My Experience with Ulnar Decompression Surgery for Cubital Tunnel Syndrome
I was diagnosed with cubital tunnel syndrome 3 years ago. My symptoms were considered "moderate": measurable loss of nerve conduction, moderate to severe pain at times, slight numbness, some weakness, but no atrophy. I had been attempting conservative treatment, including wearing a splint at night, wrist brace during the day, exercises, special computer keyboard and mouse, and pain medication. But the pain wouldn’t go away, especially while using the computer, which is my job as a software developer. So my doctor finally decided it was time for surgery, and given that my symptoms were not yet severe, he recommended ulnar decompression surgery. This article describes my experience with ulnar decompression surgery for cubital tunnel syndrome.
In case you don’t want to read through the details, here are my conclusions about my ulnar decompression surgery for cubital tunnel syndrome: I got my affairs in order including my will and insurance. Cubital tunnel surgery isn’t dangerous, but it involves general anaesthetic, and there is always a slight risk of complications when you are put to sleep. I also finished any big jobs around the house that required two good arms: replaced a battery in the tractor, cut the lawn, chainsawed a tree, etc. I finished some final projects at work and around the house. I paid the bills, called my family, and prepared for a few days off work. Since I’m not allowed any food or drink after midnight, I had a second light supper around 11pm and drank a big glass of water as the clock struck midnight. I woke up thirsty but not nervous or anxious. I stayed focused on the good chance that the surgery would reduce my pain. I showered and shaved, then dressed in loose-fitting clothing: short-sleeved button-up-front shirt, sweat pants, tennis shoes, and no contact lenses. My wife drove me to the surgery center. A nurse called me back before I even had a chance to open a magazine. She showed me to a small dressing room, handed me a gown and told me to strip, put on the gown, and leave it untied in the back. I brought a book to read in case I had to wait, but the nurse immediately took it and all my clothes and possessions and secured them in a locker. She led me to the surgery room, which was fairly large and bright and had three operating areas separated by curtains. I laid down on the operating table, and the nurse covered me with a heated blanket, which was nice in the cool room. She also wrapped stimulator pads around my legs to promote blood circulation during surgery. The nurse asked me a few questions, confirming who I was and what surgery I was to receive. She used a pen to mark my right elbow where it was to be cut. This gave me a certain level of relief, as I certainly didn’t want to wake up with a kidney removed or sex change operation! Another nurse gave me a pill (can’t remember what it was for) and my first sip of water in 10 hours. She also started me on a saline IV, inserting the needle in the back of my hand, which not pleasant. The surgeon stopped by and gave me a few reassuring words. After a few minutes, the anesthetist stopped by and told me it was time to go to sleep. She hooked the knock-out juice to my IV and warned me that it would burn a little, which it did. Within minutes I fell softly asleep… CUT, SNIP, STITCH When I awoke, the nurse was standing at the end of my bed, and she said, "Welcome back, Timm, please move your fingers for me." All five digits working! My arm was wrapped snugly in an ace bandage. My elbow hurt a little, but the IV in the back of my other hand actually hurt more. They removed the IV, eased me off the operating table, and handed me my clothes. My wife was waiting for me when I emerged from the dressing room. They sat me in a chair, went over post-op instructions with me (and made sure my wife understood them since my brain was still fuzzy), and then gave me a soda. My wife drove me home and took care of me that day. It’s important to have someone with you that entire first day. She prepared my meals, cut my food, and attended to my needs. I spent most of the day sleeping and relaxing. I woke up in pain, and in spite of a liberal supply of prescribed codeine, I spent most of the day in significant pain. Though honestly the pain was similar to what I had experienced on my bad days for the past few years, so I was somewhat used to it. I spent most of the day resting, reading and watching TV. My wife had to work, so I was on my own, which was a bit of a struggle. Not only was I down to one arm, but it was my weak arm. Fortunately, during the past few weeks I had spent some time practicing my daily routine left-handed. Nonetheless, many of the activities I take for granted were quite challenging with only my one weaker hand. These include getting dressed, preparing meals, combing my hair, brushing and flossing my teeth, inserting and removing my contact lenses, shaving, bathing, itching, blowing my nose and wiping my butt. Sorry to be explicit, but you don’t normally think about these things until it’s too late. By the end of the day my left arm was exhausted, and so was I. The second day after surgery started with a little less pain. I took my first post-op shower, which required me to wrap my entire arm in a garbage bag and hold it above my head so it wouldn’t get wet. This is easier than it sounds. So was shampooing my hair, washing up with soap, and cleaning those hard-to-reach body parts, all a little more difficult with only one hand. But mission accomplished; it’s not like I had anything else to do! I spent most of the day resting. I work at home, so fortunately I tried to use my right arm to type and move the mouse a few times. Given that my arm was wrapped snugly in a bandage and couldn’t bend much, it was less touch typing and more of the Frankenstein stiff-arm hunt-and-peck method. I didn’t type much because it still hurt too much. It was my wife who noticed and pointed out to me that I was starting to use my sore arm a lot more. I was opening and closing doors, clicking the TV remote, and even made my own sandwich. But any activity that required me to bend my arm was still impossible, including flossing my teeth and inserting contact lenses. I was still experiencing moderate pain at times, but today was my last day on Codeine, and I ended up with a few extra pills. Back at work, I attempted to start touch typing. I could