I could've rested it today more... at least I flexed it a lot as I was walking around. I want to keep my elbow as extended as reasonably possible (it doesnt hurt when I try..just feels tight and Im not going to force it straight until it is more healed unless doc tells me otherwise)
Last night I woke up a lot again... definitely from having my arm on the side on a pillow. When I put the pillow slightly on me and had my hand lying on me it was a bit better. For a bit I let it just lay directly on me and that felt much better.. cant wait - two more nights until I dont have to keep it elevated.
My hand still has a lack of sensation in all fingers. I can only attribute this to trauma/swlelling. I would think if it was only the ulnar nerve being affected then only the pinky and ring fingers would feel that way - but the whole hand does.
Also if I put my hand straight above my head I feel a slight pain right at the start of the armpit. I felt this in the 'in situ' procedure but that was because my nerve was blocked by injecting it several times and as such hurt a lot. For this procedure it is just sensitive.
My right arm is acting up some because it is now the only arm being used.
No twitching/flexing spontaneously is happening anymore.
Four days post-op for ulnar nerve transposistion
Sunday
Bruise is starting to yellow (disperse)
this does not hurt:
So - not too much different than yesterday - bruise is slightly dispersing.
The one thing different - I had a bad nights sleep (I did take pain meds last night). Worst night of sleep yet. I will say though part of it was because the dog was on the bed and he was healing from surgery so when I heard him move I woke up - fearing he was getting to his incision which was sutered and then glued on top of it. He wont wear a cone - he freezes and trembles.. so he's still getting used to it, meanwhile we keep it off most of the time.
Anyways... my shoulder and elbow burned during the night it was quite uncomfortable. I'm certain it's because of how elevated it is, as during the day I don't have that issue and the arm is moved around.
Bruise is starting to yellow (disperse)
this does not hurt:
So - not too much different than yesterday - bruise is slightly dispersing.
The one thing different - I had a bad nights sleep (I did take pain meds last night). Worst night of sleep yet. I will say though part of it was because the dog was on the bed and he was healing from surgery so when I heard him move I woke up - fearing he was getting to his incision which was sutered and then glued on top of it. He wont wear a cone - he freezes and trembles.. so he's still getting used to it, meanwhile we keep it off most of the time.
Anyways... my shoulder and elbow burned during the night it was quite uncomfortable. I'm certain it's because of how elevated it is, as during the day I don't have that issue and the arm is moved around.
Saturday, November 22, 2008
Three days post-op for ulnar nerve transposistion
Saturday
Notice the jellyfish sting looking marks - ie significant bruising (I'm not one that usually bruises easily)
Notice they stop at the bandage from the pressure - weird.
I'm half way to not having to keep arm elevated all the time....woohoo! The bandage isnt changed until a week after. I can flex the arm a little easier today, being careful not to force the arm. Im twisting wrist, moving up and down/left/right, and moving figers ok.
What does the arm feel like today?
Fingers still feel fat and feel slightly numb.
I won't describe the arm as usually pain, more of a burn and thats when I move it or hold it up as I move - like if you held your arm straight out and held a book, the burn you would feel in your arm is similiar. Every now and then there is pain, I can tell the incision area is a little sore but the bandage is so big. The actual pain though is not bad. I take meds only at night now just so I sleep better. When I had the 'in situ' procedure on the right arm that much smaller incision was sore for some time so I fully expect that to be worse since this incision is about 6-7 times longer.
Today it was slightly itchy, but not directly in the incision area.. at least itching just in the bandage works.
The bruising is really out today..in a way I've never had before after injury/sugery. It looks like I was stung by a jellyfish near my armpit, red/purple odd shaped lines - but it is not sore to the touch there like it was the day after the surgery. Intrestingly enough if I pull the bandage back a little there is _no_ bruising there - it seems the pressure from the bandage stopped it right on a straight line. I had a couple 'cramps' in my index finger.. they werent painful but the finger just flexed and tensed up for a few seconds.
The hand this am felt cool again, my Wife came back today and felt my hand and thought the same thing, although not too much different than thw right to cause concern and there was no lack of color or blueness either. Later in the day it was the same temp as my right arm.
We babysat my Niece and Nephews tonight (1,2, 5 yrs old) and their dog. So with my surgery and my dog being there... we were always on the lookout from their dog wanting to say hi.. and the kids playing around. I assumed the recently usual position on the couch with the arm propped up above heart level on two big pillows.
I had to drive shortly today although I dont recommend it yet if possible. There was an accidental alarm triggering at work and no one else was available so I put a pillow on the armrest, set my foot up on the paperholder in the door and was good to go (work was only about 10 minutes away and it was a saturday night). It wasnt bad driving like this..but for safetys sake you only have one hand so avoid as long as possible.
Notice the jellyfish sting looking marks - ie significant bruising (I'm not one that usually bruises easily)
Notice they stop at the bandage from the pressure - weird.
I'm half way to not having to keep arm elevated all the time....woohoo! The bandage isnt changed until a week after. I can flex the arm a little easier today, being careful not to force the arm. Im twisting wrist, moving up and down/left/right, and moving figers ok.
What does the arm feel like today?
Fingers still feel fat and feel slightly numb.
I won't describe the arm as usually pain, more of a burn and thats when I move it or hold it up as I move - like if you held your arm straight out and held a book, the burn you would feel in your arm is similiar. Every now and then there is pain, I can tell the incision area is a little sore but the bandage is so big. The actual pain though is not bad. I take meds only at night now just so I sleep better. When I had the 'in situ' procedure on the right arm that much smaller incision was sore for some time so I fully expect that to be worse since this incision is about 6-7 times longer.
Today it was slightly itchy, but not directly in the incision area.. at least itching just in the bandage works.
The bruising is really out today..in a way I've never had before after injury/sugery. It looks like I was stung by a jellyfish near my armpit, red/purple odd shaped lines - but it is not sore to the touch there like it was the day after the surgery. Intrestingly enough if I pull the bandage back a little there is _no_ bruising there - it seems the pressure from the bandage stopped it right on a straight line. I had a couple 'cramps' in my index finger.. they werent painful but the finger just flexed and tensed up for a few seconds.
The hand this am felt cool again, my Wife came back today and felt my hand and thought the same thing, although not too much different than thw right to cause concern and there was no lack of color or blueness either. Later in the day it was the same temp as my right arm.
We babysat my Niece and Nephews tonight (1,2, 5 yrs old) and their dog. So with my surgery and my dog being there... we were always on the lookout from their dog wanting to say hi.. and the kids playing around. I assumed the recently usual position on the couch with the arm propped up above heart level on two big pillows.
I had to drive shortly today although I dont recommend it yet if possible. There was an accidental alarm triggering at work and no one else was available so I put a pillow on the armrest, set my foot up on the paperholder in the door and was good to go (work was only about 10 minutes away and it was a saturday night). It wasnt bad driving like this..but for safetys sake you only have one hand so avoid as long as possible.
Friday, November 21, 2008
Eating right while recovering
Just a quick note on this. Since protein is absolutely essential for muscle growth/repair its important to eat a lot of protein during the healing process. Just like if you are physically active you need a lot of protein, now with cut skin and a cut muscle your body needs protein to repair everything as best it can. I'm eating a lot of tuna and drinking a lot of green tea (buy an iced tea maker - they rock). There is an asian food market nearby that has green tea w/ roasted brown rice which gives it a very unique and tasty flavor. Drink lots of liquids too.
