AIN to Ulnar nerve transfer/supercharge surgery

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clink262
New Member


Date Joined Oct 2016
Total Posts : 1
   Posted 10/27/2016 2:48 PM (GMT -6)   
Hi all, new to this page. I broke my elbow in april 2016. During the elbow repair surgery, my ulnar nerve was injured. It was decompressed a week after the original surgery. That alleviated pain, but did nothing to regain function. I found another surgeon a few months later. He ordered an EMG, where they found the motor function was nil and unlikely to recover. He subsequently performed a supercharge AIN to Ulnar transfer. That took place on 8/31/16. I am slowly regaining sensation, my thumb is much stronger. I've increased my pinch and grip strength, however the gains in the ring and pinky fingers are slow. I realize it's much easier to strengthen the thumb, but still find the other fingers frustrating. At least I am no longer wearing the brace, as the fingers stay out of the way and don't get pinched. Wondering if anyone has any experience with this surgery. Would love to hear other's experience.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16804
   Posted 10/28/2016 12:01 PM (GMT -6)   
Hi Clink & welcome to Healing Well. Wow, that is quite a story you have to tell. But, that is ok, everyone that comes here has their own story to tell.

From what you are saying it sounds like things may finally be on track for you & lets hope it continues. Keep up the good work, what you do is just as important as any of the surgeries you have had.

We have had some past members have ulnar nerve problems. It can be a tough road but hang in there.

Keep us posted. Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

pitmom
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Date Joined Jan 2015
Total Posts : 2407
   Posted 10/31/2016 10:04 AM (GMT -6)   
Welcome clink. I've not had the surgery you describe but have ulnar nerve damage. Time. That's the only thing that has really helped me.

I'm glad to hear that the surgery has helped you. Now, you just have to let time do what it does. Listen to your surgeon and physical therapist (assuming you have one). My p.t. used a modality he called 'points'...a stylus is placed at different points along the nerve path and electrical stimulation is sent through the stylus to the nerve. It helps it regenerate the ability to carry signals to and from the brain. It helped restore additional function to the nerve. I don't remember the exact numbers, as this was way back in 1996. Pinky's aren't known for strength to begin with, but mine is pretty good now. Sensation is still an issue but, I manage.

Keep posting and let us know how things progress.
multiple surgeries for rotator cuff both shoulders with residual chronic impingement syndrome, ulnar nerve transposition, carpal tunnel release, wrist ganglionectomies/denervectomies/tenolysis, multiple herniated discs, tarlov cyst, whiplash, bursitis of hips, tendonitis, torus, 3rd degree shoulder separation, torn labrum, ovarian cysts, fibroid tumors of the uterus

AJ110
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Date Joined May 2018
Total Posts : 4
   Posted 7/9/2018 10:27 AM (GMT -6)   
Hi Clink,

I am going to be going for a similar surgery after my second EMG and Ultra Sound report show negative signs of improvement and loss of severe muscle mass. I am experiencing sever pins and needles after removal of a scar tissue from my injury which compressed the ulnar nerve above my elbow and since after this I am experiencing pins and needles which gets worse at night with the position of bending the elbow. I went to see a Neurosurgeon and he thinks from the reports the nerve is cut and some stuff might be connecting but not 100% since I am 7 months into this now was suggested to do an AIN transfer from my wrist area to super charge the motor function of the ulnar nerve to regain motor movement to my pinky and ring finger so that it doesn't crawl. I wanted to know the level of pain after this surgery and recovery period?

I am already facing very uncomfortable symptoms.

thank you,

pitmom
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Date Joined Jan 2015
Total Posts : 2407
   Posted 7/9/2018 3:46 PM (GMT -6)   
Hi AJ110. I don't think Clink has been back since first posting nearly 2 years ago.

I hope 'no news is good news' and that Clink continued to improve.

Each injury is different, each surgery is different, each recovery is different.

I had my sub muscular transposition done after a 'smashing' injury and months of it not being adressed where additional damage to the nerve took place. I had, according to the e.m.g., only about 20-25% of the function remaining. Post op, I was placed in a cast for 6 weeks. Once that was removed, I began about 12 weeks of physical therapy. Stretching the joint, massaging the scar line, ice being rubbed along the scar and the new nerve 'track', a modality he referred to as 'points' where a stylus would be placed at various points along the nerve and a jolt would be sent through the stylus...very uncomfortable but I think is the reason I have such a good function now, so well worth it! They sort of 'forced' impulses back and forth along the nerve to help it regenerate.

I would experience burning, tingling and jolts of pain with no way to anticipate them and nothing to be done about them...except for ice. Somewhat counter productive to try to numb a nerve one wants to be working again! I sat with the forearm resting on the softest pillows I could find...slept in a recliner, so the arm could still be on the pillows, wore a special sling that had a band around my upper arm and one at the wrist, so as not to have that part of the forearm rubbing on anything...epsom salt soaks as often as I could as well.

