Day 7 Post-Op (Sat 13th March)

A week post op and thoughts begin to wander towards how successful I feel things are going so far and how close to my impression everything has gone. Had it not been for the increased pain overnight that led to almost no sleep I would have said it was going well. I have got away with almost no bruising at all, which I am very grateful for, but then I have never been the sort of person who bruises easily.

Today also was the day to remove the final dressing. The pain when I awoke was heavy again in the back of my elbow (8/10) so I took some oramorph. I decided after the oramorph was a good time to try and remove the dressing. I was going fine until I realised that they had actually covered the incision with two dressings and the very sticky edge of the second dressing was directly over the incision. I removed the first dressing no problems, but the second one pulled on the incision a lot and caused rather a lot of pain and made me feel a little iffy. All that remains now are the dissolvable stitches that I’m told will be gone in 1-3 weeks and some more surgical strips.

I went and had a cup of coffee after that, at least the final hurdle was over now, all I can do is work on recovering, and there is no further need to disrupt the wound area.

The new pain in the outside of the elbow continued all day into the evening, but no need for oramorph, I’d say this new pain has levelled off at 5/10, which is still more than I would have hoped at this stage.

Day 6 Post-Op (Fri 12th March)

The day started off the same as the last few, heavy stiffness and increased numbness in fingers first thing in the morning with it wearing off gradually through the day back to the same stage again…. Just a slight numbness level across the two fingers and palm.

Something different happened towards the end if the evening. After having a bath I had increased pain at the back of my elbow on the very point of the bone, the part that sticks outwards when you bend your arm. The amount of numbness around my elbow had decreased rather a lot, so I would guess that the increased pain was due to this feeling returning. The pain lasted most of the night and I had to use a dose of oramorph at around 1am.

Day 5 Post-Op (Thu 11th March)

I used my left hand to hold a magazine while sat on the toilet!! This doesn’t sound like a lot, but it’s the first thing I’ve actually used that hand for in a good 5 months!! My god it felt good and perked me up quite a lot after yesterday! Thursday 11th March 2010, I will remember this day for a very long time, I hope it’s the start of a very successful recovery. I also slept about 4 hours overnight and then 4 hours in the morning! It put me behind on the exercises but my body obviously needs sleep so I’m just going with it.

The stiffness and slight increase in numbness happened again overnight, so it seems to be a regular thing I will just have to get used to. This is one of the main reasons I’m writing this, had I known about morning stiffness I could have avoided the whole trauma yesterday and hope someone will find all this information of use. It’s 2pm and I have only done one set of stretches, so better get on with some more! I have also just realised I am no longer getting twitches or spasms at all, just the odd pins and needles and slight numbness at the end of my two ulnar fingers and a general ache/stiffness in the arm. Pain level (as I haven’t mentioned it for a while) I would say is a 2/10, merely an annoying ache that I can get to disappear if I rest the arm in the right position.

No pain meds other than my regular MST taken today, I’m still trying to reduce what I take in the hope it reduces the side effects as well. I have noticed a slight increase in the amount of lost sensation in the palm of my hand, but by the end of the day I had done 8 sets of exercises and felt ok.

Day 4 Post-Op (Wed 10th March)

Bad day, bad, bad, bad day. Everything was so stiff this morning when I woke up, my whole left arm and shoulder, so much pain in my elbow I couldn’t move it. Worst of all I must have accidentally slept on my right arm and the ulnar half of my hand was completely numb and the elbow was so painful to move. The hilarious thing (looking back now, not at the time!!) was I desperately needed the toilet and couldn’t get out of bed quickly, I didn’t know which arm to try and use!!.

When I had got over that hurdle my right hand eventually started coming alive again and then I had an awful realisation…. I had pre-op nerve pain in my left elbow and hand and the two finger ends (little and ring) were completely numb again. This hit me hard, I was having thoughts of a failed operation, what would I do if it hadn’t worked and I didn’t get better? And then there would be no hope for my right arm either? How would I work? Live? I was a mess for a couple of hours and to make it worse this was the first time I had been left on my own and had nobody to slap me out of it.

