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Ulnar nerve surgery success?
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By ErikaNW
Jan 31, 2011
Rapping off the Matron October, 2010
I would also love to hear how the recovery and return to climbing went for you Rob. I am currently in the same boat trying to decide whether to have surgery or not. I am a PT myself, but find that all of that knowledge/experience goes out the window when I am the patient (ie; I cannot advise/treat myself!)

I kind of think I will end up having surgery - my nerve conduction test showed motor/sensory delay at the elbow and my ulnar nerve subluxes every time I bend my elbow. I had a traumatic injury 9 years ago which resulted in the subluxing nerve. I managed it quite well until last summer/fall when I really ramped up my climbing difficulty and volume.

I am curious to know about recovery times, and also the different procedures. One person commented on the nerve not being as well protected with the anterior placement, and frankly that was something I hadn't really thought about. I would hate to damage it again jamming my arm in a crack.

Also, if anyone has feeling one way or another about surgeons they have worked with in the Denver/Boulder area, please PM me. I am considering getting a second opinion before undertaking a procedure that changes anatomy so drastically.

Thanks in advance for any advice.

Erika

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By C Scariot
Feb 1, 2011
Tyler Wick wrote:
I have bilateral ulnar nerve subluxation/cubital tunnel syndrome as well. The Sub-muscular ulnar nerve transposition procedure has been recommended to me, but I'm trying to hold off because of the long recovery period! Rob and Scott, do you guys have any updates on how the recovery went?


i had the same surgery a couple years ago. the surgery itself was no big deal. i remember going running the day after. and the next day back to work (carpentry). so from my experience, the surgical recovery is not nearly as much of an issue as the actual nerve recovery. i was getting very little conduction at the elbow in the nerve study pre-surgery (difficulty holding a cup). i was told that it takes about one month per inch for the nerve to regenerate (terminology?). These days, i am much better off than before surgery, but still not one hundred percent (maybe eighty percent). the main issue is numbness. also some tingling, cramping and weakness. overall much better now than w/o surgery. i'm a difficult case though as i've also had a cervical spine injury that also affected the ulna nerve. maybe w/o the additional trauma, i'd have been back to normal (but maybe not). unfortunately no guarantees w/ medicine. even the best surgeon can have a bad day. best of luck! feel free to pm me if you have any other questions/conerns.

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By ErikaNW
Mar 18, 2011
Rapping off the Matron October, 2010
So I had my surgery 5 days ago.... ended up being a lot more complicated than what we initially thought. In addition to the ulnar nerve transposition (submuscular), they reconstructed my ulnar collateral ligament with a cadaver tendon graft and repaired my common extensor tendon which had a full thickness tear. So basically, my elbow was a mess - no wonder it has been so painful for the past 9 months.

It will be a long rehab - no gripping with that hand for at least 4 weeks and no strengthening for 3 months.... Hoping to get out on some easy slab climbing by the end of July though if all goes well.

Anyone else have this combination of procedures done and what was your experience with return to climbing? Trying to keep a positive attitude and figure I can still do some good hiking/backpacking this summer.

Erika

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By C Scariot
Mar 18, 2011
oddly enough, nearly two years after the initial transposition, in the last month or so the nerve somehow migrated back into a problem location. so two and a half weeks ago i had another surgery, this time submuscular, to hopefully put an end to the ulnar nerve problem. no tendon issues though. in retrospect, seems like the best way to go, although it wasn't presented as an option at the time. hindsight, right? anyway, i sympathize with you.

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By RyanE
Dec 6, 2011
C Scariot,
How was the sub muscular transposition recovery? I just want to know what it was like afterwards and how your forearm recovery was. I have had the subcutaneous transposition done, but it failed. My surgery is scheduled for december 20th, 2011. Was it painful, how long until you could use the arm, splint or cast, does your arm still feel weak?

Let me know everything. I do well with pain but just want to know what it was like to have flexor muscles cut.

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By C Scariot
Dec 9, 2011
RyanE, sorry for the delayed response.

