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"

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.

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.

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.

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.

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

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.

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.