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I had surgery on my elbow (subcutaneous anterior transposition of the ulnar nerve) one week ago. Posting my experience in case anyone else finds themselves in the same position I was in.


Original Post
Erynn Murphy · · Unknown Hometown · Joined Mar 2017 · Points: 0

Hi all,
I am a 23 y/o female. I have been climbing for just over a year. My skill and strength has been continuously improving, and I have reached my absolute strongest thus far very recently.

For the past several months, I have experienced a tingling sensation in my left ring/pinky fingers on and off. There was never pain and it always went away so I thought nothing of it. Over the past month, those same two fingers began to "claw" or bend on their own. At first it was just when I was really pumped after climbing, but it quickly shifted to occurring even during work and eventually they were almost always curled. This was what started to really freak me out. After speaking with a friend that is in the medical field, I found a great University of Chicago orthopedic surgeon who specializes in nerve compression of the hand/arm.

I went in to see her and she officially (and quickly) diagnosed me with Cubital Tunnel Syndrome, or compression of the ulnar nerve. The nerve was rubbing on the medial epicondyle (bone in the elbow) and scar tissue was forming, further hindering the nerve. She told me that many people are intimidated by surgery and want to try physical therapy first, but that most eventually come back with further progression of nerve damage (often irreparable) and end up needing the surgery anyway. She suggested I do the surgery immediately, as I was right on the cusp of reversible/irreversible damage. I discussed this with my boyfriend and decided I would rather get it over with and not risk permanent nerve damage. She scheduled surgery for the next week.

I was TERRIFIED. I have never had surgery before and although she assured me she has done tons of these exact surgeries, all I could think about was something going wrong and being unable to climb again. But I didn't have a better option, so I stuck with the decision to go through with it. That weekend my boyfriend and I went down to the Red River Gorge for one last pre-surgery hurrah, I sent my first 5.11c (Banshee at Solarium in Muir Valley!! Such a great route) and I headed back up to Chicago for the surgery on Tuesday.
Essentially the surgery involved them going in and moving the nerve. The surgery went as smoothly as it possibly could have. Nurses were great, doc was great, it took about an hour plus recovery. Doc told me that she found far more scar tissue around the nerve than she normally sees and they had to go in and break it up all along the nerve up into my tricep.

The day of the surgery was pretty bad pain once everything wore off. By the next morning, as insane as it sounds, I didn't even need pain killers. It still hurt a bit and I really couldn't move it at all, but I took a regular strength ibuprofen in the morning after the surgery and have not taken anything since.
It has improved significantly every single day. Little by little I had more mobility, less discomfort, and more strength in my left arm. Now, one week out and I have a FULL range of motion, only minor discomfort and soreness (to be expected) but I can hold things, open drawers, basically everything except heavy lifting. She warned me I might feel some "electric" sensations as the nerve gets used to its new home but I haven't had any of that. My fingers are no longer curled and I haven't had any of the tingling I was experiencing before.
She says I should be able to start back up with climbing in 3 weeks.

Overall, so glad I did this!! There seem to be no negatives really other than a month off of climbing. And with the nerve in a completely new position, I won't ever have to worry about this issue again. As long as it doesn't happen to my right arm.

john strand · · southern colo · Joined May 2008 · Points: 1,640

Yes, we had a discussion about this last year (i think). Several people have had various ulnar stuff done.

I had cubital about 2 years ago..doing well, I also had gout tophi in there pretty bad

Good luck

Parker Wrozek · · Denver, CO · Joined Mar 2012 · Points: 86

Good luck healing up. Nice send at the red.

Salty Margarita · · Unknown Hometown · Joined Oct 2017 · Points: 0

Hi Erin-- did you have a submuscular or subcutaneous?  usually for rock climbers/athletes they do a submuscular, which has a much longer recovery time.

David Pagel · · Milwaukee · Joined Mar 2016 · Points: 175

Happy to hear your success story! (At least so far so good) I was part of the discussion over the past two years. I have had both elbows done with a standard translocation surgery (more exposed). One was done in July of last year and the other in October of last year. Surgeries were great until I got elbowed, unintentionally, on the inside of my right elbow last year in November. I have since had a long recovery of numbing and pain all up my arm into my fingers. Basically being hit in the area (we think) has caused scar tissue to tether the nerve and cause a different compression area to form. So, as of now I’m going in on the 23rd to have a intramuscular translocation done on the same nerve to protect it and decompress it again. 

Overall my surgeries were a complete success, just be careful with any hard hits to the nerve for a few months as it is getting used to it’s new home. 

Jace Browne · · Unknown Hometown · Joined Feb 2018 · Points: 0

Hello Erran!