Its been about 10 months since that surgery. Things are going reasonably well. Strength has improved for sure, but not 100 percent. Still get some irritation that comes and goes, causing minor numbness and tingling. Also get some minor pain where the muscle was opened to bury the nerve; mostly only notice that when doing barbell curls of similar (i.e. low powerful under-cling).

The surgery/recovery: Pain wasn't really an issue. I think it was 4-6 weeks in a full arm splint which kind of sucked. Not much use of the arm at all during that time. Then another few weeks in a removable soft cast type thing to prevent full extension of the arm (don't want to risk pulling the muscle back apart before its healed). Minimal use of the arm during this time. Seems like I was on a weight/use restriction for nearly three months. While its a long time to not use the arm for much of anything, i was able to start running/hiking really quickly after the surgery - i think the same week. At least you can stay somewhat fit while waiting to climb again.

best of luck w/ the surgery. feel free to contact me if you have any other questions or concerns that i might have neglected to address here.

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By RyanE
Dec 9, 2011
C Scariot,
Thanks for the info. Did you have compression issues before the surgery or was your nerve subluxating (moving around)? 2 years ago I broke the ligament that keeps the nerve in the cubital tunnel. It was the ulnar collateral ligament. Ever since then my nerve just grinds over my medial epicondyle every time I extend it. I rarely get the tingling sensation but I def. feel the throbbing pain and muscle weakening. Doctor says it is amazing that my arm still works after 2 years. Is there a lot of pain, weakness, and irritation due to the forearm muscles/ incision area? I don't think my nerve will have too much of these sensations since it is still somehow working. Also, my doctor said about 1 week or so in a splint but I think it should be longer. How was PT?

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By C Scariot
Dec 9, 2011
initially i did have a compression issue. the result of an elbow first (then face) mtn bike crash. had the nerve moved (subcutaneous) and all got better. like 2 years later, somehow the nerve came free and began subluxating. could see it underneath the skin popping back and forth. began having strength and feeling issues again. next time around i went w/ the submuscular option. i didn't find the incision to be particularly painful, but as i mentioned, i due still get some pain in the muscle at the incision site, but only in certain positions/motions. one week in a splint seems really short. my surgeon was very clear that i needed to keep the arm from fully extending while still healing. i wouldn't want to risk further damage/delay healing. might be worth another opinion. pt was no big deal, but then again, i'm perpetually rehabbing something....

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By ErikaNW
Dec 9, 2011
Rapping off the Matron October, 2010
Hi Ryan - thought I would chime in on this one as well... I had the submuscular transposition done March, 2012 as well as a UCL reconstruction and extensor tendon repair. It seemed to me that the flexor tendon was by far the most limiting at least initially since I could not use my fingers/wrist/hand for about 4-5 weeks to protect the repair. I was in a hard cast-like splint for 7 days, and then a locking brace for another 3 months (more for the UCL reconstruction than the nerve surgery) with gradually increasing range of motion allowed. I was riding a mountain bike on the road at 8 weeks (for about 20-30 minutes at a time - would have to stop due to flexor tendon pain with feathering the brake), and back to climbing on TR at 4 months, leading at 6 months.

Make sure your PT does a lot of manual work early to address scar tissue around the incision, nerve gliding to keep the nerve from scarring down (the nerve glides need to be done in the median nerve position since the anatomical course of the ulnar nerve has changed with the surgery), and scapular/shoulder strengthening.

I still have numbness in my pinky which gets worse when I exercise or type a lot, and it was about 6 months before I had much sensation at all in the hand. My hand, forearm and shoulder are still pretty weak on that side, but getting better all the time.

Ligament of Struthers is the ligament that keeps the nerve in the groove and is frequently torn resulting in nerve subluxation. If it is actually the ulnar collateral ligament that you tore, you really should look at having that repaired at the same time (Tommy John surgery) as you will have an unstable elbow without that ligament. I cannot believe how stable my elbow feels with an intact ligament - for the 1st time in 10 years I feel confident hanging on that arm. If you have a complete UCL tear and your doc has not suggested repairing it, I would for sure get a second opinion. I know the more 'old school' approach has been to only do the UCL repairs on throwing athletes, but my doc was adamant that it should be done for anyone who has a high level of activity - and I have also learned it is a fairly common climbing injury.