I think i actually let out all the pent up emotion I had been feeling for the last few weeks (and months) and after a while I felt a bit better and the pre-op symptoms subsided and some of the feeling came back in my hand, Phew!!! My partner came home from work at lunch because of the upset of seeing me in so much pain/anguish in the morning and inability to concentrate on anything at work because of worrying what was happening at home. I think it is a good reminder that this kind of operation and recovery isn’t just difficult and demanding for the person going through it, I was certainly glad of the company.

I managed to get 7 sets of stretches done in the afternoon/evening despite the pain and then did little else, after having a bath I was more than ready for this day to be over.

Day 3 Post-Op (Tue 9th March)

I woke up at 1.00am, a whole 90 minutes of sleep, wonderful!! I decided at this point if I get the chance pain free to sleep during the day today that I would take it, and probably should have just done that sooner. Also after researching the internet decided I would step up the range of motion exercises today. As we didn’t get chance to speak to my surgeon post op I had no advice on what to do. I decided to ring later in the day to check with him this is ok to do.

I spoke to surgeon’s secretary in the morning and she said the op went perfectly and there were no notes about what not to do so I could just get on with life as best I could. The exercises I found on the internet were 4 different ones ten times each 8 times a day, I managed 6 sets today and will aim for 8 sets tomorrow. Links to the exercise images are here:



The blog I found these on is here: http://quitelucid.blogspot.com/2006/04/cubital-tunnel-syndrome-part-four-post.html

I hope the owner of the blog doesn’t mind me re-posting these images (and if he does I will of course remove them), I found his blog very useful before my operation and was one of the reasons I also decided to create mine. I would definitely recommend it for a good read of his experiences.

The two sides of my ring finger and little finger went numb after the first set, but it slowly came back a few minutes later, I think this must have been the first time the nerve had been moved since the operation. Pins and needles increase and so does twitching after each set, so I kept it raised and still for 30 minutes or so afterwards.

I slept a couple of hours in the morning, and a little snooze in the afternoon which was excellent. Pain is noticeably lower today, achey and weakness would be the best way to describe it (3/10) more annoying than painful.

I was up and about more today, I helped cook a meal and made a coffee myself, although my right arm continues to deteriorate and is now more painful than the operated arm! Only one oramorph taken today to hopefully make me sleep at night, I took a few ibuprofen and my MST during the day. Overall I would say a very positive day with less pain and noticeably less twitching and spasming, but possibly an increase in aching probably due to my arm being tired of being held strangely. I look forward to being able to just let my arm hang again and just relax it.

I received an email from my surgeon’s secretary late evening saying:

Hi Andrew

The answers to your questions are:

1. No, you have no need to elevate your arm now.
2. Use your arm for all normal activities
3. Pain control as necessary
4. Will see you for follow-up in April

Hope this helps.

Sue

Excellent news for me, I will try and step up the use of it tomorrow. I do wonder why other people are put in a cast or brace and told not use the arm/hand for up to two/three weeks etc. My incision seems to be a lot smaller than photos of other people’s I have seen on the internet as well.

Day 2 Post-Op (Mon 8th March)

I put telly on at 2.30am and watched the Oscars through to breakfast time as I couldn’t sleep. In the morning I removed the outer bandaging for first time as I was told to after 48 hours, it was a little early but I was curious. I immediately noticed a lack of support and slight increase in pain (6/10), I had to rest it a long while on the pile of padding removed afterwards to settle it down. I took my MST tablet as soon as I could at 7.30am. My plan today was to reduce the amount of oramorph I use as I want to be off the Morphine as quickly as possible. I was still experiencing twitching and the occasional cramping in fingers.

When I had removed the outer dressing I first noticed the incision is nowhere near as big as I expected, good news, no huge scar! The waterproof dressing underneath is almost see through and approx 3 inches at a guess would guess, maybe a little bigger. The arrows on the picture are what the surgeon drew on me before the operation, which makes it look a bit silly! I could definitely tell it is more sensitive to motion without the bandaging, I may put back on for support when I get up later. There is still no real noticeable swelling either and still no bruising at all.

