Ulnar Nerve Transposition Surgery Recovery
I had a hard time finding information about this on the Internet so I figured I would keep a log and hopefully this will help someone else.
Update 07/08/2018 (2+ years post surgery):
It took about a year for the nerve to completely quiet down after being moved, but by 2 years this was a thing of the past for me. One thing to note is that nerves heal very slowly. When I was having this done, my surgeon told me that there would be an initial peak of pain due to the nerve being upset it was moved, but by moving it, it would allow the nerve to finally heal.
Update (11/16/16, 6 months post surgery):
Overall really happy with my decision to get surgery. I still get numbness/tinging sometimes, especially when holding my arm in downward-facing-dog position (i.e. arm fully extended, wrist bent back, weight put on it). My doctor has said that it could take a year or more for everything to fully settle out, but my symptoms are nowhere near where they were.
Disclaimer: I’m using speech to text for writing this out and so some wording may be weird and a lot of punctuation will probably be missing.
Typical pre-surgery procedure overall; I had to not eat or drink after midnight the night before my surgery and also avoid any drugs/substances that are blood thinners. Including, unexpectedly, fish oil. I also was instructed to shower the night before and the morning of with an antibacterial soap (i.e. Dial hand soap). I had to buy some since I purposefully avoid triclosan and other unnecessary antibacterial things.
I got to the surgery center and they did the normal vitals and had me put on the silly gown. They repeatedly made sure they were doing things to the proper arm. The anesthesiologist came by, as well as my surgeon to check up on me pre-surgery. I got an IV with a dose of antibiotics and then they added the anesthesia, and I was out.
The surgery took about an hour. I, of course, was out for it.
I got back from the doctor’s office feeling sleepy but not really in pain. I slept for little bit. When I woke up I was pretty hungry, as I hadn’t eaten for close to 24 hours at that point. I’m still pretty groggy but overall feeling pretty capable and pleased with how I feel. I’m sure that once the pain meds from the surgery wear off I will probably feel more. Also, my awesome boyfriend brought me grapes and Kombucha and lots of kisses and also drove me home. (re: Kombucha — I’m a huge proponent of keeping your body’s bacteria in good shape, so I made sure to take lots of probiotics after a round of antibiotics. Probiotics also keep your digestive system functioning, so they theoretically will help me avoid unpleasant side effects of the painkillers. Kombucha, kefir, etc are great for this.)
Seven hours post surgery I took my first pain pill. Pain was in the elbow and also upper arm.
On day one I think I overdid it a bit. Dmitriy and I went on a long walk throughout SF totaling about five or 6 miles. After that I started feeling a little bit nauseous and a slight temperature fever or something and my arms are hurting a lot more.
Probably after dinner I’m going to take another pain pill. Until then I think I’m ok. While I was out walking I did use my sling but the ice pack wasn’t cold for long and my arm wasn’t as elevated as it probably should’ve been.
The evening of day one was a bit rough. I started feeling some numbness in my ring and pinky fingers and I think also the caffeine that I had the previous afternoon prevented me from being able to sleep.
I woke up this morning with stiffness in my ring and pinky fingers which went away after some stretching. Some amount of sensitivity is still present in those fingers and I’m still getting a bit of numbness but I have full range of motion of those fingers. I decided that I’m going to take it a bit easier today and not go on a really long walk because I don’t think that was a good idea. I called my doctor to confirm that the numbness and stiffness is expected and will update that soon. (Answer: I didn’t get a response from the doctor)
By the end of the day I hadn’t actually received a response from my doctor so I am hoping it’s not emergency. Yesterday afternoon I also walked over to the store and bought a couple of things and that was about a 3 mile walk round-trip. I also went over to the embassy for a talk and overall that was completely fine although a lot of people were curious about what happened to my arm. Once again I took some pain medication to sleep since I find that it’s hard to get comfortable at night but I’m not using any pain medication during the day.
On the three I woke up with about the similar symptoms to the day before. There were some stiffness in my ring and pinky fingers and stretching feeling when I fully extend them but some careful movement stretching sort of gets that stiffness out.
I made breakfast and coffee for Dmitriy one-handed and I learned that I should’ve used scissors to cut the sausage. One other thing I’ve been doing is having a lot of probiotics and Kombucha since I’m aware that the pain medication can destroy your digestive system. By taking those things I haven’t had any issues. Also, for showers I’ve been getting Dmitriy to tie a garbage bag over my splint and I haven’t had any issues with getting showers that way. For clothing I’ve been wearing tank tops and then just draping my jacket or something around my right shoulder since my splint is too big for my sleeves and the convolutions required to get sleeves on can be painful.
Day 4 continued without any major issues. I went to brunch and chopped potatoes much to the displeasure of Dmitriy, who is more or less following me around the house trying to prevent me from using my arm. When I lift my arm significantly I feel a pain but it’s mostly pain that is more surprising than unbearable. I went on a walk and also who made dinner using both a mix of my left and right and. The main complaints I have at this point in time are that my splint is itchy and I really want to take it off but I can’t yet. Still using painkillers to sleep because it is useful for that and also because my arm is more sensitive at night. I think it’s because all I have to think about when my eyes are closed are how much my arm hurts and when I’m distracted during the day I don’t think about it at all. My arm is also not super sensitive to touch or getting bumped.
