On July 8th 2011 I had ulnar nerve transposition surgery. Now unless you are a doctor or nurse or have had problems with your elbows you may not know what your ulnar nerve is. It is one of three main nerves in the arm and runs from the collarbone down the arm to the inside of the elbow and on to the hand. It is responsible for the feeling sensations in the little finger, half of the ring finger and the outside front and back edge of your palm. A more common name for the ulnar nerve is the “funny bone”. Ulnar nerve transposition surgery isn’t the most common surgery but it’s also far from rare. Normally the main reason for this surgery is nerve compression in which the nerve is trapped or pinched behind the elbow. Symptoms of this entrapment typically include tingling in the pinky and half of the ring finger and it feels kind of like they are falling asleep. This feeling is actually the reason I finally went back to the doctor which I will talk about in a minute. Before I get to that I want to start my experience from the beginning of when I first noticed the problem with my elbow and the steps leading up to and after my surgery.
You Have Medial Epicondylitis or Golfer's Elbow
On New Years of 2010 I made the resolution that I would get myself in shape and after a month or so of working out lifting weights I seen an infomercial for P90X. Needless to say I bought the program and after a few months was really starting to see some great results. Then one Saturday in May while doing the Kempo X workout, similar to kickboxing, I noticed the inside of my left elbow was hurting nothing horrible just a dull ache. Over the next month the pain never really went away and the worst part is it was keeping me from working out. So I eventually went to my family doctor. He informed me that I had what was known as medial epicondylitis or golfers elbow which is an inflammation of the tendons on the inside of the elbow. This is basically the same as tennis elbow except tennis elbow is on the outside of the elbow. The doctor prescribed me some anti-inflammatory medication that I took for about eight to ten weeks. This did absolutely nothing for me so back to the doctor I went. This time he recommended I get a cortisone shot and that it should help relieve the pain. I decided it was worth a try even though he warned me that the cortisone would be injected just under the skin and it may discolor the skin at the site of the shot, which it did. Not only did it turn my skin white but it made that area very sensitive to the touch. Later I found out from another doctor that the cortisone shot was not administered correctly. The worst part about this was that it didn’t even help with the pain and the sensitive skin actually made it worse. So after this fiasco I decided I would just stop using my arm as much as possible so that maybe it would heal on its own. This also began my new hobby of running since I could no longer lift weights.
Your Ulnar Nerve is Slipping over the Bone
Now we’ll fast forward about a year and a mini marathon later. My elbow was still bothering me but only when I over used it. Then one day while looking in the mirror while shaving I noticed something in my elbow move. Almost like a piece of spaghetti under the skin, it looked kind of like a vein was moving or something. I immediately checked the other elbow for a comparison but it did not have this movement which seemed strange but it didn’t bother me enough to go back to the doctor. So I did what ever man does and just forgot about it. Another month or so goes by and I start noticing that my pinky and ring finger are going numb and tingling for no reason. This scared me to the point that I did go back to the doctor. I showed him what was going on with my elbow and he wasted no time referring me to an orthopedic surgeon.
Two days later the orthopedic surgeon tells me that my ulnar nerve was slipping out of the cubital tunnel which is what keeps it in place. When I bent my arm the nerve would roll over the bone in my elbow which was inflaming the nerve and that was why it was going numb. This is when he said I would need an ulnar nerve transposition but first he wanted me to have an NCV (nerve conduction velocity) test performed which measures how quickly electrical impulses move along the nerves. This test helps the surgeon determine if there is any damage to the nerve and to helps localize areas of concern. And yes this test is as fun as you would think. What they do is hook you up to some electrodes and then shock you in different locations. In my case they were testing from my shoulder down. There really wasn’t much pain but it would make my arm and hand twitch. Anyways I passed this test with flying colors so there was not permanent damage to my nerve.
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Time for Surgery
Four days later I was back at the orthopedic surgeon making my appointment for surgery which would be the following Friday. The surgery took about an hour which was not big deal because I would be asleep the whole time. The worst part though was that I couldn’t eat after midnight the night before and my surgery wasn’t until 1:00pm. I was starving! After the surgery I woke up in the recover room I felt very sleepy and drugged and couldn’t really talk or think right. The anesthesia was making sick and every time I moved I vomited, so they gave me an anti-nausea pill which also made me sleepy. Fifteen hours later I woke up in my bed at home. I had no memory of getting dressed or any part of the hour long drive home. I’m sure my wife who was driving had a good time with that. When I finally woke up the next morning I realized my arm was wrapped in a soft cast that went from my shoulder to my wrist and was bent to ninety degrees. It basically kept me from doing anything.
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Recovery after Ulnar Nerve Transposition
For the next two weeks I didn’t do a whole lot except play on the computer and watch TV. I didn’t even go outside because this time coincided with the hottest two weeks of the summer. We had twenty days of over ninety degree temperatures which included humidity that could kill. Don’t get me wrong I could have gone out but I figured I didn’t want to get the cast all sweaty and stinky. The hardest part for me during this time was that I couldn’t do much with my two boy’s ages two and three. And getting them to understand why daddy couldn’t hold them or give them baths was kind of hard. One good thing though was I didn’t have to change any diapers. My wife wasn’t very thrilled with this, bless her heart.
So after two weeks of healing I went back to the doctor and they removed the soft cast. This is when I got to see my scar for the first time. It goes right across the bone on the inside of my elbow and measures about six inches long. This kind off shocked me a little since I have no other scars on my body. After this I was immediately sent to a physical therapist that fitted me with a thermoplastic cast. These casts are made from a type of plastic that is heated and molded to your arm. It wasn’t too bad though since I could remove it if I wanted but I did have to wear it when I was around my kids, driving, or sleeping. The purpose of this cast was to protect my elbow from getting hit.
For the next three weeks I had to go to therapy but all I was allowed to do was range of motion exercises which consisted of turning my wrist back and forth as well as straightening and bending my arm from 0 to 135 degrees. The one other thing I was told to do was to desensitize my scar. This is done by touching and moving it around with your fingers. This didn’t hurt but it did give me the hebby jebbies the first few times. I had returned back to work during this period but still couldn’t do anything that involved lifting. After three weeks of this light therapy I had another appointment with the surgeon. He released me from any restrictions and told me to just listen to my arm. If it started hurting I was doing too much. He also sent me back to therapy for strength training which consisted of doing basic upper extremity exercises using very light weights with high repetitions.
And this brings us to today just shy of six weeks after my surgery. I can now hold my kids and do just about anything I normally would. My arm is still a little sore and stiff but I do have my full range of motion back. I can feel it getting better almost everyday though it is still very weak from lack of use. I feel I should also mention that at no point did I ever feel any pain, I didn’t even take the pain pills I was prescribed. There is one thing that does bother me and that is I have a numb spot on the underside of my forearm right above my elbow. The doctor said this was normal and that I will probably get the feeling back in time.
I hope this story will be a comfort to anyone else that might need this surgery. And though it will be quite some time before I know for sure I can’t help but feel I will be 100% back to normal with nothing but a scar to remind me of this time. If you are interested in how the rest of my recovery from ulnar nerve transpositions goes check back often as I will be updating this article as time passes to let everyone know how it turns out in the end.
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