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Hello,
On June 2nd, I had an anterior transposition of the ulnar nerve in my left arm. I also elected to have a carpal tunnel decompression in the left wrist at the same time. This is my report of my experiences:
- It is important to find the right surgeon. I have read these forums numerous times and found myself distressed at some choices people have made. As a result of not finding the proper surgeon, some of the cubital-tunnel.com forum posters have obnoxious scars and recurring symptoms.
I went to four doctors before I found the right one. For me, he was Dr. Robert Neviaser, the Chair of the Department of Orthopaedic Surgery at George Washington University Hospital.
- During my initial consultation, Dr. Neviaser made one thing very clear: nerve conduction tests and EMGs are not proper objective diagnostic exams. They are completely unnecessary, and worse, may cause a false-positive result for patients who do not have carpal or cubital tunnel conditions. He indicated a well-trained doctor should be able to properly diagnose carpal or cubital tunnel conditions by simple tests conducted over a few minutes in the doctor's office. For me, these simple tests included examining my "funny bone", putting my elbow and wrist in peculiar conditions (causing them to go numb), and using a little octagonal thingie with little, dull needles on the ends to test nerves on the edges of the fingers.
My initial consultation was 20-30 minutes, and from that we scheduled the two surgical procedures. (It helped that I was well-read on the topics, and had seen previous doctors and been through occupational therapy already [to no avail]. An educated, informed patient is just as important, in my opinion, as a well-trained doctor. But you are here already, reading cubital-tunnel.com, so you probably already qualify as an educated, informed patient!)
- I was instructed to undergo pre-surgical exams, which included a physical, a medical history, blood tests, and an EKG. These were designed to ensure I was healthy enough to survive a surgery with general anesthesia. I was able to do the pre-surgical exam at my general practitioner's office three weeks before the scheduled surgery.
- I was scheduled for a 7am surgery, and was at the hospital promptly at 5am for admitting and pre-surgery preparations. No less than 6 nurses and doctors visited me with clipboards to ask all their questions as I lay on a gurney mentally preparing for this (read: trying to stay calm!!). Finally the anesthesiologist injected a mild sedative into me and they started wheeling me down to the operating room.
It gets progressively colder the closer you get to the operating table. The OR was quite chilly.
- According to my chart, my operation lasted 2 hours and 2 minutes. I learned after-the-fact they cut my finger nails, shaved my arm, operated on me, and put me in a cast (technically a splint, but to laypeople, it looks like a cast). GWU Hospital being a teaching hospital, there were 10 people listed on my chart as having been in the OR.
- I awoke to a world of pain. The first 20 minutes or so were the worst pain I would be in over the entire multi-week ordeal. My entire body was shaking from the anesthesia, and I'm told I was wrapped in blankets head to toe, like a mummy. My best friend, who was at my side, said he felt helpless looking at me in such pain, powerless to do anything.
Because I felt like I was at an 8 on the pain scale, the nurse advocating me getting morphine from the anesthesiologist. It helped ease the pain some, but not much. It also lengthened my stay at the hospital by 2 hours because it made me nauseous.
- It took 3 days for the worst pain to subside. I spent the first 5 days in bed full-time. The anesthesia plus the morphine plus the percocets I was taking every 4 hours were really messing with my brain, so I don't remember much of those days except feeling pain.
Please note: percocet (5 parts oxycodone, 325 parts acetaminophen) causes significant constipation. I did have a bowel movement for 5 days after my surgery. It was not uncomfortable during those 5 days, mind you, but I anxiously awaited a bowel movement. I took stool softeners during those days, but they did not help. The first bowel movement was mildly painful.
- I was in a splint, covering my palm, wrist, arm, elbow, and half my bicep, for 3 weeks (23 days and 2 hours to be precise). It was not a fun time. None of my shirts fit because the splint was so bulky. I cut up some t-shirts so that the left arm sleeve had no width limitation. I bought some Hawaiian shirts which had generously sized sleeves.
For the first week I was told to keep my forearm pointing up in the air so as to reduce swelling. In the second and third week I was told to start trying to work my fingers out so they would not stiffen up, but I was allowed to hold my arm in a normal cast position in front of my stomach. I was not allowed to wear a sling, as Dr. Neviaser does not allow any of his patients to use slings (he says they cause more shoulder damage than provide relief and, in turn, should never be used by anyone).
- My cast came off this morning, and I was told to do specific exercises to ameliorate the stiff elbow and wrist joints. I am now typing near full-speed (it helps that I am a touch typist) only 8 hours after having the cast off.
My scars are very, very neat. He used a single stitch for both, and I am confident the scars will disappear and become skin-color in the near future. The wrist incision is almost completely healed already. The elbow incision is much lengthier and will take a few more weeks.
- He set my expectation at 3 to 6 months to make a reasonable conclusion about the success of the ulnar transposition. I can tell you, however, that 3 weeks after surgery, I can bend my arm and hold it for minutes at a time without any of the symptoms I used to experience (hand numbness, finger numbness, and everything turning red).
So that is my experience. I hope it helps you, the reader, if you are thinking about having, or are imminently having, ulnar nerve transposition.
Garp74
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