Insert blurb about eating your vegetables here, using whatever nagging voice from your childhood that fits : )
Here is more info:
http://www.thedietchannel.com/Post-Surgical-Nutrition-Speed-Your-Healing-With-A-Good-Diet-and-Supplement-Plan.htm
Now to play devil's advocate here is an interesting study on rats and having them heal under malnutrition doesn't seem to affect the healing process. These are rats, not people though. Does the same hold true? Why risk finding out, it only makes sense to be healthy while healing.
http://cat.inist.fr/?aModele=afficheN&cpsidt=3677619
Insert blurb about eating your vegetables here, using whatever nagging voice from your childhood that fits : )
Here is more info:
http://www.thedietchannel.com/Post-Surgical-Nutrition-Speed-Your-Healing-With-A-Good-Diet-and-Supplement-Plan.htm
Now to play devil's advocate here is an interesting study on rats and having them heal under malnutrition doesn't seem to affect the healing process. These are rats, not people though. Does the same hold true? Why risk finding out, it only makes sense to be healthy while healing.
http://cat.inist.fr/?aModele=afficheN&cpsidt=3677619
Two days post-op for ulnar nerve transposistion
Slept ok last night, but Im turning on my side to sleep with my arm up on my hip because my back was hurting a bit, so now my shoulder is getting a little sore from sleeping on it.
I have to stop myself from using the hand for small things...like adjusting the pillow the arm is resting on, etc.
woke up this am and noticed my surgery hand was colder than my right hand... I attributed it to being raised and swollen to less circulation. I covered it up and then stood up for a few minutes to help circulation, it seemed to help.
My hand definitely feels less sensitive than pre surgery still (ie I can tell there is some loss of ability to tell the same level of detail as my right hand) and swollen even though it doesn't look very swollen.. maaaaybe slightly swollen. The issue probably is the arm itself is swollen and your tendons move in your arm. Its not all unexpected as the nerve of course went through a lot of trauma getting moved (some of the capillaries are cut during the procedure and of course the nerve is jarred and moved).
Just sitting here with the arm still up.. a little more mobile now.. I can bend prob 40 degrees without much pain I just have to go slow.
One word though... bored. thank goodness for being able to type decently fast one handed (and tv and the net).
I do recommend for anyone else having this procedure to practice usual activities with the other hand (ie getting dressed, brushing teeth, getting drink/food). I'm mostly left handed, so I brush teeth with right now, etc, At least so you get a little used to the coming downtime and it wont be so frustrating.
I didnt feel the need for pain meds during the day today. Its not painful when its just sitting there... more swollen and slow when moving hand. When I flex the elbow (using onlt that arm itself, ie not pushing on it with the other arm) it gets sore the more bent the elbow is.. but necessary for keeping the nerve glding/moving and helping to prevent scar tissue formation.
I have to stop myself from using the hand for small things...like adjusting the pillow the arm is resting on, etc.
woke up this am and noticed my surgery hand was colder than my right hand... I attributed it to being raised and swollen to less circulation. I covered it up and then stood up for a few minutes to help circulation, it seemed to help.
My hand definitely feels less sensitive than pre surgery still (ie I can tell there is some loss of ability to tell the same level of detail as my right hand) and swollen even though it doesn't look very swollen.. maaaaybe slightly swollen. The issue probably is the arm itself is swollen and your tendons move in your arm. Its not all unexpected as the nerve of course went through a lot of trauma getting moved (some of the capillaries are cut during the procedure and of course the nerve is jarred and moved).
Just sitting here with the arm still up.. a little more mobile now.. I can bend prob 40 degrees without much pain I just have to go slow.
One word though... bored. thank goodness for being able to type decently fast one handed (and tv and the net).
I do recommend for anyone else having this procedure to practice usual activities with the other hand (ie getting dressed, brushing teeth, getting drink/food). I'm mostly left handed, so I brush teeth with right now, etc, At least so you get a little used to the coming downtime and it wont be so frustrating.
I didnt feel the need for pain meds during the day today. Its not painful when its just sitting there... more swollen and slow when moving hand. When I flex the elbow (using onlt that arm itself, ie not pushing on it with the other arm) it gets sore the more bent the elbow is.. but necessary for keeping the nerve glding/moving and helping to prevent scar tissue formation.
Thursday, November 20, 2008
One day post-op for ulnar nerve transposistion
oh how typing with one hand is funb. i mean fub. i mean fun. there we go : )
backspace key is my friend. My left arm is propped on two pillows and I'm typing leaning over on the couch. people walking by on the teail out back can see in.. they are probably wondering what the heck Im doing.
I woke up today earlier than I expected... 7:20am or so but didn't go to sleep until after 1 (we watched wall-e and other movies - wall-e is a cute movie...pretty good). I expected to sleep longer but I guess I slept a bunch during the day yesterday and wasn't active.
Thankfully, I had no pain or tingling when I woke.. but upon a little moving the soreness kicked in. The swelling/bruising in my arm has arrived.. even though I cant see it with the large bandage, it just feels sore bruised and swollen (as the movement early in the day in fingers was slower).
While I spent most of the day on the couch, one visitor kept coming to see what was up. Ya.. he is real not a stuffed animal. Cute huh?
I had to go to the bank.. but as soon as I got in the car (ford expedition) there was plenty of room on the middle console for a big pillow. As I stand up the arm hangs at an angle not straight at my side. The bandage isn't straight, it was put on when my arm was slightly bent. So standing even for a few minutes increases pain. Luckily we were in and out of bank in about 4 minutes.
There is no more twitching in the hand today that I had yesterday.
Does my arm feel better compared to pre-op? Not yet..of course there has been a lot of trauma to the area. I prob wont know until swelling goes away, it heals and I use it again... as that is when my symptoms acted up the most. It isn't as painful _at this time_ in my hand as it was a couple days after my previous less invasive surgery.. but it is possible I used my hand too much/too soon in the other procedure.
11:29 PM watching Wall-E again, just finished Hellboy 2 - my Wife took our dog Mac to Palm
Springs area to get fixed. Both guys having surgery this week..ouch.
A couple twitches around my armpit this evening. I noticed earlier today the red/bruising spread to almost the armpit and it is sore to the touch at the very top of my bicep near the shoulder. My shoulder also feels a little achy from being raised all the time.. the directions were to keep it elevated for a week.
I put off the surgery for so long because of bad timing, no I finally get it done and it really is bad timing - a really need to be at work now for a big project. Surgery was Wednesday, I'll be back to work Monday. I was told I can type with it in two weeks. Here you can see some of the bruising creeping up.
backspace key is my friend. My left arm is propped on two pillows and I'm typing leaning over on the couch. people walking by on the teail out back can see in.. they are probably wondering what the heck Im doing.
I woke up today earlier than I expected... 7:20am or so but didn't go to sleep until after 1 (we watched wall-e and other movies - wall-e is a cute movie...pretty good). I expected to sleep longer but I guess I slept a bunch during the day yesterday and wasn't active.
Thankfully, I had no pain or tingling when I woke.. but upon a little moving the soreness kicked in. The swelling/bruising in my arm has arrived.. even though I cant see it with the large bandage, it just feels sore bruised and swollen (as the movement early in the day in fingers was slower).
While I spent most of the day on the couch, one visitor kept coming to see what was up. Ya.. he is real not a stuffed animal. Cute huh?
I had to go to the bank.. but as soon as I got in the car (ford expedition) there was plenty of room on the middle console for a big pillow. As I stand up the arm hangs at an angle not straight at my side. The bandage isn't straight, it was put on when my arm was slightly bent. So standing even for a few minutes increases pain. Luckily we were in and out of bank in about 4 minutes.
There is no more twitching in the hand today that I had yesterday.
