Surgery Beta - ulnar nerve transposition

[Twoplanker]

I've got nerve damage in my left hand due to too many late nights spents making websites, working on PMGEAR, mountain biking, virtually continuous masturbation and feces throwing, etc.

My fucking hand is atrophying away - it looks old, frail, and thin because the muscles cannot live without nerve enervation. The solution comes in two parts, the first being an operation called ulnar nerve transposition. The "funny bone" nerve will be taken from the inside of the ulna and placed on the inside of my arm, making the path of the nerve more direct and less impinged.

Anyone had anything like this done? What can I expect: recovery time, pain, whatever you can tell me.

The second surgery is in the wrist, basically what is done for carpal tunnel syndrome. Any beta on that?

I go under the knife next week.

[Viva]

J Hand Surg [Am]. 2004 Jul;29(4):619-24.

Functional outcomes in young, active duty, military personnel after submuscular ulnar nerve transposition.

Fitzgerald BT, Dao KD, Shin AY.

Division of Hand Surgery, Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA.

PURPOSE: The purpose of this study was to report on the results of submuscular ulnar nerve transposition (SMUNT) for treatment of cubital tunnel syndrome in a young, active duty, military population. METHODS: Twenty patients (20 extremities) were evaluated retrospectively a minimum of 12 months after surgery. Outcome analyses were performed using the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Bishop-Kleinman rating scales, physical examination, return-to-work analysis, evaluation of complication rate, and overall patient satisfaction. RESULTS: At an average follow-up evaluation of 24 months (range, 12-38 mo), 19 patients had returned to full military active duty work status. The average duration of limited work capacity after surgery was 4.8 months (range, 3-7 mo). The DASH scores improved from an average of 32.5 points before surgery to 6.2 points after surgery. In 19 patients the functional outcome evaluated with the Bishop-Kleinman rating system was excellent. There were no poor outcomes using this rating score. Statistically significant improvements in both key pinch and grip strength were noted. Complications included one permanent and 2 transient neuropraxias of the medial antebrachial cutaneous nerve. Overall 19 of 20 patients were satisfied with the procedure and would have the surgery again if required. CONCLUSIONS: Submuscular ulnar nerve transposition for cubital tunnel syndrome provides a reliable rate of return to full active duty work in military personnel with good patient satisfaction and minimal complications.

[Viva]

Int Orthop. 2003;27(4):232-4. Epub 2003 Jun 12.

Stabilized subcutaneous transposition of the ulnar nerve.

Hashiguchi H, Ito H, Sawaizumi T.

Department of Orthopaedic Surgery, Nippon Medical School Second Hospital, 1-396 Kosugicho, 211-8533, Nakahara-ku, Kawasaki City, Kanagawa, Japan.

We treated 50 patients (average age 47.9 years) with a stabilized subcutaneous transposition of the ulnar nerve. The average follow-up period was 42.4 months. The indication was cubital tunnel syndrome in 19 patients and injuries around the elbow in 31 patients. Postoperatively, satisfactory results were obtained in all the patients, and there was no complication or aggravation of the preoperative symptoms. None of the patients experienced slipping back of the nerve to the cubital tunnel. In the 31 patients with injuries around the elbow, there was only one patient with transient aggravation of parasthaesiae in the ulnar nerve region. Stabilized subcutaneous transposition is a simple and less invasive procedure that can facilitate decompression and prevent slipping back of the nerve. This procedure also can be applied to patients with injuries around the elbow that require ulnar nerve transfer.

[Viva]

: J Bone Joint Surg Am. 2000 Nov;82-A(11):1544-51.

Stabilized subcutaneous ulnar nerve transposition with immediate range of motion. Long-term follow-up.

Black BT, Barron OA, Townsend PF, Glickel SZ, Eaton RG.

C.V. Starr Hand Surgery Center and St. Luke's-Roosevelt Hospital, New York, NY 10025, USA.

