Cubital Tunnel Release Surgery

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Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/5/2018 3:01 PM (GMT -6)   
Hello,
This is a post regarding cubital tunnel release surgery, hoping to get some insight as members on this forum seem to be far more insightful than many doctors.

I fell on my wrist and sprained it in October 2017. I did not immediately notice any issues with my elbow at all. In early December, I could feel that my my ulnar nerve was badly compressed in my elbow on the same arm. It was a very sudden onset.

The EMG showed very severe ulnar neuropathy, but my surgeon recommended trying physical therapy. At the end of physical therapy, I slept in a slightly compromised position, and the nerve pain in my elbow went off the charts. I lost complete use of my arm and struggled even to write. I begged my surgeon to schedule surgery ASAP. I went through 10 days of off the charts nerve pain waiting for surgery.

I finally had endoscopic cubical tunnel release surgery on March 7. I felt much better the day after surgery.

Although the surgery helped very much, I still really have to baby the arm due to nerve pain. I again slept in a slightly compromised position 2 weeks ago, and the nerve flared up a lot. The following week, I got electric shocks going from my elbow into my arm. Those have resolved, but my arm cramps up very easily. The cramping actually started before I slept in a slightly compromised position.

Oddly, I never really had tingling or numbness in my hand, but I would take that over the debilitating nerve pain in my elbow. Sometimes, it's like a sharp pain.

A May 29 EMG done by the same neurologist who did the first EMG showed that the nerve is normal. The nerve does not feel normal at all though.

I have not really had any nerve desensitization therapy so far.

I wish everyday that the surgeon would have skipped physical therapy, as I even told him I didn't think it would work. He was actually my second opinion surgeon. The first surgeon I saw recommended surgery as the only solution, but he does not perform the endoscopic cubital tunnel release.

Both surgeons I saw are highly regarded, but my experience has not been satisfactory.

Thank You.

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 894
   Posted 8/5/2018 6:08 PM (GMT -6)   
Q22:
I can appreciate your growing frustration with a highly irritated ulnar nerve that is not quieting down as hoped for and expected.

Peripheral nerve injuries with associated hypersensitivity take time to heal. There is no easy way around the necessity of time. Desensitization is a gradual process. It is less often a smooth process of ever decreasing sensitivity but rather, more often than not, a process punctuated with periodic flares and upticks in pain that can be like a bolt of lightening.

What can be done to facilitate the best possible outcome?

You mention several occasions of sleeping in a slightly compromised position. This stands out as a key variable.

Most people are unaware of their range of positions assumed and movements during sleep. Sleep studies that record stages of sleep via brain electrode monitoring and body position/movement via recording camera have brought new levels of awareness. A large number of people assume tight “fetal positions” during sleep. Arms flexed tightly at the elbows and wrists, held against the chest. The degree of muscle co-contraction can be significant.

An obvious approach would to have an occupational therapist provide you with a individualized upper extremity resting splint. You would wear this splint during sleep. It would position that elbow (at a minimum) in an anatomical alignment that would prevent compression of the ulnar nerve. I am surprised that this has not been offered to you?

In the interim, you can use an ordinary hand towel, wrap it around your arm and forearm, secure with masking tape or cloth medical tape. The arm need not be completely straighten/extended at the elbow. Allowing for 20-30 degrees of flexion is fine. The idea is to swaddle the arm/forearm with the elbow in a comfortable position, limiting extreme flexion or pulling the arm up close to your chin/chest.

There are home activities that can be incorporated to desensitize an irritated nerve. Key is to provide meaningful sensory input into the affected area/affected nerve. A nerve needs purposeful input in order to calm errant nerve impulse firing that is the hallmark of an irritated and hypersensitive nerve.

Select a few different types of fabric. Perhaps a piece of rough burlap, a piece of soft felt or fleece, a lofa sponge, a piece of silk. Spend 2-3 minutes gently stroking the area of skin where you have altered sensation with one of the textured cloths. Then rest.