Does my arm feel better compared to pre-op? Not yet..of course there has been a lot of trauma to the area. I prob wont know until swelling goes away, it heals and I use it again... as that is when my symptoms acted up the most. It isn't as painful _at this time_ in my hand as it was a couple days after my previous less invasive surgery.. but it is possible I used my hand too much/too soon in the other procedure.
11:29 PM watching Wall-E again, just finished Hellboy 2 - my Wife took our dog Mac to Palm
Springs area to get fixed. Both guys having surgery this week..ouch.
A couple twitches around my armpit this evening. I noticed earlier today the red/bruising spread to almost the armpit and it is sore to the touch at the very top of my bicep near the shoulder. My shoulder also feels a little achy from being raised all the time.. the directions were to keep it elevated for a week.
I put off the surgery for so long because of bad timing, no I finally get it done and it really is bad timing - a really need to be at work now for a big project. Surgery was Wednesday, I'll be back to work Monday. I was told I can type with it in two weeks. Here you can see some of the bruising creeping up.
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)
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)
Tuesday, November 18, 2008
T-Minus one day until ulnar nerve transposition surgery for cubital tunnel syndrome
I've stopped eating, it's after 9, I don't want to turn into a gremlin. Luckily I still have three more hours to drink liquids. The lovely thing I remember about the in situ procedure in Louisville was them injecting the nerve for the nerve block. Im not a man who loves needles.. so not looking forward to that. Maybe they will give me something good in the IV first : )
My left hand fingers are actually tingling a lot more today - did a lot of lifting at work to get ready for one of the Navy projects we are working on. It confirms to me even more that it is the right time to get the surgery - although it is never a convenient time to get it. I hope I can get some skiing in at the end of the season (Im hoping to get the right arm done in December so I'll be all good by March to hit late season skiing somewhere - last year in May we were at Mammoth skiing).
My left hand fingers are actually tingling a lot more today - did a lot of lifting at work to get ready for one of the Navy projects we are working on. It confirms to me even more that it is the right time to get the surgery - although it is never a convenient time to get it. I hope I can get some skiing in at the end of the season (Im hoping to get the right arm done in December so I'll be all good by March to hit late season skiing somewhere - last year in May we were at Mammoth skiing).
Monday, November 17, 2008
The start of it all - T-Minus two days until ulnar nerve transposition surgery for cubital tunnel syndrome
This is my first of hopefully a bunch of entries on my cubital tunnel syndrome experience. So.. lets get to it : )
Why am I doing this? When I was diagnosed with Cubital Tunnel Syndrome, most information was from the hand centers telling basic causes, treatment, and a very very high level of how the surgery went. Doctors aren't always up front with how a surgery will go. So let this be a log of my surgery experience. (Added note 2.5 weeks after the surgery - hand feels pretty good. using it for light driving, typing is no problem. Walking around during the day now I am surprised at how little I notice I had a major procedure done on it 2.5 weeks ago)
First.. some thanks goes to James:
http://quitelucid.blogspot.com/2006/04/cubital-tunnel-syndrome-part-one.html
He posted his experience which pushed me more to post all of this - it was great he had his info posted, so hopefully this adds to it a bit. There was little out there of people's detailed experience with the surgery and recovery so I wanted to add to the little info out there from a patient standpoint.
Second.. I'm just typing as I think (and watch TV) so forgive the lack of cohesiveness in these thoughts here.
If you need this surgery:
1. Practice one arm activities here and there ahead of time.
2. Purchase floss picks if you dental floss, otherwise you wont be able to.
3. If the doctor doesn't provide anything to put around your arm for bathing (click here for example) then you can buy one or use a trash bag with tape around your arm. Yea.. its rigged but if the doc doesn't give you one you'll find something quick that works. Just keep the arm raised in the shower (or take only baths and not showers for two weeks and avoid this trouble)
4. Make sure you have extra pillows or blankets to raise your arm up on while resting.
5. Have as much stuff around as possible to prevent boredom - netflix is awesome and so is a nice cable package
6. Make sure you have some clothes that can stretch wide easily in the arms to fit around the thick bandage without squuezing it. Some stretchable cotton shirts (ie most t-shirts) have a seam on the sleeve where it is folded over and sewn. That can prevent it from being stretched the amount you need over the bandage. Like I said... its a thick bandage, so just check to be prepared.
7. If you will be recovering mostly alone - either living alone or others around you will be away working/school/etc then you want to make sure the food is easily accessible with one arm and you've bought stuff that can easily be opened with one arm. Note: water bottles are somewhat difficult. You can open them by squuezing the bottle between your legs.. but if its a very flexible bottle then when you twist it - it can overflow on your lap from squeezing the bottle.
8. Train your pet to stay away on command or figure a way to avoid it. My dog kept wanting to say 'hi' and almost jumped on my arm several times untill I figured how to avoid it (pillows on the bed to keep the dog on my Wife's side hehe) and the arm would stay on the edge of the couch during the day.
Useless tidbit: Neurologist said these nerve issues show up more in people that spend first 12 years in east coast/colder climates.
I developed numbness/tingling in my right hand in the pinky and ring fingers about 2.5 years ago. I was pretty sure it was carpal tunnel syndrome, since I worked all day and night (literally) on the computer, doing software development for a corporation during the day, and working in security software for my own company at night. I was on a plane when I first noticed it. About two weeks later the other hand started feeling the same way. It wouldn't go away. It was worse when I worked on the computer. I purchased carpal tunnel braces wrist braces and wore them during the day and at night, but the symptoms didn't go away. I went to go see a doctor in Allentown, PA at orthopedic associates. The tingling felt like it was in my ring and pinky fingers. At times I would feel a 'ticking' or pulsing (more like a click rather than a pain) at the base of my ring finger. Weird.. I know.
The doctor said I should pay attention of how I rest on my arms. Don't put pressure on the elbow (more importantly right beneath the elbow where you sometimes lean on armrests and desks at work - this compresses the nerve and can irritate it). Sleep at night with my arms straight, not bent, use a towel if needed wrapped around the arm to keep it straight. Some people naturally have a sublaxation of the nerve, which means as they bend their elbow, their nerve pops over the point on the side of your elbow or rubs on it. If you look at the inside of your arm, there are two points and between them the nerve passes (your funny bone nerve). The one you can see without bending your arm out is the one the nerve _can_ pop over and wear away at the nerve. This does not happen to everyone (oh ya.. disclaimer: Im not a doctor.. Im just sharing my experience with having CTS and what I seem to have found out during my experience). In my case, I did not have sublaxation of the nerve. In one arm the nerve moved close to the edge of the bump but never went over. In the other arm it was even less pronounced.
The doctor told me it goes away in 90% of the cases, with that said he still did about 12 surgeries a week for it. My Step-Father had it years back and his healed up with no problem when he followed the conservative treatment. I was sent for a nerve conduction study and then told we would follow up in 12 weeks (I believe it was 12 weeks.. this was a while ago). I scored just under the norm of 50 m/s nerve speed on both arms if I recall. As part of the test they put a needle in several places in your hand and have you put pressure (ie they press on your finger - not the needle - and you push back). This causes a voltage/signal reading on the equipment. The specialist said 'yep - that nerve sounds crusty and unhappy'. To me it sounded like an 80's cheesy racecar sound... so I knew something was obviously wrong, as I was born in the 70's. duh. : )
My Aunt warned me about this test (this is an EMG test - ie nerve conductivity test) - she said it was worse than the surgery she had for her carpal tunnel syndrome, so I was kinda dreading the test. It was an absolute piece of cake. I hate needles, but they weren't bad either.. they just barely tap them into the skin, its not like a shot probably more like accupuncture. They are barely tapped in, it does pinch a tiny but though.