Anyway, hope this helps add more to the picture... good luck!

Erika

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By RyanE
Dec 10, 2011
Erika,
I was wondering about whether or not your surgeon was specialized for this specific surgery or whether he mostly did the subcutaneous one. My surgeon does tons of sub cut, he is a sports/athlete doctor. However, I don't really know if he has done this surgery often especially since he told me that I am his first failed subcutaneous sling. I was told the sub muscular surgery was more "old school". As far as the UCL tear, the MRI showed that mine was completely severed. There was not any evidence it was even there! My elbow feels stable though. I tried to get a second opinion, but the doctor would not even see me since I already had the subcutaneous surgery done a few months ago. I will keep you posted on how it goes.

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By tenpins
Dec 10, 2011
I would recommend Dr John E Sarno's "Mind Body Connection"

A kid in my squad had an ulnar nerve replacement. But he was blown up by a command detonated IED in 2004. As much as possible, the surgery was successful. His remaining disabilities in that arm are not related.

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By ErikaNW
Dec 10, 2011
Rapping off the Matron October, 2010
Ryan - sent you a PM.

Erika

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By Stu QSX15
Mar 6, 2012
Hi all,

Interesting posts. I have had ulnar nerve entrapment for about 12 years, numbness in the little and ring fingers on both hands and after any serious physical activity involving arms my elbows felt like they were stuck in a fire. I was diagnosed in Australia about 10 years ago, nerve conduction tests etc done and had the option of surgery which I avoided. I tried various physio options, no acupuncture but the most effective remedy was I have simply stopped most of my sports, kyaking, swimming, climbing, riding etc. I still experience the numbness in my hands when I have my forearms resting on my chest during sleeping and sitting in an aircraft is by far the worst position. I only needed to swim a kilometre and the condition in my elbows would come straight back. I did not experience any muscle wasting in my hands but I have noticed my strength reducing which could be from my more sedentary life. The numbness is getting worse now so I have taken the plunge and had my right arm operated on 4 weeks ago for an ulnar nerve relocation to the front of the elbow.

I didn't think the operation was much of a big deal. The operation took about half an hour and I had a nerve block. Preparation was about three hours. The nerve block worked well until about 4am next morning then the pain kicked in. I went onto tylenol and Ibuprofen for about two days which sorted everything out quite comfortably. I lost a lot of movement in my arm at the elbow for about two weeks because of stiffness and pain in the forearm and elbow. I now have full movement back and strength is OK. I am able to curl a small dumbbell and I can get full extension. My inside elbow is extremely sensitive. At full arm extension and then contracting with some light weight I can create an enormous amount of pain at the location of the ulnar nerve. It is getting better over time and I will be focusing on more basic weights program. I am due to have the left elbow operated on next week. I am looking forward to not having the pain and numbness but the recovery has been longer than I had anticipated. The follow up from the doctor has not been great but the surgery was very good, virtually no bruising at all.

I decided to go with the surgery as I had really tried everything to deal with the problem. Even as I type this my left hand is going to sleep. I did note that taking Ibuprofen made a big difference to the pain in my elbows but I did not want to be on IB candy every time I did something physical. I really want to get back into my sports and I rely on my arms for work. The doctor cant really say much about the pain from the surgery other than it should ease up with time which it has been getting better. I am still very cautious about having anything knock or applying pressure to the inside of the right elbow. I would like to find some information on post op recovery advice, so if anyone has any links or advice I would appreciate it. Other than that I think I am in a better situation post op. I will keep the forum updated on my progress.

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By archienc44
Sep 29, 2012
I had the Ulnar Entrapment surgery 10 days ago. (September 19) They used the Clavicular Block and my arm felt like a log post surgery for about 12 hours. I stayed on "heavy-duty" pain killers for only 24 hours post surgery and am now just taking IB.
Right Arm Ulnar Surgery Scar
Right Arm Ulnar Surgery Scar

I have attached a photo after they took off the semi-soft cast 5 days after the surgery. You may have to rotate it right in order to see it properly.