Nerves are such a tricky thing. They take a loooonnnngggg time to heal...IF they heal.

As for another surgery...only you can decide. I looked into having another procedure done but the surgeon told me it would only have a 30% chance of giving me any added benefit of comfort. Not good enough for me to go through that pain and rehab again, so I chose to live with what I have. I am fortunate...I have use of both the ring and pinky fingers although little strength and still have numbness/burning. The more I use the hand, the more the forearm feels achy...epsom salt soaks still help with that.

Weigh your options. Have a chat with a physical therapist about what can be done post op.

I wish you the very best.
multiple surgeries for rotator cuff both shoulders with residual chronic impingement syndrome, ulnar nerve transposition, carpal tunnel release, multiple wrist surgeries, multiple herniated discs, tarlov cysts, whiplash, bursitis of hips, grade 5 right shoulder separation and torn labrum, ovarian cysts, fibroid tumors of the uterus

Sarge 83
Regular Member


Date Joined May 2018
Total Posts : 22
   Posted 9/1/2018 5:39 AM (GMT -6)   
Hi Aj

I am now 19 weeks post surgery and i have had very little improvement,i would say that my pinch strength has improved and that's it. I had a Ulnar Nerve decompression and an AIN Nerve transfer but no way will that stop the clawing that will still take months to improve and the muscle wastage has come to it's maximum. There is no time limit as to exactly when the AIN Nerve transfer works but it won't work wonders. I don't know why your surgeon didn't do the Nerve transfer at the first surgery as it's better to do them both at the same time. Maybe age is a factor as im 35 and that is considered old in terms of nerve healing. Sometimes i think the surgeon just screwed up and the nerve transfer wasn't connected right or came undone im not too sure but im starting to lose hope as neraly 5 months this will be and NOTHING!

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16804
   Posted 9/1/2018 10:36 AM (GMT -6)   
Sarge, please try your best to not lose your hope. I know that this has been a horrible roller coaster ride & you are ready for it stop & get off.

You are 5 months out from surgery, the nerves take much longer than that to heal, or get as good as it will be. One year post op pretty much tells the story of the success of the surgery.

Hang in there & keep us posted......
Susie
Moderator in Chronic Pain & Psoriasis Forums

Sarge 83
Regular Member


Date Joined May 2018
Total Posts : 22
   Posted 9/1/2018 7:25 PM (GMT -6)   
Being close to 5months and nothing that itself is bad news as I've read that people who have had ulnar nerve transfers with the AIN nerve do quite well after 3 month's so I question was mine done right? And why is mine slower. I sometimes think my ulnar nerve is just dead.
I'll keep everyone posted but I doubt the next post will be good news.

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 893
   Posted 9/2/2018 10:20 PM (GMT -6)   
Sarge83:
I think you need to sit down with your surgeon and have a more in-depth conversation regarding the particulars of your injury, AIN surgery, the recovery course and expected/hoped for milestones to look for.

AIN provides for augmented sensory and motor functional support of a severely damaged peripheral nerve. It was designed specifically to treat ulnar nerve injuries but has been adapted to treat other large diameter peripheral nerve injuries (compressed, crushed, and severed nerves).

The surgical nerve anastomosis serves to “babysit” motor end-plates until the native (now damaged by injury) axons can regenerate and reinnervate the affected downstream muscles. That is, the side-to-end nerve anastomosis serves to provide temporary nerve impulses/transmission to keep the affected muscles viable while the native/original axons regrow and refined the narrow pathway to each of the motor endplates of the affected distal musculature.

Healing and recovery of a severe peripheral nerve injury (crushed or severed) is a slow and exacting process. Regeneration of each native axon occurs at the rate of approximately 2 cm (plus or minus) a month.

2 cm = 1 inch

For an ulnar nerve injury at the elbow (which I believe you mentioned is where your nerve was injured) would be the measured distance from the elbow to the hand/fingers. This distance can be 10” to 14 “ for an adult. At a rate of 2 cm/1 inch per month, peripheral axon regeneration would be estimated at 10 to 14 months.

The journey of the regenerating axon is not an easy one. The axon has to “find” its way along the original nerve pathway to the motor end plate of the distant muscle. There are no posted signs or directions for the axon, no road map. It is an amazing but uncertain process.

Physical/occupational therapy that uses external evoked potentials (which Pitman has described as points therapy) serves a valuable role by giving the regenerating axon a sort of GPS as to it’s needed/intended direction. It is like providing a blinking direction light . . . “Come here” it relays to the regenerating axon, “keep aiming this way.”

The AIN nerve transfer is providing a bridge of neurological transmission to the muscles after by the damaged ulnar nerve until the original/native axons can regenerate and find their way to the motor endplates of these same affected muscles. This is a slow, slow process. 2 cm/1 inch per month.