So I was careful in everything I did and went back 12 weeks later and had another nerve conductivity test. No change. No better, not worse. The test results were the exact same. So....he recommended surgery.
Let me also state for the active folks I'm also an avid mountain biker. I like technical - rocky - steep riding if its around. Who cares you say. Well, in PA when I lived there.. I enjoyed a lot of rocky riding and that I'm sure helped aggravated my arms a bit. Now that Im living in CA - the local trails are long (for instance my local 'hill' is 13 miles off road up the mountain to an elevation of about 5600 feet - http://en.wikipedia.org/wiki/Santiago_Peak), but it is not nearly as rocky as some flatter trails in PA (salisbury - walking purchase for instance). So biking out here my arms never hurt during and not really after either. During biking (in PA and CA) there was enough stimluation I guess that overrode any sensation in my hands to CTS. However it would seem two days later or so it would be worse after heavy biking in PA, not immediately after though. I could never say 'the night after biking it hurt' within reason of course (at Mammoth mtn bike park in CA this past summer I can say that night my arms bugged me at night after the first ride- but thats a lot of riding in a day). Let me say again, I tried not riding for several months but it didn't go away at all. No matter what conservative treatment I tried it would never get better past a certain point.
I tried anti inflammatories, less computer, no biking, etc. It never went away. I also was going to the gym a lot when this happened. I'm a thin guy, by no means stocky. I asked the doctors assistant in PA if going to the gym could cause this. She gave me this attitude like it was a silly question and said no we have guys that come in that are huge without these issues. In hindsite.. she was a dummy.. just probably in pre-med and already over-confident in her knowledge. What I had thought could have happened.. and later confirmed is possible with a hand/arm surgeon - is that indeed - parts of your anatomical structures can thicken and put pressure on the nerve. When going to the gym your body adapts - regardless of your size. Everyone has different physiology and reacts differently to activities. So I feel once they thickened and put pressure on the nerve, they never thinned out - if that is what happened in my case. It seems to fit though since it would get better but only to a point/
So. life has been a constant adjusting of activities. I stopped weight lifting and haven't done it since (btw.. when this first started and I would do tricep exercises I would feel a pain/pressure right near where my nerve was in the elbow.. but never felt it any other time in that area, and I stopped going within two weeks of that starting ). I've tried not biking, not working on the computer as much, etc for months on end with minimal change. If it really acted up (lots of tingling) and I took it easy for a few weeks.. it would get better.. but never fully go away no matter what I tried, even though it was very manageable at times.
I was planning a move to CA and the doctor said check with a doc in CA once we move. Right before we moved I was biking again a lot, and packing, etc and it really started bugging me. Even driving cross country was a pain.. luckily I had a good stay in New Orleans and other places to make me feel better : )
Once I was in CA I went to go visit a doctor out here and he felt surgery was the option at this point. I couldn't believe though there wasn't an 'easier' surgery for this. An incision 6 inches long, cutting the muscle, moving the nerve sounded excessive. Three months before I could resume full physical activity and biking? no way! No one seemed to know of an alternative. Finally I found one! An Indian doctor in Germany developed a technique for decompression of the nerve via endoscopic means. At last.. I don't have to get sliced open with a 5-6 inch incision.
The endoscopic method is called in situ decompression and is now finally gaining some momentum. NOTE: This surgery opens up the tunnel.. think of it as a tube through which the nerve travels. If the source of the problem is not the tunnel being too tight but instead another structure putting pressure on it (ex muscle/tendon) then this procedure may not solve the issue - as it did not in my case. I was told by Dr. Tsai though that he's only had two others it didn't work for - but Im just relaying my experience. It was worth it though for me to at least try that surgery..which I did.
This is a youtube video showing this technique.
http://www.youtube.com/watch?v=qttiyxBP0uM
Here is a study in an in situ decompression technique:
http://www.egms.de/en/meetings/dgnc2006/06dgnc190.shtml
Here is a doctor I spoke with in Germany:
"A novel endoscopic technique in treating single nerve entrapment syndromes with special attention to ulnar nerve transposition and tarsal tunnel release: clinical application."
http://lib.bioinfo.pl/pmid:16888558
Well.. I didnt really want to travel to Germany for as it was put.. a 'medical vacation'.
So I searched further and finally found someone in the US that did this procedure. Dr. Tsu-Min Tsai in Louisville, KY. He seemed to be an accomplished surgeon, he took part on the team that actually did a whole hand transplant. It was pretty neat to see the video of a guy that didn't have a hand for years get a new hand and he was able to move it. Frankenstein.
I was happy at finding this. The procedure involves cutting a small Z shaped incision and going in with a tube and cutting the area around the nerve away to release some pressure on the nerve. I called the office.. setup an appointment at the Jewish Hospital in Louisville with the potential for surgery if I needed it. They had a special rate at the local hotel. Btw - there is an _awesome_ restaurant nearby serving Mayan/Mexican cuisine. It was tasty.. but I would drive there and not walk from the hotel. We walked and got to a street corner at night and suddenly there was a flash and a voice said "you are entering a restricted area and your picture has been taken". This came from a device mounted on a light pole, so it seems that corner must have had some pimp problems or something. It wasn't restricted, there were businesses, etc on that street. Nonetheless, we walked back to the hotel (10 min) and drove to the restaurant.
It was confirmed after an examination by Dr. Tsai that I needed surgery... so I went downstairs for all the paperwork, vitals, etc.
The surgery the next day was a piece of cake. My arm was numbed before the surgery. They give you something in your IV to make you loopy and not care about anything, it felt quite good. Then they have you put your arm above your head and inject the nerve to numb your entire arm. They let you sit around for a while in bed and keep checking your arm to see if its numb. Then they bring you in to the operating room. I remember being pushed down the hall and suddendly felt warm and wonderful. I asked the nurse if she just gave me something in my IV. "YUP" she said. Nice! Then I was out.
I woke up and was out of the hospital in no time. My Wife and I went to the "Lucky Strike" restaurant for lunch in downtown Louisville which was a neat smaller city. Now.. this is funny. My arm is totally numb and in a sling. I felt great.. like I never even had surgery that day. So I go into the restroom. OF course, being a guy, we have our urinals, which Im standing at and... um.. checking the time. Well I am in the restroom alone and just looking around as Im doing my thing and suddenly feel movement in my shoulder, which wasn't numb. My arm was slipping out of my sling and about to fall directly in the path of you guessed it. Luckily the other hand saved it in time. I had to share that because I've been laughing for about a year for what almost happened.. so if you are a guy.. just be careful. My sling maybe wasn't quite large enough for a guy like me with long arms.. or it just wasnt in there all the way from me moving around in the car or something. There is a baseball museum there - think louisville slugger. Also there was a neat old graveyard where not only Colonel Sanders from KFC is buried, but also rows and rows of Civil War soldiers lined up like Arlington National Cemetary.
Later in the day (hours later) I was laying in bed at the hotel and still couldn't move my hand. The block started to wear off and I would seng a signal to my fingers to move and would get a slight twitch. 15 minutes later more of a twitch.. and so on until I regained full movement when I awoke the next morning .. that was a weird feeling.
