Okay here we go. It is long, so it I am splitting it over a few posts.

Brenda


My Log

Procedures: Ulnar Nerve Transposition at the elbow, Ulnar nerve release in Guyon’s Tunnel and 4th & 5th Trigger Release 4-25-2008

Female 45 YOA Law Enforcement Agent

For reasons unknown to me (no impact or trauma injuries of recent date) my 5th and 4th fingers (1/2 of the ring finger) of my right hand went numb in September of 2007. Initially it was just annoying, but shortly there after I started noticing a weakness and clumsiness in my other fingers, thumb, and hand overall. Additionally numbness on my lower wrist and palm (heal side) was developing. While I did discuss this with Dr. G shortly after symptoms appeared, being left handed, I didn’t put a lot of emphasis on this evolving situation. At the same time too, I was experiencing a lot of pain due to a herniated disk at C5/6 – thus causing constant neck pain and pain which constantly radiated through the top of my shoulder and down my right arm. He referred me to a Neurologist for further consult. The Neurologist consulted felt much of my numbness might be due to this. Note: Some effect does come from this region, but the majority presents from C6/7 and C8 (mine were normal). After EMG testing and a physical exam, I was referred to a Neurosurgeon. On March 19th, 2008 I underwent an anterior cervical discectomy and fusion of C5/6. Immediately upon waking from the anesthesia all neck/shoulder/arm pain was gone. While ½ of my right ring finger was a bit better, that I found was short lived.

Approximately 3 weeks after cervical surgery, I made a follow up appointment with Dr. G – to update him on the improvements with my fusion, and to re-address my hand issues. After Dr. G re-examined my elbow, wrist and hand along with my demonstrating the two fingers curling (described to me by him as “triggering”), we agreed to a surgical intervention concerning the Ulnar Nerve at the elbow (Cubital Tunnel Syndrome) and trigger release. He still also had some concern of possible irritation or further nerve entrapment in the hand or “Guyon’s Canal.”

The initial surgery plan was for an Ulnar Nerve Transposition at the elbow along with possible “trigger” release for my 4th & 5th fingers in the Palmer pulley region. My 5th finger had started to “stay curled” when flexed about 3 weeks prior, and my 4th (ring) finger about 2 weeks prior to surgery would curl at the middle knuckle. If left alone, after a few minutes they would slowly release, but most times I had to pull them to release them or flip (whip out my hand to release them). While only minor discomfort was felt palm side base of these fingers, a “pop” feeling was felt by me when they would release.

Cont.

On April 25th, 2008 I arrived at the Kendell Surgical Center for the above mentioned surgery. Dr. G went over the planned procedure with me and conducted a more detailed exam of my hand reactions to touch and reflex sensitivity, and suggested releasing (un-trapping) the Ulnar nerve in my hand and wrist. I agreed to the additional procedure. Note: My own research on the internet after surgery of case studies, this was a very good call on Dr. G’s part, and mine as a well informed (by him) patient as this with the prolonged numbness and weakness gives me the higher odds of recovery. Thanks very much Dr. G!!! Still no guarantees of course, but MUCH better odds as there aren’t a lot of areas this nerve gets trapped. The neck of course was ruled out.

From what the attending Nurse told me, surgery lasted just under 2 hours. Recovery from anesthesia was normal. Due to the surgery impacts, I did not feel much initial pain or discomfort. I awoke to a ½ hard cast and ace bandage support, 90 degree set point. My middle, 4th and 5th fingers were numb along with my middle finger, and my index and thumb were normal sensation. Dr. G came by a short time later stating all as discussed was performed, and no problems were encountered. I will most likely see him on a post-op on Wednesday April 30th. For pain management, I was prescribed 325mg Percocet. From what I got off of forums, “child birth” type pain is to be expected! I’ve never had a kid, but this does not sound like fun!!! 2130 hours local, still not in much discomfort, but very tired and have very swollen fingers – pink/hot. I took 1 pill as I went to sleep to cover for “this pain” that will arrive in my sleep. I slept around 12 hours without interruption!