I hope you can still see this reply. I am scheduled for Ulnar Nerve Transposition Surgery on Feb 13th, 2018. The surgery is creating a new tunnel above the medial epicondyle. I don't think mine was as close as bad as yours. I never had the claw hand, but last summer there was a point i couldn't bend my arm for about about month with pretty bad shooting pain. It got better since then, so I've continued to work out ( Yes, I know you're not suppose to, but noting crazy). So my pain went down to just irritation. The nerve is still enlarged, and occasionally would feel pins and needs and small pain at the cubital tunnel region when the arm is bent for a prolonged period. It's annoying more than pain. It's been a year about since i've had symptoms, but the pain and tingling has went down. I'd say in general, its about a 4/10 max. I still have full grip strength but like i said, just a little irritation and very minimal pain. I had 3 reviews, which they said they would just go ahead and do the surgery since my EMG/ NCV can back negative, but since i've had symptoms for a year and it really hasn't progressed. They all think it's in the early stage, a years down i would most likely need surgery any. Plus, when I do a certain weird moment with my arm my nerve pops out. It's not a everyday moment so i'm not worried, but he still considered this subluxation. However, my other arm does this as well in a different pose. When It happens with the injured arm, it inflames it, but no pain. The other doesn't get bothered at all. I was wondering based on your experience with this and your short recovery time, do you think I would be around the same time since my arm has no muscle wasting and minimal pain? And, when did you return to work? I hope you're doing well btw! Thanks for the post.

David Pagel · · Milwaukee · Joined Mar 2016 · Points: 175

It matters if they are keeping the nerve outside or if they are lengthening muscle and semi burying the nerve into muscle. I have had both done and just a transposition is relatively quick. 10 days in a sling, then stitches get pulled and you will have another 10-20 days of getting range of motion back. It’s not necessary painful, but it feels weird/uncomfortable. The intramuscular transposition is a little longer in the rehab process but I was back climbing within 5-6 weeks post surgery. Depending on what you do for work, I wouldn’t think you would be out for more than 2-3 weeks. Unless it’s heavy lifting, in which case you might be out longer. 

Jace Browne · · Unknown Hometown · Joined Feb 2018 · Points: 0

Just to keep everyone updated. Surgery went great & I was back in the gym in 3 weeks! I also went ahead and had the right arm done as well. I believe I irritated it more as I was leaning on it while I was recovering from the left. I called my doctor and had it done six weeks later ( This past tuesday). I was bending my right arm fully in three days. I'm a week out and feel great. I should be about 100% in another 2 weeks. My doctor said my issue happened to be genetic, as my triceps was forcing my nerve out, thus causing irritation. Thanks for this blog and the reply David, helps a lot!

David Pagel · · Milwaukee · Joined Mar 2016 · Points: 175

Happy to hear it turned out so well! Thankfully my issues after being revised in November with another surgery seem to be drastically improving as well. Seems the only thing that irritates me nerve is crack climbing at the moment, but face climbing I’m climbing harder than I ever could have imagined! If anyone else has any issues or concerns related to Carpal Tunnel or Cubital Tunnel syndrome, don’t hesitate to DM me! I’m here to help

Sami Brucelee · · Aix-en-Provence, FR · Joined Jul 2018 · Points: 0
David Pagel wrote: Happy to hear it turned out so well! Thankfully my issues after being revised in November with another surgery seem to be drastically improving as well. Seems the only thing that irritates me nerve is crack climbing at the moment, but face climbing I’m climbing harder than I ever could have imagined! If anyone else has any issues or concerns related to Carpal Tunnel or Cubital Tunnel syndrome, don’t hesitate to DM me! I’m here to help

Hello David, how are you going to return to your activities? Why have you proposed an intra muscular transposition is not a sub-muscular transposition?

David Pagel · · Milwaukee · Joined Mar 2016 · Points: 175

Back to normal! Still have some nerve discomfort every once in a while but it’s a lot better compared to how it was pre surgery. And to my understanding it has to do with how buried the nerve is in muscle. Different depths

Peter Rothe · · Copenhagen · Joined Feb 2019 · Points: 0
Jace Browne wrote: Just to keep everyone updated. Surgery went great & I was back in the gym in 3 weeks! I also went ahead and had the right arm done as well. I believe I irritated it more as I was leaning on it while I was recovering from the left. I called my doctor and had it done six weeks later ( This past tuesday). I was bending my right arm fully in three days. I'm a week out and feel great. I should be about 100% in another 2 weeks. My doctor said my issue happened to be genetic, as my triceps was forcing my nerve out, thus causing irritation. Thanks for this blog and the reply David, helps a lot!

Hi Jace, 

I know this is an old post but I just wanted to follow up. My ulnar nerve is subluxing on both arms and I'm considering surgery to correct it. I'm not able to do any sort of exercises, very few daily chores and I have pain around the inside of my elbow most of the time.
Tingling in fingers is rare and no loss of strength.

Are you still happy with the surgery? And does the nerve get irritated if something touches or hits the inside of your arm now that it's less protected?

I hope you read this and if anyone else can weigh in too I'd really appreciate it.