I had some swelling around the elbow.. and pain if I rested it on anything. However a few days later.. my hand pain was worse than it had ever been. Usually it gets better. Not in my case. It was pretty miserable and I couldn't seem to get a straight answer from the doctors office "oh.. just wait.. each person is different'. I said shouldn't it be a little better? "Usually yes.. but everyone is different". Something didn't feel right though. Since I couldn't get a quick reply from anyone I think I emailed and got a response fgorm a guy there and he was very helpful and looked into it.. the doctor was out. Anyway.. I was told this procedure had only not worked on two people during the whole number of years doing it. In fact the doctor didnt even perform the transposition surgery now (as I was told by someone there) since this procedure basically always works. Well.. in my case it didnt. I was told it can take a year to recover.. fine.. but with how my symptoms were somewhat minimal compared to some people I figured it would be a quick results.
Nerves heal because of a flow in them called axonal flow. This starts at the spinal cord and moves an estimated inch a month in humans (its been observed directly in animals but direct human testing hasn't occured, only derived measurements from the healing process as far as I know). So if your elbow issue is resolved, it could take a year for the damaged segment to flow down from the elbows to the fingertips as I understand it. In one case I was told about a patient actually got worse after surgery as it seemed the nerve was dying, but it started healing and eventually got better. This is not the norm of course but these things can happen. I had asked about the risk of cutting the nerve and was told the risk of course exists but had never been seen by my doctor.
Anway.. over a year later.. no change at all.. so the surgery did nothing for me at all.
I lost nothing but some time and a little $ trying this... so it was an experience.. and I have no pain or numbness from that surgery, and only a tiny little 'z' shaped scar... so I would urge someone to look at this as an alternative as it seems to work for most people according to that center. I was told this procedure opens all 6 points of compression.. obviously not all causes of cubital tunnel though since I still had the same problem over a year after that surgery (or so we'll find out after this next surgery)
Since this surgery didn't do a thing for me...I went back to the doctor in CA.
We scheduled the 'full monty' surgery - ie ulnar nerve transposition. Since my symptoms were minimal compared to some people (no strength loss yet) right before the surgery he said he wanted me to get another nerve test. So literally the day before the surgery I went to see a neurologist for another nerve test (this would be my third - and now prob a year or longer after I first developed symptoms). The doctor had an ancient machine that he shocked the arm with (its a minor jolt) and they look at the response graph on the screen. I asked if this would give the same results as the 'more current' machine I had results done on in PA. He said it would yield the exact same results. Well.. it didn't. The software/machine used in PA was "Sierra Wave" EMG machine. This doctor (NOT Dr Tsai, Cook, or Smith) had what looked like an old eniac (ie ancient computer) contraption. The Sierra Wave is powered on a laptop. Big difference in look. Anyways.. he asked about my symptoms and I told him. After the test he said it didn't look like I had it and he called my doctor and recommended against surgery. I was a little irked because I wanted this to be over and everything/everyone else pointed to me having it. My hand surgeon (Dr. John Cook in Newport Beach) had a great personality. The office wait is long at times (try for the earlier appointments they seeem to be better), but he is a really good doctor. The fact the I had all the symptoms (I forgot to mention I also had tinels sign - when they lightly tap on the nerve and your fingers tingle) and two tests showing I seemed to have it but another doctor saying I didn't was aggravating.
So Dr. Cook sent me to see Dr. Harold Smith in Irvine, a fine neurologist and sleep disorder specialist (who also says be very very very careful of Ambien to anyone else out there reading this and recommended alternatives. In some of Europe where there is no prescription required it seems there may be permanent memory loss by young people taking a lot of this). Dr. Smith gave me the most comprehensive EMG I had. He tested the neck/back/shoulder/arms to look for double crush injuries (ie two points of impingement at shoulder/neck/elbow etc). He also looked for signs of ALS and other nerve disorders and thankfully didn't see any signs of it. He also checked for signs of permanent nerve damage and there was none of that either. The thing with nerve injuries is you have to be careful with the length of time you have them. Eventually permanent damage can occur and there may be no coming back from it. I admit.. mine has gone on for too long, however I was able to manage symptoms to make it 'manageable but still frustrating since it never went away'.
There are several components of the nerve that are tested, sensory and motor functions. He said in my case there was an abnormally fast response in a particular test on my nerve and I should thank my parents. I don't recall the portion I just believe he made the analogy of it being like the copper inside a wire. He then added it made no difference in day to day life - except in nerve resiliency and compensation - which is why he felt could be why I've had this for so long without reaching a critical point and the strength/etc has remained pretty strong.
Dr. Smith immediately said after the first test "I strongly disagree with the last neurologist.....you clearly have signs of CTS right across your elbow". I was still just a bit below 50 m/s around the elbow however the rest of the nerves he tested all measure at least 60 m/s in speed, so even though 50 m/s is the low end of normal.. in comparison to the rest of my nerves it was significantly different. I think I scored 48 and 49 for each arm across the elbow. He said its not necessary to immediately rush into surgery that day (like in the case where he sees damage occuring now) but I should look into it. btw.. when he did the needles for the test he claimed he did it without _any_ pain. The last time I felt a pinch in PA with different people giving me the test, but very manageable. He used teflon coated needles. So.. when the needle was put in my hand (and back later) it seriously didn't hurt one bit.. not even a pinch. The teflon coated needles made a big difference.
I went back a few months later for another test with Dr. Smith. He is a funny guy too. The left arm was bugging me a lot more. He did the same tests again and the left arm had deteriorated and was now around 39 or so, so he thought it is time now to get the surgery. Summer was here so I figured I'd wait until after summer (since I had biking/surfing/etc ahead of me this summer). Now its November 17th and I'm schedule for Wednesday to have the surgery.. so hopefully a good follow up.
Btw...my concern was that at some seemingly unknown point, the nerves can deteriorate. You can develop ulnar claw. Do NOT let this go. Ulnar claw is not reversible and you will lose the use of your hand. You never know when this can happen.. so if you need surgery.. get it. The neurologist told me of several patients that developed it - scary.
Additional notes: I was not prescribed physical therapy when first diagnosed. Some doctors do.. but it seems there is debate if its more useful than just 'leaving the nerve alone' and making sure you stop damaging it if indeed it is from putting too much pressure on it.
Also it seems different doctors have very different methods after transposition surgery. Some in the past would put almost a cast on. I would think with this there is even more atrophy. I was concerned about this but today the doc said its not as bad as the knee (which I was comparing it to.. when I had knee surgery my leg shrunk considerably in two weeks). He said the arm doesn't respond the same way.. but I should still expect atrophy. Some doctors prescribe PT, mine did not. he said just keep flexing it to keep the nerve gliding and minimal scar tissue from forming around the nerve and Im presuming putting pressure on it.
The surgery Im going in for moves the nerve and it goes something like this (this is my understanding anyways, it may be a bit off)
1. Block the artery in the arm to stop or limit bloodflow.
2. Cut open the arm at the elbow, 5-6 inches or so...
3. One through the skin try to avoid cutting smaller nerves if possible. Sometimes it is necessary to move the nerve.
4. cut around the nerve to free it - small capillaries are cut. The 'in situ' method does not do all of this and thus they say preserves nerve vascularity, althoug the doctor did tell me there seems to be no negative affect on the nerve of 50 years of doing this, as the nerve has its own blood supply anyways inside of it.
5. cut the muscle that attaches to the inside point of your elbow. Cut at a zigzag because when it is reattached, the points of the zigzags will be sewn together to make the muscle slightly longer to limit stress on the muscle during healing. I am told it heals fine, and this doesnt seem to affect anything permanent in the muscle usage. I asked if people can feel the scar in the muscle under the skin, he said he hasn't heard that.
6. lift the muscle and move the nerve from your elbow under the muscle. I read on the net a new tunnel is 'formed' but was told there actually isn't one formed, the nerve is set under the muscle and it settles into its own pathway.