Day 2…. A short time after I awoke I did find that my “pain” had arrived, but mainly in my outer wrist and upper palm with itching in my elbow. I did not reach anything to which *I* would equate to child birth, but it was enough for pain management. With me however (and maybe this is good for uninterrupted healing), 20 minutes or so later – sleepy time for like 6 hours. I found after waking and putting the splint back on my neck (headache shortly thereafter) and right shoulder hurt a lot. I took 1 pill (allowed 2 every 4 hours) and took a long nap. I have stayed out of the splint and rested my arm on my elevated leg – very comfy. I now have noticed pronounced swelling and bruise like discoloration in my 3rd, 4th and 5th fingers – swelling mainly in the 3rd and 4th fingers. (Pictures taken for this log) No “throbbing is felt” however, and no temperature elevations at this time. Piggy and ring finger behaving (no curl/trigger) normally.

Cont.

Day 3…. I went to bed without meds, but awoke around 0830 with throbbing in my hand and wrist (more so the wrist). I took 1 pill and hit the pillows. I awoke around 1400 hours – no pain, just tired. Pinky and ring finger still not curling, outward flexation feels stronger. Still can’t cross fingers, but 1st finger does not bend 90 degrees as with prior attempts before surgical intervention. Middle finger can now touch first finger without 1st finger bending 90 degrees. Knuckle swelling reduced by half, bruising color still the same. Extension of fingers and thumb strength feels better (stronger). Piggy still has numbness, but can detect surface item texture (prior to surgery, could NOT distinguish between say cloth and cement), and ring finger numbness *seems* to have lessoned. I still have swelling in the fingers, so truly I can not factually judge on this day. I do feel uplifted however. Negatives to the multiple surgical procedures…. None at this point short of itching!!! The surgical center contacted me today to see how I was doing. My response was basically the “pain” is MUCH less than I expected, and that I was using less that a ¼ of the meds approved. I also discussed my shoulder pain and headaches with the splint, and the nurse confirmed it was for comfort. No sling = no meds, sling = meds (neck/shoulder/headaches). I can now make a fist with very minor discomfort, 5th and 4th fingers not staying curled.  Bedtime plan; No pain management. A follow up is scheduled for this Wednesday afternoon with Dr. G.

Day 4 ….Swelling is further reduced. I haven’t needed pain management since this morning (had throbbing in the hand and wrist). Ring finger better, can feel temperatures of things better, pinky still a bit swollen, no real change that I can detect. Bruising is starting to go away on my fingers and most notably my knuckle below the finger nail. Itching is the main irritant – abeam my thumb, upper arm towards body, elbow (bottom). With fingers I can reach the itch in the upper arm and thumb. I trimmed my nails prior to surgery for sanitary reasons, and it is proving beneficial for post op itching! I can tell swelling overall has reduced as I can feel more room in the cast/wrapping. Thumb, 1st & 2nd fingers feel more in “command” and stronger than before surgery. Example, being ambidextrous, I feel more control (short of the bulky wrap in the palm) holding a pen. Finger cross – still can’t cross, but can now touch my index fingernail with my middle finger! My middle finger at the mid knuckle is still bruised and swollen, but lessoned from yesterday. Prior to surgery if I stretched my fingers out fully, I would feel pain from my first knuckle below the nail in the pinky finger; post op, I can not duplicate. For were I can reach, the feeling is much improved on the top side of my hand above the pinky and ring fingers. Trigger finger (first finger) feels “almost normal strength”.

Week 5 plus 6 days….If I rub my hands and warm them up, I have for the first time crossed my middle and first finger!!!! I haven’t been able to do that since at least August. Typing is getting better on the qwerty side. I can hit the letter “P” and the quote sign. The pinkie still has numbness, but I can feel the knuckle to just below the top joint on the top of the hand, and the sensation on the bottom of the pinkie isn’t prickly.