History – Background, Symptoms & diagnosis

I could find very little information on the internet about the treatment for subluxing ulnar nerves (where the ulnar nerve jumps out of the ulnar groove over the medial epicondyle when the elbow is bent). The effect of this can be physically felt at the inside of the elbow when the nerve slides over the bone, and in my case caused me a lot of pain. The ulnar nerve passes through the elbow and controls muscle motion in the hand and is responsible for the feeling sensation in your little and index finger and the area of the hand below these fingers.

My Symptoms

1) General tenderness around the inside of my elbow which gradually increased to the point where I couldn’t stand to touch any part of the inside elbow area.
2) Slowness of the fingers in my left hand initially, mainly the small finger and index finger, it felt like a lack of control when typing.
3) Forearm pain, shooting from the inside of my elbow.
4) General weakness in the hand for any task lasting more than a few seconds.
5) Pain in the palm of my hand directly below the little and index fingers.
6) Numbness in these two ‘ulnar nerve fingers’ when waking up in the morning and also in the palm below it.

These symptoms increased rapidly and pain increased to the point where I couldn’t use my left arm/hand at all. I was still able to use my right arm/hand at this point, but I could feel that symptoms in that arm were rapidly catching up, so something had to be done about it quickly. Interestingly I am right handed, so I have no idea why my left hand deteriorated first.

Initial Treatment

My pain was initially controlled with Amitryptiline (various doses - no effect), Co-codomol (no effect), Co-drydramol (no effect), Dihydrocodiene (Some pain relief, but awful side effects including nausea, headaches, stomach aches, constipation), Tramadol (Again some pain relief but caused increased liver function tests). Eventually my pain was controlled with slow release Morphine tablets twice a day and Oramorph (A fast acting liquid form of Morphine) along with many other tablets to control the side effects of the Morphine including nausea and constipation.

The Diagnosis

My eventual diagnosis from the orthopaedic surgeon was bilateral subluxing ulnar nerves which was causing damage to the nerve itself. The best treatment decided was Anterior transposition of the ulnar nerve. This involves moving the nerve out of the groove to the other side of the epicondyle and embedding the nerve in the muscle so that it could no longer move over the bone when the arm is bent. There is quite a lot of information about this procedure on the internet, but very little where it has been used to treat subluxing nerves, it’s more common use is to treat Cubital tunnel syndrome (CuTS). I was to have my left arm operated on first on 6th March 2010 followed by the right arm four months later (assuming the success of the initial operation).

The Plan

Because of this apparent 'gap' in information and people's experiences in having this surgery to treat subluxing ulnar nerves I decided to try and make a small step to filling this gap by documenting the treatment process. There will be a lot of detail! This is what I really craved when searching for information, I wanted to know absolutely everything about what was going to happen to me. I also hope it will be of use to people who have been told that they need ulnar nerve transposition surgery for any other reason.