7. muscle is reattached - it is now 1/2 inch or so longer
8. artery unblocked
9. everything closed up and arm wrapped.
Immediately the arm can be moved, although with a big bandage it will be limited. The doc said the stitches won't be overstressed by moving it, plus the bandage limits the range for the first week. Nothing should be lifted. The muscle that is cut is responsible for moving the wrist up and down (ie when holding the hand parallel to the floor) so of course you want to be careful with the healing process.
Today at the doctor was the first time there seemed to be slight weakness in the left pinky and ring fingers. You put your hand flat on the table and he tries to pry the fingers apart. he never used to be able to do it and can now do it on my left ring/pinky fingers. Good thing I guess surgery is in two days. This shows possible slight signs of degradation of the muscle function. I didnt have too much of a difference in sensation of the fingers. This varied at times over the months. Sometimes the pinky would feel more numb when they put a roller with spikes on it on the finger.. today it felt pretty similiar _maybe_ a little less sensitive.
Another test they do is to have two points on a tool, and on the other side one point. Close your eyes and try to tell if it is one point or two points touching. If you cant tell in the ring or pinky fingers - then possibly nerves are troubled there.
Why am I doing this? When I was diagnosed with Cubital Tunnel Syndrome, most information was from the hand centers telling basic causes, treatment, and a very very high level of how the surgery went. Doctors aren't always up front with how a surgery will go. So let this be a log of my surgery experience. (Added note 2.5 weeks after the surgery - hand feels pretty good. using it for light driving, typing is no problem. Walking around during the day now I am surprised at how little I notice I had a major procedure done on it 2.5 weeks ago)
First.. some thanks goes to James:
http://quitelucid.blogspot.com/2006/04/cubital-tunnel-syndrome-part-one.html
He posted his experience which pushed me more to post all of this - it was great he had his info posted, so hopefully this adds to it a bit. There was little out there of people's detailed experience with the surgery and recovery so I wanted to add to the little info out there from a patient standpoint.
Second.. I'm just typing as I think (and watch TV) so forgive the lack of cohesiveness in these thoughts here.
If you need this surgery:
1. Practice one arm activities here and there ahead of time.
2. Purchase floss picks if you dental floss, otherwise you wont be able to.
3. If the doctor doesn't provide anything to put around your arm for bathing (click here for example) then you can buy one or use a trash bag with tape around your arm. Yea.. its rigged but if the doc doesn't give you one you'll find something quick that works. Just keep the arm raised in the shower (or take only baths and not showers for two weeks and avoid this trouble)
4. Make sure you have extra pillows or blankets to raise your arm up on while resting.
5. Have as much stuff around as possible to prevent boredom - netflix is awesome and so is a nice cable package
6. Make sure you have some clothes that can stretch wide easily in the arms to fit around the thick bandage without squuezing it. Some stretchable cotton shirts (ie most t-shirts) have a seam on the sleeve where it is folded over and sewn. That can prevent it from being stretched the amount you need over the bandage. Like I said... its a thick bandage, so just check to be prepared.
7. If you will be recovering mostly alone - either living alone or others around you will be away working/school/etc then you want to make sure the food is easily accessible with one arm and you've bought stuff that can easily be opened with one arm. Note: water bottles are somewhat difficult. You can open them by squuezing the bottle between your legs.. but if its a very flexible bottle then when you twist it - it can overflow on your lap from squeezing the bottle.
8. Train your pet to stay away on command or figure a way to avoid it. My dog kept wanting to say 'hi' and almost jumped on my arm several times untill I figured how to avoid it (pillows on the bed to keep the dog on my Wife's side hehe) and the arm would stay on the edge of the couch during the day.
Useless tidbit: Neurologist said these nerve issues show up more in people that spend first 12 years in east coast/colder climates.
I developed numbness/tingling in my right hand in the pinky and ring fingers about 2.5 years ago. I was pretty sure it was carpal tunnel syndrome, since I worked all day and night (literally) on the computer, doing software development for a corporation during the day, and working in security software for my own company at night. I was on a plane when I first noticed it. About two weeks later the other hand started feeling the same way. It wouldn't go away. It was worse when I worked on the computer. I purchased carpal tunnel braces wrist braces and wore them during the day and at night, but the symptoms didn't go away. I went to go see a doctor in Allentown, PA at orthopedic associates. The tingling felt like it was in my ring and pinky fingers. At times I would feel a 'ticking' or pulsing (more like a click rather than a pain) at the base of my ring finger. Weird.. I know.
The doctor said I should pay attention of how I rest on my arms. Don't put pressure on the elbow (more importantly right beneath the elbow where you sometimes lean on armrests and desks at work - this compresses the nerve and can irritate it). Sleep at night with my arms straight, not bent, use a towel if needed wrapped around the arm to keep it straight. Some people naturally have a sublaxation of the nerve, which means as they bend their elbow, their nerve pops over the point on the side of your elbow or rubs on it. If you look at the inside of your arm, there are two points and between them the nerve passes (your funny bone nerve). The one you can see without bending your arm out is the one the nerve _can_ pop over and wear away at the nerve. This does not happen to everyone (oh ya.. disclaimer: Im not a doctor.. Im just sharing my experience with having CTS and what I seem to have found out during my experience). In my case, I did not have sublaxation of the nerve. In one arm the nerve moved close to the edge of the bump but never went over. In the other arm it was even less pronounced.
The doctor told me it goes away in 90% of the cases, with that said he still did about 12 surgeries a week for it. My Step-Father had it years back and his healed up with no problem when he followed the conservative treatment. I was sent for a nerve conduction study and then told we would follow up in 12 weeks (I believe it was 12 weeks.. this was a while ago). I scored just under the norm of 50 m/s nerve speed on both arms if I recall. As part of the test they put a needle in several places in your hand and have you put pressure (ie they press on your finger - not the needle - and you push back). This causes a voltage/signal reading on the equipment. The specialist said 'yep - that nerve sounds crusty and unhappy'. To me it sounded like an 80's cheesy racecar sound... so I knew something was obviously wrong, as I was born in the 70's. duh. : )
My Aunt warned me about this test (this is an EMG test - ie nerve conductivity test) - she said it was worse than the surgery she had for her carpal tunnel syndrome, so I was kinda dreading the test. It was an absolute piece of cake. I hate needles, but they weren't bad either.. they just barely tap them into the skin, its not like a shot probably more like accupuncture. They are barely tapped in, it does pinch a tiny but though.
So I was careful in everything I did and went back 12 weeks later and had another nerve conductivity test. No change. No better, not worse. The test results were the exact same. So....he recommended surgery.
Let me also state for the active folks I'm also an avid mountain biker. I like technical - rocky - steep riding if its around. Who cares you say. Well, in PA when I lived there.. I enjoyed a lot of rocky riding and that I'm sure helped aggravated my arms a bit. Now that Im living in CA - the local trails are long (for instance my local 'hill' is 13 miles off road up the mountain to an elevation of about 5600 feet - http://en.wikipedia.org/wiki/Santiago_Peak), but it is not nearly as rocky as some flatter trails in PA (salisbury - walking purchase for instance). So biking out here my arms never hurt during and not really after either. During biking (in PA and CA) there was enough stimluation I guess that overrode any sensation in my hands to CTS. However it would seem two days later or so it would be worse after heavy biking in PA, not immediately after though. I could never say 'the night after biking it hurt' within reason of course (at Mammoth mtn bike park in CA this past summer I can say that night my arms bugged me at night after the first ride- but thats a lot of riding in a day). Let me say again, I tried not riding for several months but it didn't go away at all. No matter what conservative treatment I tried it would never get better past a certain point.