BACKGROUND: Anterior transposition of the ulnar nerve at the elbow produces generally good results regardless of whether the nerve is transposed subcutaneously, intramuscularly, or submuscularly. The eventual recovery of nerve function is related less to the specific surgical technique than to the severity of the intrinsic nerve pathology. A primary variable in surgical management is the duration of postoperative elbow immobilization. The purpose of this study was to review the longterm results of a specific technique of subcutaneous anterior transposition of the ulnar nerve that utilizes a stabilizing fasciodermal sling. The study compared the results of immediate and late institution of a range of motion postoperatively. METHODS: Forty-seven patients with fifty-one elbows were reexamined, by an investigator who had not been involved in their treatment, at a minimum of two years (range, twenty-four months to fourteen years) after an anterior transposition. Of the fifty-one elbows, twenty-one were immobilized for two to three weeks whereas thirty were managed with an immediate range of motion. RESULTS: At the latest follow-up evaluation, there were occasional, mild paresthesias in 16 percent of the limbs and there was still subjective weakness of 19 percent. Both pinch and grip strength had increased substantially. No patient had lost elbow motion. A positive Tinel sign persisted in 31 percent of the limbs, but it was mildly positive in most of them. The elbow flexion test was uniformly negative. The results for 92 percent of the limbs were satisfactory to the patients, who stated that they would undergo the same procedure again if necessary. Overall, 73 percent of the limbs had an excellent result; 18 percent, a good result; 4 percent, a fair result; and 6 percent, a poor result. With the numbers available, no significant difference could be detected, with regard to these outcomes, between the group managed with elbow immobilization and that managed with immediate elbow mobilization. However, patients treated with a postoperative cast returned to work at an average of thirty days after surgery whereas the group treated with immediate motion of the elbow returned to work at an average of ten days. CONCLUSIONS: This technique of stabilized subcutaneous anterior transposition of the ulnar nerve yielded predictably good results for a wide spectrum of patients. Patients returned to their occupation sooner when the elbow had been mobilized immediately.

[The Reverend Floater]

Yo Twoplanker,

Had a similiar sort of surgery done on my right leg/foot after a ski racing accident in high school. Had a "nerve graph," per se, done in that area. Due to a severe compartment syndrome and staph infection, I lost all feeling and movement in my right foot/ankle to the point where it was more or less just a blob at the end of my leg. I saw an extremely arrogant specialist at Johns Hopkins who tried something else that failed miserably. Next I saw a very nice specialist at UW who performed something similiar to what you're suggesting and a few other procedures. 11 years later, I can now feel most parts of my foot, and move my foot to a limited degree. Most importantly, said surgery allowed me to greatly surpass any and all of my initial prognosis, letting me ski, hike, sprint, climb, etc. relatively pain free. Trust me...I wasn't supposed to recover like this.

Given the advancement in technology since then and my positive outcome, I'd say I'm all for it!

[Twoplanker]

Viva - kick ass. Antecdotal accounts are interesting but empirical evidence is what I wanted to see. Thanks so much. Rev - glad to hear it worked out for you as well.

My doc is good, the best around. He said that I could go subcutaneous (under the skin) or under the muscle. He reccomended under the skin since it is less serious surgery, but it leaves the nerve a bit more exposed.

I'm glad I'll be awake during the surgery so I can say "Doc, you're really getting on my nerves."

[Vinman]

This should be a walk in the park for you. I had one of my throwing athletes last fall have this surgery done. She had a very smooth recovery. A little bit of immobilization to let things clam down and then after that it is just regaining ROM and strength slowly. According to our ortho, many people wake up from this surgery and will right away know that things are better than before.

[lucidmaster]

I just had a submuscular ulnar nerve transposition--4 days ago to be exact. It's been great so far. I don't have any numbness or pain in my hand, and can move all of my fingers as I want. There was some moderate pain around my elbow the day of surgery, but I could tolerate it, and did not have to take any painkillers. I am currently typing with both hands although my arm is in a semi-rigid wrap/cast. They will remove the cast in a week. I'll provide an update if anyone's interested.