Since more or less progressed as they had been. There was pain in my arm and pain typically got worse at night when I was trying to sleep so I would take a painkiller so that I could actually sleep at night. As time went on I took walks throughout the day because that was my only real option for exercise since I didn’t want to sweat too much into my bandage since I can’t clean it. (I had to shower with a trash bag wrapped around my arm so that water wouldn’t get in). My bandages also got really itchy and at one point I called the medical assistant asking if I could take off my bandages to which she responded no, and that I had to wait until day 10 when I saw the doctor.
I have my bandages removed today and actually got to see the stitches and wound in general. The incision he made on me is smaller than probably typical because of how thin I am. The wound was closed with a stitch on each end and dissolving stitches throughout the middle. It’s turns out my doctor had put several layers of cotton padding underneath a splint and then wrapped that in ace bandages. This explains why I was able to run into things and not actually feel pain.
I realized that I didn’t take a picture of the bandage, so here it is:
After taking the bandages off, he taped up the wound with stitch tape and was going to cover it with a bandage, but the bandage he had has latex in it, so I had to go without. (I have a mild latex allergy caused by doing biochemical lab research and having latex gloves on my hands all of the time. It’s mild, but the rash/inflammation went away once I switched to nitrile gloves. Generally I don’t worry about it unless something will be on my skin for a long time, like a bandage).
It felt pretty weird when the bandages came off and I was once again actually able to bend my arm. My elbow was pretty stiff and I am at the point where I can not completely extend or contract my right elbow. I’m also very aware of any movement I make with my right elbow; I have to consciously think about using it, and I find myself relying on my left arm a lot more.
My doctor wants me to come back in four more weeks and then we will start actually evaluating how the nerve is doing. He also wants me to avoid activities that involve me repeatedly bending my elbow, including things like running because of how you generally pump your arms while running. :(
Most of the symptoms I was feeling before the surgery are coming back now that I am actually using my arm again (which my doctor is encouraging me to use it to prevent stiffness), however the symptoms are typically more sharp instead of a constant tingling or numbness. For the next few weeks the primary goal is to heal just the incision from surgery and the nerve is hopefully going to get better over time, but it will take a long time :( I understand why a lot of reports on the internet complain about their arm still hurting and still having the numbness and tingling and that’s because the nerve wasn’t really fixed by the surgery, the nerve was just moved out of the way of being more injured, and it takes a long time the nerve to heal. I’m still using a dose of painkiller at night in order to sleep; the pain is tolerable during the day, but at night when the only stimulus I feel is my arm, it makes it really difficult to relax.
I woke up with my arm feeling pretty stiff. I spent some time in the morning stretching it out. I still can’t entirely bend it or contract it; I’m probably 10 degrees shy of fully straightening it and another 10 degrees shy of fully contracting it.
Little victories, however; I finally was able to get a shower without a trash bag over my arm. Yay!
Except, I went to the gym for the first time today in quite some time and worked out on one of the stationary bikes. When I was working out I noticed very small blisters around the inner part of my elbow and scattered on my arm. After freaking out a little bit, and a bunch of Internet research I realize that they were something called prickly heat. Prickly heat is caused by a bandage or something applying too much pressure on your skin that eventually causes the skin sweat ducts to get blocked. This results in when you sweat, you then get a flareup of this rash. There is not really a treatment you just have to wait until the skin more or less resolves itself. Once again I am limited in how much I can exercise because I am not supposed to sweat. This is getting really annoying.
The stitch tape that my doctor put on fell off, so I had Dmitriy tape me up with butterfly bandages which are designed to help prevent the skin from stretching and extending the scar.
Here’s what the scar looks like. I’m not sure why it’s as jagged looking as it is.
My fingers are still a bit numb and largely I’m back to the pre-surgery level of symptoms for my fingers, but I still can’t totally unbend my elbow. My arm is still sensitive to the touch.
We went on a road trip to Portland since I still had time off of work, and was still a bit limited in the day-to-day things that I could do.
My elbow and the surrounding areas have a weird numbness to them. Applying pressure to the area will result in pain. If I press backwards on my palm (like the position your hand would be when doing a push-up or something like downward facing dog) my index and pinky fingers get a shot of numbness and tingly-ness, but I think it has reduced from where it was; now I have to apply some sort of weight when holding my hand like that rather than just moving my hand backwards on its own muscles. I think the area around the nerve is still swollen in comparison to my left elbow. My right arm still doesn’t fully extend to the degree that my left arm does, and it’s a few degrees shy of being totally straight. That being said, it doesn’t hurt to extend it anymore, unlike how it was for the first few weeks.
I’m going back to work tomorrow, and we’ll see how a full day of computer things affects my arm. I probably will continue to use my left hand for the mouse for a while longer, and I’ll also probably continue to use my weird ergonomic keyboard (the Kinesis Advantage) for a few more weeks until I feel like my nerve has actually started healing rather than just being moved.