16 days post-op for ulnar nerve transposistion - Second follow up appointment

Friday

(ok.. these pics were the next day ... Saturday at a friends place I went over while he was brewing beer. He had a camera and my cell phone cam stinks and my camera is packed away somewhere from the last move)

Note the bruising is only up top.. none around the incision which I was very surprised at how it healed up so far. When I tap my finger above the part of the incision towards the bicep, I feel a tingle in my pinky and ring fingers. This is probably from the nerve still being sensitive and swelling/healing process going on.








I had the appointment to get the stitches out today. It turns out they were dissolving stitches and when the bandage was removed, there were no stitches. Its pretty amazing, there is basically no bruising at all around the incision. Its a little swollen, not too bad. Today I can reach my thumb back and touch my shoulder without any assistance from the other hand.

At the appointment I was told to still take it easy with the arm as it is healing still of course - but now I can use it to eat, lift things like a cup of water no problem. I asked if its ok to drive in two weeks - he had me squeeze his hand and said the strength seems pretty good so I could prob use it to drive now. Of course I was told if I do anything that hurts the arm - don't do it.

Tonight sitting at home my wrist started hurting after waking from a nap.. don't know why- but it hurt a decent amount so I took some ibuprofen.

My hand is slowly feeling less 'dull' (not from the nerve issue before surgery but after effects from the surgery)

The tip of my elbow is hypersensitive. When the prickly wheel was rolled across it.. it was pretty uncomfortable - which is weird because to the touch it feels pretty numb. The elbow is definitely swollen.. but it is a lot less than I thought it would be and am shocked there is basically no bruising except for the 'garbage' that is on the bicep area flowing towards the chest cavity from keeping the arm elevated (which I am no longer doing).

I was told today I can start putting cream on it. I used a little alcohol and q-tips to remove some of the pen lines after washing it twice. I purchased some scar cream with silicone and spf (it seems better creams have silicone in it to reduce scar formation). I had used ScarGard on a previous surgery but stopped quickly because it just flaked up and came off easily after applying it. I want to keep the area moisturized so the cream is pretty good for that rather than a brush-on dried up flaking scar treatment.

13 days post-op for ulnar nerve transposistion

Tuesday

I can't wait until tomorrow to type.. sooooooo I started typing a bit today.. now tonight I'm typing fully with both hands. I doesn't hurt at all and hand speed is pretty normal for typing. Then again laptop is in lap and only wrists are moving slightly... so I wouldn't expect it to hurt at all.

Fingers on left hand are still 'duller' than right hand.

The incision is getting more sensitive around the elbow. Even resting it on a pillow is sensitive. not as in "Im infected" sensitive but more as in "Im healing so Im extra sensitive"

The burning that I had I dont think I had this morning waking up.. if I did it was minor. Im able to bend my arm back and touch my hand to my shoulder now. I can't do it on my own.. but need to push gently when I do it. There is no pain though.

12 days post-op for ulnar nerve transposistion - more flexibility/new minor pains

Monday

Differences: Last night was first without pain meds. I could've not used them sooner.. but wanted to sleep. Sure enough.. my arm burned last nigh for some reason and it wasnt a good nights sleep. This only seems to happen at night before sleep or while I'm sleeping. When I lift up and then lay it down I get a burn in my hand for about 5 seconds. It didn't happen during the day at all though. Last night I was able to touch my thumb to my shoulder for the first time since surgery, so flexibility is coming back. I had to push gently and slowly on it with my other arm though. The bruse is slowly diffuing, no new garbage. Im typing with one finger on the surgery arm now so I can still keep it still and type with the right hand. It;s going pretty fast. I still have to force myself to not use it, as it feels good enough so my body goes to use it.. ie close a door, etc, but I stop myself. I've also not been keeping it up as much as I should during the day since Im running around work a lot, although I dont see additional swelling from it.. and when I stop I usually hold it up. When I eat I just rest it on the table.. so its at least not flowing 'down'.

My right arm is definitely acting up more from using it as the sole arm.


Here you can see there is still a lot of bruising. It is not painful though. Stitches come out Friday.. cant wait for that, although I think the bandage makes it a lot more pleasant to rest it on.

Ten days post-op for ulnar nerve transposistion - more flexibility/new minor pains

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.

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!

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.