The reality is that there is no guarantee that each native/original axon will successfully find its way. But certainly, ongoing physical or occupational therapy does help augment success. An occupational therapist with clinical specialization in the hand would be a coveted resource for you on both the short and long term. Fabrication of resting hand splints to prevent contracture as well as dynamic hand splints that jumpstart functional strength are invaluable during recovery. OT would also monitor the nerve’s regeneration and can give you an idea of where it is. Stretching and soft tissue mobilization to keep scar tissue at bay. Scar tissue is a major impediment to nerve/axon regeneration. Therapy to minimize scar tissue is key. Nerve endings can easily become embedded in scar tissue. Like turning a car into a dead end culvasac.

OK . . . This morphed into a longer post than I intended. But try not to feel a sense of doom that your ulnar nerve is “dead” with only darkening news on the horizon. Make an appointment to talk with your surgeon. Get more detailed information on the nature of your injury, AIN surgery, expected recovery timeline, and an occupational therapy hand specialist referral.
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Sarge 83
Regular Member


Date Joined May 2018
Total Posts : 22
   Posted 9/6/2018 10:15 AM (GMT -6)   
Sea Shell Thank you for the length reply I do appreciate the insight of the length you have gone to explaining this. Just two weeks ago I went to my hand surgeon who specialises in this proceedure and that all he could tell me was the AIN isn't suppose to give back all the function of the hand which the ulnar nerve did which I understand but by now and I mean 20 weeks I would have expected some sort of recovery and it's basically nothing.

I would have assumed that the nerve transfer of the AIN nerve to the Ulnar would have reached my hand by now that's why I feel the nerve transfer has disconnected.
I am having a MRI and Ultrasound to the forearm to see if the anastomosis is intact.

For the last 10 weeks I have been doing low level lazer class 3 for minimum 3times a week even electro acupuncture twice a week.
I take the adequate vitamins for nerve regeneration even the most effective ones like Lion's Maine and Deer Velvet.

I have had cupping done extensively on the forearm scar and many many soft tissue massages of the wrist scar to enable full extension.
Now this is a fair bit to do as some people do nothing and I've not seen anything this is why I think doom thought's.

I struggle every single day with this not to mention I have had Stem cells done aswell and nothing has been effective.
There is no nerve pain which is good and bad so I don't know what to think of that.
One Neurologist says my ulnar nerve is as good as dead and another is more compassionate.

My regular Dr even tries to say you don't need to hand's to live but that Is beyond the point.
All I can do is wait another 3 month's then if still nothing I will know this failed and I can't do occupational therapy as I have already been dismissed by two as I can't the excersises what are given so I'm told to come back when it's reached my hand and then start.

Not to mention this actually took 6 week's to atrophy from the time I became symptomatic so I was operated on 8 weeks later which Is very fast but I had no choice.

I don't know what else to do I can't believe my one was so bad so quick.

Sarge 83
Regular Member


Date Joined May 2018
Total Posts : 22
   Posted 9/7/2018 2:27 AM (GMT -6)   
Pitmom

What was that exact nerve stimulation that you had done and what was it called,? I don't think anyone in Sydney Australia practice's that particular nerve stimulation.
I've looked at many physiotherapy sites and there is nothing on that.

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 893
   Posted 9/7/2018 5:42 PM (GMT -6)   
Sarge83:
Your writing clearly enunciates the deep dispair that envelops you as you face yet another day without evidence that your ulnar nerve has regenerated/recovered. I am genuinely sorry that full neurological recovery continues to evades you.

Your surgeon gave you a fair and objective explanation of the AIN transfer/anastomosis. The nerve transfer provides for a low level of impulse transmission to keep the damaged ulnar nerve viable during the regeneration process. An analogy would be connecting a low voltage cable to a damaged high voltage power line or the illumination of a low wattage night-l. The AIN transfer provides an ongoing impulse transmission, but it is not equivalent in intensity to that of a healthy/lively nerve.

Sarge 83
Regular Member


Date Joined May 2018
Total Posts : 22
   Posted 9/7/2018 7:53 PM (GMT -6)   
SeaShell
That is right there is no evidence so I've asked My Neurologist and he has agreed to do a MRI and a Ultrasound of the forearm to see if that anastomosis is intact as that's what I fear most.

My Surgeon gave me a varied response at first he said that the AIN nerve will reinnervate the hand in a few month's time and I have also read that many people have had reinnervation of the hand just after a few month's now I'm not having that.

I understand that idea concept of a low level cable but even a low level cable would give some charge and I don't even have that that's why I'm thinking it didn't work for me.
My surgeon just says it's early but I don't think it is as 5 month's is not early and I'm suffering not knowing.

I'm even considering another Neurosurgen to do a revision surgey to see what's going on.
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