I stayed layed down with arm up until lunch time and from about 10am the most amazing thing happened, no pain in my arm! I can move it a little and put it to rest with no pain for the first time in many months! I was so pleased to be seeing such good progress and I didn’t take any oramorph during the day all, just a couple of ibuprofen.

I called work in the afternoon to update the boss on how I was going, she was so pleased and really positive about the whole thing which was lovely. I also discussed with my partner about the length of time between arm operations, the surgeon had said at least 4 months but we decided between us the ideal time would be early may (about 7 weeks after the first). I will have to work hard on recovering fast for this to be remotely viable and convince the surgeon to do it, I felt this gave me some good motivation.

Mum visited at lunch and was amazed how much motion I had in it and how small the scar will be and no bruising at all. I was beginning to think I was having a very rapid recovery and felt very grateful for it. After lunch I went back to bed and almost dozed but not quite! I’ve still had no proper sleep since the operation.

I had to take a lot of constipation meds today as I’d not been since Saturday morning before the op, it is still an ongoing problem with the morphine! Eventually the motions started at tea time after taking way more meds than I should have needed to to get going! I ended up sitting on the toilet many hours today which sent my foot numb and had an evil nerve like pain in my right foot all evening, stupid body!

I had a bath in the evening and carefully washed around the waterproof dressing to try and get rid of all the yellow dye on my arm and hands. I noticed numbness around elbow and incision area that I didn’t know about before as it was covered by the big bandage. I don’t know if it was caused by the rubbing or not but by 10pm pain and severe twitching had returned to my hand and the pain was as bad as it had been again (8/10). My right arm was also very painful so ended up taking a dose of oramorph which calmed things down some.

I went to bed at 10.30pm feeling gutted that such a good day had ended so badly, I think I realised at this point how much of a bumpy ride recovery was going to be. Overall through the day I had been trying to make my hand into a fist regularly and move my arm about a little more, not until the point it hurt though, just trying to remove stiffness. It is definitely easier to make my hand into a fist and better range of motion today.

Day 1 Post-Op (Sun 7th March)

I woke up at approx 4.30am with strong stiffness in my fingers, pain was a marked increase on the night before (7/10) and had to wait until 7.30am for more painkillers. I took my MST as soon as I could which eased it to around 5/10, which was still more than the low point yesterday.

8.00am: Went to toilet, which was actually a tricky operation! I still had to keep my arm up high most of the time to keep the pain down and I took a pillow so that I could sit on the toilet and rest my arm on the pillow on my knee – it worked well! I left a pillow in the toilet for ease in future, which is probably not the most hygienic of things, but it saved time. Before the operation I had broken toilet paper up into piles of 2 sheets which was also very helpful! I got back into bed and with this exertion the pain was back up to 7/10.

I stayed in bed in the morning working on gently moving my fingers, it did become easier again with a little more range than night before. I felt quite down about the pain level after feeling so good the night before – reality was beginning to setting in and I’d lost some of the optimism. I took 5ml oramorph and 400mg ibuprofen and the pain settled to 5/10. I dozed a little, then the phone rang, instinctively I rolled over to answer it and reached with my left arm…. REAL PAIN, the first bad pain I had experienced, really made the eyes water!!! Won’t be making that mistake again!!

I had some visitors came at 2pm, which was nice, I got up and dressed (with some help), went downstairs and sat with them for an hour. I had a pillow on my knee to rest my arm and I felt a little better than in the morning. No real bruising is showing yet, there is a small line of marks around my bicep, possibly from a tourniquet – it’s a very uniform line. I can almost make a fist with my hand now, I’m not forcing it, just gently trying to increase movement.

3.30pm – 9.00pm: Worst pain so far, I got back in bed and was uncomfortable, pain was at 8/10. I had twitches and cramps in fingers, spasms in bicep muscle and forearm muscle and all over my arm. I took 5ml oramorph which only took the edge off it. I really struggled to eat tea with my ‘good’ arm also really playing up with spasms and elbow/hand pain just so it didn’t feel left out. My left shoulder is also now in pain from taking the weight of the arm all the time and holding it in a raised position while moving about.