go for brief stretches of touch typing without pain — the first time in years. But usually after a few minutes it would become too painful, and I had to resort to hunt-and-peck again. Today was the pre-scheduled follow-up visit with my surgeon. The nurse removed my bandage and informed me that I had dissolvable stitches, so there were no stitches to remove. Nice! The surgeon inspected my incision and said it looked good. He checked my arm movement and tested my hand strength. He told me that I should begin using my arm as much as possible, and that I should work through the pain but of course stop if it becomes too severe. He said I should expect 10% improvement per week with complete recovery in 2-3 months. This was my first day of typing without the ace bandage, and it really made a difference. Now that I was able to hold my arm in the proper position and angle, I could type for longer stretches without pain. It was also terrific to take a shower without wearing a garbage bag on my arm. However, without the padding and protection from the ace bandage, my elbow was exposed to every little bump and scrape, and I found myself saying "ouch" many times throughout the day. Maybe I was typing too much that day, but I experienced a lot of pain and a surprising number of nerve shocks along my injured arm. I could literally see my ulnar nerve pulsing at both my shoulder and forearm. It was a freaky experience, but I was starting to get used to the up-and-down pattern of my recovery, so I stopped typing and hoped for a better day tomorrow. And that’s what I got, a better day. It helped that it was Saturday, so no typing, and hence, much less pain. I was able to touch type more with only limited pain. I’m starting to regain some grip strength. After about 7 hours of work my elbow was aching and sending electric shocks down my arm. I had to stop working. Today was my first work day in over three years that I did not take any pain medication, even an Advil. The pattern continues: I have 3-4 good days, followed by a bad day. I had some pain and a few nerve shocks today, but I’ve come to accept these small setbacks as part of the recovery process. My elbow was throbbing a bit, and I had to stop work late in the afternoon. I didn’t feel completely “fixed,” as I still had some pain, and the wound itself was still sensitive (my dog hit it and briefly sent me over the edge). But I was definitely better than before surgery, and at many times I barely noticed any pain, which hasn’t happened in years. The best part was that annoying “nerve irritation” was mostly gone. Like when you hit your funny bone… not only do you feel pain, but also an irritating, tingling sensation. My doctor said I would recover fully in a few months, so I still had some time to go. But at this point, I was very glad I had the surgery. I started to skip my pain medication on a regular basis! I was down to a couple Voltaren (a prescription NSAID) each day. I still felt some pain, especially when using the computer, but nowhere near what it used to be. I could touch type again at near-normal speed, though I still required a split keyboard and special mouse. I went the entire week without pain medication. I still felt a low-grade elbow pain, especially when using a computer. But it wasn’t enough for me to take any pain pills. It’s also possible that I’ve built up a higher pain threshold after three years of moderate to severe pain. The problem with eliminating one pain is then you can feel any other pain that you may have. Whether it’s arthritis or simply 25+ years of excessive computer use, I now feel slight pain in my fingers, wrist and both elbows. But at least it’s not that annoying nerve pain from my cubital tunnel syndrome, and nowhere near the intensity I had before surgery. I still cannot use a regular mouse for more than a few minutes without pain and shocks in my operated elbow. I must still use a split keyboard, hold my arm as close to handshake position as possible, and continue to use good ergonomics and assistive technologies to reduce my repetitive motion while using the computer. My operated arm still suffers from reduced strength and loss of dexterity. But I’m no longer in severe pain. My arm doesn’t throb and pulse at night and consume my thoughts while watching TV. I don’t constantly think about my sore elbow. I no longer get into a pain-driven foul mood. So after seven weeks, count me as one of those patients whose condition was "significantly improved but not fixed" by cubital tunnel surgery. Hopefully I will continue to improve over time. My case seems to mirror the anecdotal evidence on the Web: surgery helps but does not completely cure cure cubital tunnel syndrome, especially if you return to the activities that caused you pain in the first place. Surgery is often a painful and stressful experience. But several people helped me get through my cubital tunnel treatment, surgery and recovery. First I’d like to thank my wife Theresa for taking care of me and picking up my slack while I was down. And for her terrific health insurance, which reduced a four-figure bill down to about the cost of a night out at the movies. I’d also like to thank my mother, family and friends for their wonderful support and prayers. And finally I’d like thank my doctor, Dr. Thomas Kiefhaber from Cincinnati Hand Surgery Specialists, for helping me for years with conservative treatment, and for his excellent and professional job performing my ulnar decompression surgery. Discuss this article in our forums Related posts:Conclusions
Week Before - Affairs in order
Day Before - Final preparations
Surgery Day
Day After - Worst day of pain
Day 2 - Pain is less
Day 5 - First day back at work
I didn’t have to worry about getting dressed or driving to work on this Monday morning. My arm was too sore to use, so I rested it on a pillow for most of the day, while using voice recognition and my left hand to work the computer.Day 7 - First attempt to use my arm
Day 10 - Actually using my arm
Day 12 - Typing with pain
Day 13 - Follow-up visit with surgeon
Day 14 - Typing without the bandage
Day 16 - Another setback
Day 17 - A better day
Day 19 - Still seeing improvement
Day 21 - Good for most of the day, then bad
Day 26 - First day in years without pain medication
Day 27 - Another bad day
Day 28 - Glad I had surgery
Week 5 - Still improving
Week 6 - No more pain medication!
Week 7 - Today - Much better but not "fixed" yet
Special Thanks