[0BernhardFranz]

i would do all the stuff for nerves, regrowth and also antiviral stuff for OP talking meds and treatments - see my webpage at http://liwa.funtigo.com
really i hope my ma can tell you all that stuff if you want to - sucks ! sounds like the kind of stuff we do well with mannatech manetic matt germ killing natural antibiotics for surgery and all the nerve supportive supplements and regrowth supplements i wonder the nerve can´t be healed with surgery but it takes some medical skill to apply all the stuff
bf

[beaterdit]

...we do well with mannatech manetic matt germ killing natural antibiotics...

WTF?
6789

[wendigo]

Twoplanker - How did this turn out for you?

Was mentioned to me today as a possibility...

[haydukelives]

if both, do it at the same time. but usually its just one.

[Twoplanker]

Twoplanker - How did this turn out for you?

Was mentioned to me today as a possibility...

Well, it seems to have been unsuccessful. My most prominent symptom, interosseous muscle wasting, has not improved. I can't really determine for sure if it has gotten worse though...

Other hypotheses are that:

1) the damage was too severe before the surgery for me to benefit from it
2) the surgery was successful in that it prevented further damage
3) the surgery was successful and I've not seen the benefits because I've not worked the muscles enough. For example, if I've suffered 50% reduction in nerve conductivity, then I would have to work 50% harder to see the benefits of physical therapy (i.e., rebuilt muscle).

FYI, I also had the nerve released at the wrist, too (Guyon's Canal).

Hard to say for sure which is the case. My left hand is terribly wasted and, it seems, unlikely to ever recover. Fortunately I've not lost any functionality, save for some noticeable weakening of the left hand. No biggie, I just open the pickle jar with the right hand instead.

[drmark]

I rarely see improvement in interosseous wasting after ulna nerve surgery. By then the damage is mostly done. The surgery is just to relieve pain, numbness, and limit further atrophy.

[Twoplanker]

I rarely see improvement in interosseous wasting after ulna nerve surgery. By then the damage is mostly done. The surgery is just to relieve pain, numbness, and limit further atrophy.

That pretty much sums it up. The weird thing is, I never experienced numbness or pain -- except in my right hand where I have pretty classic RSI symptoms minus any wasting.

I must of sustained some crushing blow to my left ulnar that I don't remember...

[wendigo]

Hmmm my injury sounds a bit different. I think there is a mechanical in my hand (tendon?) injury influencing the pain, while my UN was found to be a bit slow from the elbow (partial impingement) no problem with the Goyun's Canal. Injury was from rock climbing and has been off and on for a couple of years. Has been getting worse and my right (right handed) hand is now about 20% weaker than it should be and is actually weaker than my left hand now. Probably be time for an MRI next I'm guessing.

[cynlamb]

I rarely see improvement in interosseous wasting after ulna nerve surgery. By then the damage is mostly done. The surgery is just to relieve pain, numbness, and limit further atrophy.

This is exactly what my Dr. told me when I went in for ulnar nerve transpostion a year and a half ago -- sub muscular (the most radical one where they cut the muscle to reroute the nerve). The interosseous between thumb and index finger was very atrophied, and my hand looked wasted and much older than its 43 years.

As a bass player and guitarist, I was really freaked out. I could no longer play barre chords or fret a bass very well. I also couldn't open an older-style cardoor or the dishwasher.

Post surgery, in addition to the physical therapy (difficult to keep going after awhile), I made up my own exercise: I used the thick rubberband from a bunch of broccoli, put it over my 4 fingers, and stretched out. I still do this every time I see a rubber band lying around. I also 'pinched' my fingers together regularly.

For a long time, I would see a tiny stretch of a muscle twitching, similar to the leg of a cricket. I'd cheer it on!

Now, a year and a half later, my muscle has come back almost completely, and seems stronger than the same muscle in my right hand! The other interosseous muscles were also extremely weak (I couldn't make my fingers separate), but the rubber band seems to have helped them all (I vary the fingers).

I still have constant slight numbness in my pinky, ring finger, and on the side of my hand. No pain, however, and strength is there. So I just ignore it.