I am a golfer but found this forum to find about others who have had this surgery. I am also old...65...and hope to play golf competitively for another two years. Hitting down on the golf ball became a huge issue this past summer. I just could not do it and my handicap went up 10 points. I could hit the driver and hit most fairways but using the irons and hitting down on the golf ball was something my numb hand wouldn't allow me to do very well.

I just want to know how your pain is doing...and any advice you can provide would be great.

Best,

Arch

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By Devin Fin
From DURANGO
Sep 29, 2012
dream canyon fun!
holey shit!!!!!! im gona just keep giving my self "the stranger" every time that shit happens .....

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By Stu QSX15
Sep 29, 2012
Had forgotten about the post. I am now 6 months post op for both elbows and have had a full recovery. I was very surprised at the length of recovery and there was certainly some discomfort for several weeks after the op. I had a lot of trouble with pain in my forearms and shadow pain in the elbows. i went to see a massage therapist who suggested a cleanse, magnesium and tissue salts. He maintained my ph level was way out and needed to be corrected for the muscle tissue to be able to repair. I followed his advice and the muscular pain in the forearms was gone within days. I have been quite diligent in slowly building up my strength through static weights through to swimming. The surgery has definitely been worth while having as I am now almost back to the fitness and strength I had 10 years ago. There is still discomfort in my elbows and some odd nerve stuff in one of my hands but nothing compared to pre-op. Don't go into the surgery expecting to walk out and hit the gym in two weeks. it will take months to get back on track but with the right post op care life should be much better.

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By David Barbour
From Longmont, CO
Feb 4, 2013
I have had ulnar nerve issues in my left arm for 5 months now. I only have moderate numbness in my pinky and ring finger, no pain as of yet, slight weakness if any. I've been to PT and they gave me a brace to wear and nerve gliding exercises to do.

Did anyone else have numbness which eventually progressed to pain? Or numbness which eventually went away? My symptoms don't seem to be getting better or worse.

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By C Scariot
Feb 4, 2013
I only had numbness and weakness. never turned into a pain issue w/ the ulnar nerve.

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By David Barbour
From Longmont, CO
Feb 5, 2013
Thanks. As of now, I'm only about 10% weaker in my left hand, which could be attributed to being right-handed. It hasn't gotten any worse in 5 months, only the numbness.

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By ErikaNW
Feb 5, 2013
Rapping off the Matron October, 2010
My initial injury happened 10 years before I had surgery. The ulnar nerve issue never progressed to pain either, and the numbness itself didn't bother me all that much. If I hadn't had other injuries to deal with that were painful and impacting my daily function I might not have dealt with the ulnar nerve at all.

However after 10 years, I had a lot of muscle wasting in the intrinsic muscles of my hand that happened so gradually I never really noticed it. I had a nerve conduction study that showed the motor function of the nerve was being affected as well as the sensory portion. I probably won't regain that, but surgery was necessary to keep it from progressing further. That hand is about 80% on power grip and 50% on pinch grip compared to my other hand.

Have your PT check your grip and pinch strength if they haven't already, and also check the hypothenar eminence (pinky side of the palm) and the 1st dorsal interossei muscle (back side of your hand, squeeze the thumb into the first finger, it is the muscle that pops out) for flattening/wasting compared to your hand. Ulnar nerve glides are great also.

Good luck!

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By David Barbour
From Longmont, CO
Feb 5, 2013
Thanks! PT wants to do strengthening exercises, but I don't know how it would help considering the nerve is still affected. I feel like I'm wasting my time/money at this point, and I should just get one of those grip testers and keep track of it over time. And continue with the nerve glides, stretches, and brace. I'm meeting with the surgeon again in a month.

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By Extrablue
From Bronxville, NY
May 20, 2014
So I had it done about year ago on my left elbow after years of pain.
I still dont have full feeling my pinky and it still hurts when I go climbing, and the motorcycle really makes it feel unhappy.

BUT
When I get on something really hard and I flame out my left elbow (transpositioned one) seems to recover in a few hours, the right elbow which has not undergone surgery will hurt for days.

Seems like you trade climbing grip strength for pushing grip strength with the surgery.

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