I tried anti inflammatories, less computer, no biking, etc. It never went away. I also was going to the gym a lot when this happened. I'm a thin guy, by no means stocky. I asked the doctors assistant in PA if going to the gym could cause this. She gave me this attitude like it was a silly question and said no we have guys that come in that are huge without these issues. In hindsite.. she was a dummy.. just probably in pre-med and already over-confident in her knowledge. What I had thought could have happened.. and later confirmed is possible with a hand/arm surgeon - is that indeed - parts of your anatomical structures can thicken and put pressure on the nerve. When going to the gym your body adapts - regardless of your size. Everyone has different physiology and reacts differently to activities. So I feel once they thickened and put pressure on the nerve, they never thinned out - if that is what happened in my case. It seems to fit though since it would get better but only to a point/
So. life has been a constant adjusting of activities. I stopped weight lifting and haven't done it since (btw.. when this first started and I would do tricep exercises I would feel a pain/pressure right near where my nerve was in the elbow.. but never felt it any other time in that area, and I stopped going within two weeks of that starting ). I've tried not biking, not working on the computer as much, etc for months on end with minimal change. If it really acted up (lots of tingling) and I took it easy for a few weeks.. it would get better.. but never fully go away no matter what I tried, even though it was very manageable at times.
I was planning a move to CA and the doctor said check with a doc in CA once we move. Right before we moved I was biking again a lot, and packing, etc and it really started bugging me. Even driving cross country was a pain.. luckily I had a good stay in New Orleans and other places to make me feel better : )
Once I was in CA I went to go visit a doctor out here and he felt surgery was the option at this point. I couldn't believe though there wasn't an 'easier' surgery for this. An incision 6 inches long, cutting the muscle, moving the nerve sounded excessive. Three months before I could resume full physical activity and biking? no way! No one seemed to know of an alternative. Finally I found one! An Indian doctor in Germany developed a technique for decompression of the nerve via endoscopic means. At last.. I don't have to get sliced open with a 5-6 inch incision.
The endoscopic method is called in situ decompression and is now finally gaining some momentum. NOTE: This surgery opens up the tunnel.. think of it as a tube through which the nerve travels. If the source of the problem is not the tunnel being too tight but instead another structure putting pressure on it (ex muscle/tendon) then this procedure may not solve the issue - as it did not in my case. I was told by Dr. Tsai though that he's only had two others it didn't work for - but Im just relaying my experience. It was worth it though for me to at least try that surgery..which I did.
This is a youtube video showing this technique.
http://www.youtube.com/watch?v=qttiyxBP0uM
Here is a study in an in situ decompression technique:
http://www.egms.de/en/meetings/dgnc2006/06dgnc190.shtml
Here is a doctor I spoke with in Germany:
"A novel endoscopic technique in treating single nerve entrapment syndromes with special attention to ulnar nerve transposition and tarsal tunnel release: clinical application."
http://lib.bioinfo.pl/pmid:16888558
Well.. I didnt really want to travel to Germany for as it was put.. a 'medical vacation'.
So I searched further and finally found someone in the US that did this procedure. Dr. Tsu-Min Tsai in Louisville, KY. He seemed to be an accomplished surgeon, he took part on the team that actually did a whole hand transplant. It was pretty neat to see the video of a guy that didn't have a hand for years get a new hand and he was able to move it. Frankenstein.
I was happy at finding this. The procedure involves cutting a small Z shaped incision and going in with a tube and cutting the area around the nerve away to release some pressure on the nerve. I called the office.. setup an appointment at the Jewish Hospital in Louisville with the potential for surgery if I needed it. They had a special rate at the local hotel. Btw - there is an _awesome_ restaurant nearby serving Mayan/Mexican cuisine. It was tasty.. but I would drive there and not walk from the hotel. We walked and got to a street corner at night and suddenly there was a flash and a voice said "you are entering a restricted area and your picture has been taken". This came from a device mounted on a light pole, so it seems that corner must have had some pimp problems or something. It wasn't restricted, there were businesses, etc on that street. Nonetheless, we walked back to the hotel (10 min) and drove to the restaurant.
It was confirmed after an examination by Dr. Tsai that I needed surgery... so I went downstairs for all the paperwork, vitals, etc.
The surgery the next day was a piece of cake. My arm was numbed before the surgery. They give you something in your IV to make you loopy and not care about anything, it felt quite good. Then they have you put your arm above your head and inject the nerve to numb your entire arm. They let you sit around for a while in bed and keep checking your arm to see if its numb. Then they bring you in to the operating room. I remember being pushed down the hall and suddendly felt warm and wonderful. I asked the nurse if she just gave me something in my IV. "YUP" she said. Nice! Then I was out.
I woke up and was out of the hospital in no time. My Wife and I went to the "Lucky Strike" restaurant for lunch in downtown Louisville which was a neat smaller city. Now.. this is funny. My arm is totally numb and in a sling. I felt great.. like I never even had surgery that day. So I go into the restroom. OF course, being a guy, we have our urinals, which Im standing at and... um.. checking the time. Well I am in the restroom alone and just looking around as Im doing my thing and suddenly feel movement in my shoulder, which wasn't numb. My arm was slipping out of my sling and about to fall directly in the path of you guessed it. Luckily the other hand saved it in time. I had to share that because I've been laughing for about a year for what almost happened.. so if you are a guy.. just be careful. My sling maybe wasn't quite large enough for a guy like me with long arms.. or it just wasnt in there all the way from me moving around in the car or something. There is a baseball museum there - think louisville slugger. Also there was a neat old graveyard where not only Colonel Sanders from KFC is buried, but also rows and rows of Civil War soldiers lined up like Arlington National Cemetary.
Later in the day (hours later) I was laying in bed at the hotel and still couldn't move my hand. The block started to wear off and I would seng a signal to my fingers to move and would get a slight twitch. 15 minutes later more of a twitch.. and so on until I regained full movement when I awoke the next morning .. that was a weird feeling.
I had some swelling around the elbow.. and pain if I rested it on anything. However a few days later.. my hand pain was worse than it had ever been. Usually it gets better. Not in my case. It was pretty miserable and I couldn't seem to get a straight answer from the doctors office "oh.. just wait.. each person is different'. I said shouldn't it be a little better? "Usually yes.. but everyone is different". Something didn't feel right though. Since I couldn't get a quick reply from anyone I think I emailed and got a response fgorm a guy there and he was very helpful and looked into it.. the doctor was out. Anyway.. I was told this procedure had only not worked on two people during the whole number of years doing it. In fact the doctor didnt even perform the transposition surgery now (as I was told by someone there) since this procedure basically always works. Well.. in my case it didnt. I was told it can take a year to recover.. fine.. but with how my symptoms were somewhat minimal compared to some people I figured it would be a quick results.
Nerves heal because of a flow in them called axonal flow. This starts at the spinal cord and moves an estimated inch a month in humans (its been observed directly in animals but direct human testing hasn't occured, only derived measurements from the healing process as far as I know). So if your elbow issue is resolved, it could take a year for the damaged segment to flow down from the elbows to the fingertips as I understand it. In one case I was told about a patient actually got worse after surgery as it seemed the nerve was dying, but it started healing and eventually got better. This is not the norm of course but these things can happen. I had asked about the risk of cutting the nerve and was told the risk of course exists but had never been seen by my doctor.
Anway.. over a year later.. no change at all.. so the surgery did nothing for me at all.