9.30pm: I took my MST and tried to sleep, again no way to get comfy, last night’s final position was not working this time. The cat was also playing silly buggers and waking me when I did doze, which made me jump and judder arm – ouch! I also had some nightmares (recurrent problem with the morphine).

Operation Day (Sat 6th March)

**Warning: In great detail!!**

I got out of bed at around 6am, although I had been awake for quite a while beforehand. I got my stuff together and my partner drove me to the hospital, I was glad it was an early start as I had no time to get even more nervous. We arrived at around 7am and was shown to the room by someone at the reception desk. I should point out for comparison’s sake that I went to a private hospital, so if you’re in the UK and are going to an NHS hospital please bear this in mind.

Pre-Operation

When in the room I was inducted by a nurse, there were loads of questions about my general health, I was weighed, given a wristband and had my blood pressure taken. She then left us in the room for a little while before the surgeon and the anaesthetist did their rounds. I think this was the point where I was most nervous during the whole procedure, I couldn’t settle at all. To pass the time a little I got changed into my lovely gown and we made our selections from the lunch menu.

8.20am: I spoke to anaesthetist who explained what would happen and what pain relief I would get during and after the operation. He explained about anaesthetic side effects like sickness and stomach upset and said that most people when travelling home on the same day as an anaesthetic get very travel sick in the car. He advised me to take my usual morning MST tablet as this was my normal medication and explained this would also help with the post-operative pain.

8.50am: The surgeon came to see me, marked my arm with a thick black pen and checked with me the procedure he was going to carry out. He also answered a few of my remaining questions and explained the ulnar nerve is very temperamental and to expect some numbness afterwards that would hopefully disappear in the long term. He said I was third on his operating list. Talking with him made me feel less nervous and I relaxed a little thinking no need to worry until at least 10am if I was third on his list. I took this opportunity to go and sit on the toilet for a while and hurrah! Finally I went, I was so pleased as I really didn’t want to wake up desperate for the toilet!

9.35am: A nurse came and told me they were ready for me in theatre…. Much earlier than I thought!! The nurse walked me down, at least there was no time to get worked up as I had been taken by surprise. Another nurse checked my details again to make sure I was the right person having the right operation, which was strangely comforting. I was told then to lay on a trolley and was covered with a blanket. This room was really cold, so much so that I started shaking even with the blanket over me.

The anaesthetist then arrived and checked my blood pressure, sprayed solution all over my hand and put a cannula in my right hand (there was surprisingly little pain, no more than when I had one in the middle of my arm).
The nurse put on ECG pads on my neck and chest and taped them down, explaining that they need to do this because of the range of motion required during the operation. They then Injected through cannula (no needle) a liquid that he said would make me dizzy, which had no effect. He then injected the anaesthetic and gave me an oxygen mask and told me to take three deep breaths, I counted to seven breathes and that was last thing I remember. He said I would feel a painful tingle but all I got was a little bad taste at the back of my mouth, no pain and no discomfort. I can’t remember any sensation of falling asleep at all.

Post-Operation

I woke up in the recovery room, it seemed like no time had passed at all. The nurse offered me a sip of water and said ‘lets get you back to your room’ and with that the bed started moving to take me back to the room. I didn’t seem to be in recovery long but must have been there for approx 30 minutes before waking up after working out the timings. The first thing I thought when I cam back to my senses was to check I could still move fingers, which I could a small amount, great! There was no real pain at this point, just a heavy dull ache (4/10 on the pain scale). When back in the room I had to slide back onto bed in room with good arm, the operated arm was put on a pillow next to me. I have no real memory of the journey from the recovery room to the room in the ward, which is strange. The bandaging was not too large (see photo), but I was shaking a little for first few minutes in the room, but this soon went as I settled on the bed. I noticed on the clock that it was now 11.00am.


Five minutes after settling in the room the pain around my elbow/forearm started to rise quite quickly (7-8/10). I rang for the nurse and told her and was given 10ml Oramorph solution which soon took it back down to a reasonable level (4/10), just mild discomfort again within 2 minutes.