Peter
David Pagel · · Milwaukee · Joined Mar 2016 · Points: 175

Being one and two years out of surgery in both elbow, I wouldn’t hesitate once second to get them done. I have full function and have been climbing better and harder than ever. I still get some burning left over after pushing hard but nerves are one of the most finicky systems in the body. The sooner you fix it, the better of a chance you have in getting full functionality back. 

Peter Rothe · · Copenhagen · Joined Feb 2019 · Points: 0

Hi David,

Thanks for your response! You had both a submuscular and subcutaneous transposition done, right? Are you equally satisfied with both? And what happens if anything bumps or touches the subcutaneous one? 

David Pagel · · Milwaukee · Joined Mar 2016 · Points: 175

Both were moved from the channel, then I got hit hard on the right one and needed to have it revised so I ended up having it don’t sub muscular the second time. With one elbow done each way, I don’t have a problem with either of them. That being said, my left can probably move a bit better but it is exposed a little more and has a higher risk of being damaged (although it has to be a pretty freak accident) 

Peter Rothe · · Copenhagen · Joined Feb 2019 · Points: 0

The doctor I've visited has strongly advised against the operation saying that all of the patients he knows of have regretted getting it. I'm currently trying to get a second opinion from some doctors who've published a research article on snapping elbow which is what I'm suffering from. In it they discuss the subcutaneous anterior transposition saying it's safe and effective.
It's assuring to know that you've recovered and aren't bothered by having the nerve in a more exposed location. Thank you

David Pagel · · Milwaukee · Joined Mar 2016 · Points: 175

I wouldn’t hesitate to have my surgeries over again if I had the choice back then. I don’t know if I would be wild about cramming myself in an offwidth crack and jamming elbows in. But I could probably get through it without major issue. Just need to baby your elbow from hitting things for around a year until the nerve is used to its new place. 

Jace Browne · · Unknown Hometown · Joined Feb 2018 · Points: 0

Hey Peter,

We may have been in the same somewhat similar situation. At first, I just experienced pain, but the tinging came a little after. I only had loss of grip strength when I kept working out to a point where I couldn't even squeeze my hand (Ignorant, I know). From what I've researched, your elbow won't get any better; it'll just get worse if you don't end up getting the surgery since it is subluxing. Before surgery, I went through physical therapy with no avail. I remember my trainers saying this would be an easy fix, but I could tell when she was looking at my nerve pop out, she knew.  Physical therapy did nothing for me but waste my money. Once the nerve subluxes, PT can't fix this. I had submuscular surgery in both arms. My right arm is 100% healed as it wasn't even close to how bad my left arm was. My left is still somewhat sensitive, but I can lift heavy weights in the gym like I used too. Sometimes the nerve just takes a while to get adjusted to the new location. I've never hit the inside of my arm on anything. Atleast for me, it hasn't been anything close to an issue. But it does happen in David instance. But like he said, just be careful. The only problem I've experienced is that if I sleep with my elbows bent for over 6 hours they'll be really sore, kinda like an intense forearm workout. But it usually goes away in 30 mins to an hour. I'm happy I went through this surgery and would recommend it to anyone. Just make sure you see an surgeon that has preformed multiple procedures of this kind. Recovery was smooth, just make sure you engage in physical therapy after your procedure. Good luck with everything, I hope the direction you choose to go works out in your favor. 

Peter Rothe · · Copenhagen · Joined Feb 2019 · Points: 0

Hi Jace,

Thanks for the reply. I'm still waiting further examinations. CT scan on Monday to check for bone spurs and hopefully my insurance will cover an EMG. I haven't been able to work out since August and have pain in both arms on a daily basis. It affects my job and my mood is at an all time low. I have this tight feeling on the back medial side of my elbow and all the way up my armpits - sometimes I have to lie on my side with both arms stretched out in front of me to ease the pain/discomfort. I spoke with the doctor about transposition surgery and he once against strongly advocated against it. I think I'll get a second opinion since everyone else seems to say the surgery is a good option.

Once again thanks for the reply - it gives me some hope that I can get past this.

Peter

David Pagel · · Milwaukee · Joined Mar 2016 · Points: 175

I can say, I didn’t even let my pain get to that point before I considered the surgery. All I know from dealing with nerve issues for 3 years on and off is the longer you wait, the higher risk of perminant damage being done to the nerves. If I could do it all over again, I would’ve waited 1/2 the time and just gotten it done. 

Robert Ball · · Brisbane, Queensland, AU · Joined 6 days ago · Points: 0

I'm getting the same surgery at the end of the month (subcutaneous ulnar nerve transposition).  I managed to whack the inside of my elbow about 5 yrs ago, causing the compression, then barely any symptoms until about February....then it came on with a vengence!  Not too worried about the surgery, although I know it will frustrate the life out of me with the immediate post-op recovery.

Guideline #1: Don't be a jerk.

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