I lost nothing but some time and a little $ trying this... so it was an experience.. and I have no pain or numbness from that surgery, and only a tiny little 'z' shaped scar... so I would urge someone to look at this as an alternative as it seems to work for most people according to that center. I was told this procedure opens all 6 points of compression.. obviously not all causes of cubital tunnel though since I still had the same problem over a year after that surgery (or so we'll find out after this next surgery)
Since this surgery didn't do a thing for me...I went back to the doctor in CA.
We scheduled the 'full monty' surgery - ie ulnar nerve transposition. Since my symptoms were minimal compared to some people (no strength loss yet) right before the surgery he said he wanted me to get another nerve test. So literally the day before the surgery I went to see a neurologist for another nerve test (this would be my third - and now prob a year or longer after I first developed symptoms). The doctor had an ancient machine that he shocked the arm with (its a minor jolt) and they look at the response graph on the screen. I asked if this would give the same results as the 'more current' machine I had results done on in PA. He said it would yield the exact same results. Well.. it didn't. The software/machine used in PA was "Sierra Wave" EMG machine. This doctor (NOT Dr Tsai, Cook, or Smith) had what looked like an old eniac (ie ancient computer) contraption. The Sierra Wave is powered on a laptop. Big difference in look. Anyways.. he asked about my symptoms and I told him. After the test he said it didn't look like I had it and he called my doctor and recommended against surgery. I was a little irked because I wanted this to be over and everything/everyone else pointed to me having it. My hand surgeon (Dr. John Cook in Newport Beach) had a great personality. The office wait is long at times (try for the earlier appointments they seeem to be better), but he is a really good doctor. The fact the I had all the symptoms (I forgot to mention I also had tinels sign - when they lightly tap on the nerve and your fingers tingle) and two tests showing I seemed to have it but another doctor saying I didn't was aggravating.
So Dr. Cook sent me to see Dr. Harold Smith in Irvine, a fine neurologist and sleep disorder specialist (who also says be very very very careful of Ambien to anyone else out there reading this and recommended alternatives. In some of Europe where there is no prescription required it seems there may be permanent memory loss by young people taking a lot of this). Dr. Smith gave me the most comprehensive EMG I had. He tested the neck/back/shoulder/arms to look for double crush injuries (ie two points of impingement at shoulder/neck/elbow etc). He also looked for signs of ALS and other nerve disorders and thankfully didn't see any signs of it. He also checked for signs of permanent nerve damage and there was none of that either. The thing with nerve injuries is you have to be careful with the length of time you have them. Eventually permanent damage can occur and there may be no coming back from it. I admit.. mine has gone on for too long, however I was able to manage symptoms to make it 'manageable but still frustrating since it never went away'.
There are several components of the nerve that are tested, sensory and motor functions. He said in my case there was an abnormally fast response in a particular test on my nerve and I should thank my parents. I don't recall the portion I just believe he made the analogy of it being like the copper inside a wire. He then added it made no difference in day to day life - except in nerve resiliency and compensation - which is why he felt could be why I've had this for so long without reaching a critical point and the strength/etc has remained pretty strong.
Dr. Smith immediately said after the first test "I strongly disagree with the last neurologist.....you clearly have signs of CTS right across your elbow". I was still just a bit below 50 m/s around the elbow however the rest of the nerves he tested all measure at least 60 m/s in speed, so even though 50 m/s is the low end of normal.. in comparison to the rest of my nerves it was significantly different. I think I scored 48 and 49 for each arm across the elbow. He said its not necessary to immediately rush into surgery that day (like in the case where he sees damage occuring now) but I should look into it. btw.. when he did the needles for the test he claimed he did it without _any_ pain. The last time I felt a pinch in PA with different people giving me the test, but very manageable. He used teflon coated needles. So.. when the needle was put in my hand (and back later) it seriously didn't hurt one bit.. not even a pinch. The teflon coated needles made a big difference.
I went back a few months later for another test with Dr. Smith. He is a funny guy too. The left arm was bugging me a lot more. He did the same tests again and the left arm had deteriorated and was now around 39 or so, so he thought it is time now to get the surgery. Summer was here so I figured I'd wait until after summer (since I had biking/surfing/etc ahead of me this summer). Now its November 17th and I'm schedule for Wednesday to have the surgery.. so hopefully a good follow up.
Btw...my concern was that at some seemingly unknown point, the nerves can deteriorate. You can develop ulnar claw. Do NOT let this go. Ulnar claw is not reversible and you will lose the use of your hand. You never know when this can happen.. so if you need surgery.. get it. The neurologist told me of several patients that developed it - scary.
Additional notes: I was not prescribed physical therapy when first diagnosed. Some doctors do.. but it seems there is debate if its more useful than just 'leaving the nerve alone' and making sure you stop damaging it if indeed it is from putting too much pressure on it.
Also it seems different doctors have very different methods after transposition surgery. Some in the past would put almost a cast on. I would think with this there is even more atrophy. I was concerned about this but today the doc said its not as bad as the knee (which I was comparing it to.. when I had knee surgery my leg shrunk considerably in two weeks). He said the arm doesn't respond the same way.. but I should still expect atrophy. Some doctors prescribe PT, mine did not. he said just keep flexing it to keep the nerve gliding and minimal scar tissue from forming around the nerve and Im presuming putting pressure on it.
The surgery Im going in for moves the nerve and it goes something like this (this is my understanding anyways, it may be a bit off)
1. Block the artery in the arm to stop or limit bloodflow.
2. Cut open the arm at the elbow, 5-6 inches or so...
3. One through the skin try to avoid cutting smaller nerves if possible. Sometimes it is necessary to move the nerve.
4. cut around the nerve to free it - small capillaries are cut. The 'in situ' method does not do all of this and thus they say preserves nerve vascularity, althoug the doctor did tell me there seems to be no negative affect on the nerve of 50 years of doing this, as the nerve has its own blood supply anyways inside of it.
5. cut the muscle that attaches to the inside point of your elbow. Cut at a zigzag because when it is reattached, the points of the zigzags will be sewn together to make the muscle slightly longer to limit stress on the muscle during healing. I am told it heals fine, and this doesnt seem to affect anything permanent in the muscle usage. I asked if people can feel the scar in the muscle under the skin, he said he hasn't heard that.
6. lift the muscle and move the nerve from your elbow under the muscle. I read on the net a new tunnel is 'formed' but was told there actually isn't one formed, the nerve is set under the muscle and it settles into its own pathway.
7. muscle is reattached - it is now 1/2 inch or so longer
8. artery unblocked
9. everything closed up and arm wrapped.
Immediately the arm can be moved, although with a big bandage it will be limited. The doc said the stitches won't be overstressed by moving it, plus the bandage limits the range for the first week. Nothing should be lifted. The muscle that is cut is responsible for moving the wrist up and down (ie when holding the hand parallel to the floor) so of course you want to be careful with the healing process.
Today at the doctor was the first time there seemed to be slight weakness in the left pinky and ring fingers. You put your hand flat on the table and he tries to pry the fingers apart. he never used to be able to do it and can now do it on my left ring/pinky fingers. Good thing I guess surgery is in two days. This shows possible slight signs of degradation of the muscle function. I didnt have too much of a difference in sensation of the fingers. This varied at times over the months. Sometimes the pinky would feel more numb when they put a roller with spikes on it on the finger.. today it felt pretty similiar _maybe_ a little less sensitive.
Another test they do is to have two points on a tool, and on the other side one point. Close your eyes and try to tell if it is one point or two points touching. If you cant tell in the ring or pinky fingers - then possibly nerves are troubled there.
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