New situation, however. The muscle on my inner elbow gets sore, very achy, and slightly swollen very easily now when I do any kind of activity with my left arm, including carrying grocery bags, fretting a guitar, etc. I went back to my Dr. but did not feel satisfied with her response (she didn't say much and gave me a referral for physical therapy; I haven't gone yet). I don't know if I'm making it worse by overusing the arm and muscle, or if I should be trying to slowly stregthen it more. This pain did not come out at all the first year after the surgery.

By the way, I have full range of motion in my elbow.

[wendigo]

I was right, MRI tomorrow (3rd this year) seems I likely have some facia tear in my hand (can't pinpoint the area so figure it straddles a number of muscles) along with the UN issues. Trying to do everything I can to get my hand strong / increase mobility of the nerve to see if I can avoid the transposition surgery or or at least have it strong going into the operation.

Been told that I will be looking at 6-8 weeks of pretty much one armedness if the surgery happens. Does that seem about right? I feel like that is a long time, but have nothing to base it upon.

[wendigo]

MRI came out negative, which is good news.
Apparently all of the pain is due to atrophy of the muscle groups?
Doctors have put the surgery ball squarly in my court.
Couple of questions:
1. Am I doing any further damage by not doing anything about it? Other than atrophy if I don't do PT.
2. Is it possible to stregthen the muscle groups while the nerve still has problems. (back to "normal" strength?)

If the muscles will continue to atrophy without surgery no matter if I try to strengthen them then I guess it is time to slice, if not...

[buggsy999]

[QUOTE=cynlamb;1342727]This is exactly what my Dr. told me when I went in for ulnar nerve transpostion a year and a half ago -- sub muscular

I have had one operation to move my ulna nerve in my left arm 26/07/06, the operation was in my elbo. I was having pins and needles in my pinky and ring finger, plus loss of movement. After the operation for a short while i had full movement back and thought all was well, sadly this did not last and everything got worse than before the op, plus i had alot of wasteing on my left hand. (it looks like i have a 60 year olds hand on my 25 year old body)
i too have been told i that the muscle wastage will never return so just asking if you def got yours back as i have been on a real downer since i got the news?
i go for my second operation within the next three weeks and was just hoping that i might get my muscle back!!

[wrench]

I too have been diagnosed with ulnar nerve problems. Age 56, mechanic all my life, relatively healthy.

I am now sleeping with splints on both arms at night (ever try to scratch your ___________ with these things on?).

I have been given a 30 day (while using the night splints) wait before they decide whether or not to operate. CTS has also been detected via the nerve tests.

My condition began in March this year in my left arm and is only mild so far. Two weeks later, the right hand followed with a vengeance.

So, anyone have some useful links regarding these types of surgeries (ulnar nerve)? How long is recovery?

Excellent site, BTW.

[kikietami]

I had ulnar nerve transposition surgery in Aug. of 2006, still struggling with pain and swelling of entire arm and hand. Make sure your surgeon has done this before. My surgeon said he did, but obviuosly he didn't. Make sure your surgeon removes part of the medial intermuscular septum and places nerve under muscle, instead of just under skin and fatty tissue or u will be in pain forever. I am planning on having another surgery to remove some of the medial intermuscular septum soon to get some relief. Hope this helps you.

[drmark]

If the nerve is just decompressed, not transposed, and the incision is remote from the nerve, so the nerve and the adjoining medial antebrachial cutaneous nerve doesn't get caught up in the scar, complications are minimized and sad stories like this don't occur.

[zonta68]

I have had 2 emg studies and they both came back severe ulnar neuropathy at the left elbow... i had one done a week ago and it was normal.. the only problem is i still have issues with the left arm... i have more pain and numbness and did i mention more pain.... i have a burning pain not comfortable at all.. i don't get why the emg showed the nerve as normal??????? i also have a couple of strange new symptoms.... one my left pinkie feels really tight and the middle part of my hand from wrist to center of palm feels tight and hurts alot !!!!!!!!