I now started to check out the feeling in my hand, the little finger and ring finger and half of my palm were completely numb, no sensation at all. The middle finger had 50% sensation and the thumb and other finger 100% sensation. There was a lot of yellow liquid stain over my hand and the top of my arm which I presumed to be the iodine. I also had small scratch like cuts between fingers 1, 2 and 3 which I couldn’t work out at all. No pins and needles in my hand at all, just numbness.

I felt I came out of the anaesthetic very quickly, no sickness, no drowsiness, normal conversations, clear thoughts and can remember everything perfectly from being brought back into the room. I had been warned that some people take a long time to come out of an anaesthetic, so I was very pleased with feeling bright straight away. The nurse took my blood pressure and heart rate every 30 minutes or so for first 2 hours in the room. I had bottle of water that I sipped slowly as I had a very sore throat, painful to swallow.

12.30: I ate some lunch, some melon slices and approx 60% of a jacket potato and beans with a glass of orange juice, very nice. I was feeling no real discomfort or sickness, but my arm looked swollen to almost double normal size, but a lot of that could be bandaging.

2.30pm: The cannula in my right hand was starting to become annoyingly uncomfortable and at this point I wanted it to be taken out.

3.00pm: I asked the nurse if the surgeon will be coming round to speak to me or if I could get ready and go home. She explained he was still in theatre and would be for a few more hours but she would ring and find out if I could go home. She returned a few minutes later and said that if I had eaten and been to the toilet I could go home. She advised that I should keep my arm elevated when possible and that the outer bandaging could be removed after 48 hours. Underneath I have a waterproof dressing that I could remove after 7 days. She said that they had used dissolvable sutures and would need to see the surgeon again in 6 weeks.

3.30pm: The nurse removed the cannula from my hand which I think was the single worst pain of the day so far! But at least it was short. I took 5ml of my Oramorph solution in preparation of a painful ride home. It was a long walk to the car (I should have had it driven round to meet me at the exit but didn’t think). I had to keep the arm elevated, as there was much more pain if I let it drop below heart. I had prepared with two pillows in the car which I used to rest my arm on my knee which worked well, I also took my sick bucket from the hospital room. Even driving very slowly, every bump in the road was quite painful, although I could lift my arm if I knew a bump was coming! I experienced no sickness in the car at all which I was very pleased about! It seemed a long time to get home due to bumps, I was very glad I had taken the pillows.

At Home

I got home and went straight to bed. I raised my arm next to me on two pillows, took 400mg ibuprofen for the swelling and laid for about an hour. The pain was still 4/10, really not bad at all, much better than I had expected or even hoped.

5.00pm: I suddenly became very hungry and ate a good dinner and drank a lot of fluid, my throat was still quite sore, so it would have been a good idea to have throat sweets/strepsils ready. I moved my fingers carefully every 30 minutes or so just to keep making sure that I could!!

8.00pm: Very strong pins and needles in the numb part of my hand turned into strong burning sensation, pain level 6/10. It turned out to be the feeling returning in my hand and fingers and by 9.00pm approx 90% of feeling had returned. I was ecstatic about this as I was beginning to worry it could be permanent. I had random twitches and spasms in my fingers every few minutes, not painful, I just assumed it must be the nerve settling in to its new home.

End Of The Day

I was extremely happy with the level of pain, feeling almost euphoric that the journey had started and it had been nowhere near as bad as I had imagined – possibly due to the huge amounts of pain I had been in for months beforehand. No pain today had been worse than on a bad day pre-operation.

I took my 30mg MST tablet and settled down, I got approx 2 hours sleep as there was no way of getting my arm comfy enough to sleep soundly. I tried for 6 hours in different positions and eventually dozed for a while.

One Day Before Surgery (Fri 5th March)

I was very nervous and was having problems with the side effects of the Morphine, the biggest being constipation. I took a lot of laxatives in the hope of going to the toilet before the operation as I knew it would be a lot more difficult afterwards. I had to stop eating and drinking at midnight, but my last meal was at 6pm and my last drink at 9pm just to be on the safe side.

I had a pretty sleepless night, partly due to nerves and partly due to the laxatives causing quite a lot of stomach upset. I still hadn’t actually been by the morning and I’d say I got maybe an hour’s sleep in total.

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.