You can do the same with cool and warm water. Alternating submerging the affected area in cool water for 2-3 minutes. Rest for 10 minutes in the ambient air. Submerge the affected area in warm water for 2-3

Some people find tremendous value wearing a compressive sleeve over the arm and forearm. The compression is 10-12 mg HG or less. Ex. A neoprene sleeve or lycra/spandex material sleeve. Compression sleeves should be available from your physical therapist or occupational therapist (OT).

These are only a few possible examples.

An occupational therapist with speciality in the hand would serve you well to help establish an individual program tailored to you and your specific ulnar nerve injury and recovery. Some hospitals and outpatient therapy clinics provide special hand rehabilitation OTs and OT programs.

There is definite hope for a better outcome for you.
Karen

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/5/2018 8:47 PM (GMT -6)   
Hi Karen,
Thank You so Much for your elaborate reply filled with helpful information.

My forearm usually feels pretty normal. Hot is hot. Cold is cold, etc. Sometimes though, my forearm feels very nervy when my elbow flares.

I was told that a nerve with a normal EMG usually should become fairly pain free.

Regarding sleeping position, I used to be a side sleeper, but since my ulnar nerve issue, I always sleep on my back as that's the only position that's "comfortable". I have mild cubital tunnel in my other elbow, which I believe was caused by sleeping on my back. I've tried everything to keep my arms comfortable when sleeping on my back. I currently wrap foam above my elbows to keep them, and the ulnar nerve, from resting on the bed. Then, I rest my forearms on towels so my elbows are slightly bent with both arms at my side. It feels comfortable, but it seems my arms are not completely comfortable. Sometimes my nerve in my mild cubital tunnel elbow twitches in this position, unless it's positioned perfectly. I've noticed that the more a mattress sags, the less comfortable my arms are.

I was given a generic splint, but I never really used it because it was uncomfortable and often slips down. I tried it on my arm with mild cubital tunnel, and it seems I feel worse in the morning.

I very rarely (once in 8 months) wake-up and find either elbow bent, but it could still be happening.

I've read posts by Pitmom (very intuitive), where she mentioned it took about 2 years for her nerve to calm down.

As a side note, it's very curious how my surgeon recommends other treatments when my condition deteriorated very rapidly due to a slightly compromised sleeping position about 4 weeks into his grossly flawed treatment plan.

When my nerve became very painful and hypersensitive, he recommended a mental health provider, and possibly medication to cope with the anxiety. He said my coping mechanism is lacking. Now that the nerve, unsurprisingly to me, hasn't calmed down after 5 months, his nurse practitioner wants me to see a neurologist.

I didn't sign up for any of that when I became his patient. The initial appointment was too rushed.

My surgeon had said the nerve will likely recover, but what else would he say when my condition deteriorated so much and so rapidly about 4 weeks into phase 1 of his treatment plan?

I give him some credit for not wanting to rush into surgery, but his judgment was grossly bad. How did we go from "Let's try physical therapy" to off the charts nerve pain less than 4 weeks later?

Darla
Regular Member


Date Joined Jun 2018
Total Posts : 150
   Posted 8/6/2018 5:57 AM (GMT -6)   
Hi Q22,
I have had ongoing issues with (and surgery for) ulnar nerve issues. I have had the tests that showed no problem where there clearly was. My surgeon was really great in the office and went with his intuition, expertise and physical exam to agree there was a problem that needed to be addressed. I had a bit of relief after the surgery but honestly not that much. When I went back to the Surgeon (who I really still think is great) with ongoing complaints he recommended a Cervical MRI to see if the pain was coming from the neck/spine. He saw badly deteriorated vertebrae in the neck and bone spurs pressing on the nerves. I recently had surgery to correct that and I am not sure how the nerves will be after full healing but I just wanted to pass along that sometimes it is coming from somewhere else. Good luck to you!

pitmom
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Date Joined Jan 2015
Total Posts : 2407
   Posted 8/6/2018 12:13 PM (GMT -6)   
I'm trying to picture a 'compromised' sleeping position that you keep referring to. What I see is you, trying to do the job only a professional should be attempting. We can cause ourselves more harm than good, trying to come up with solutions on our own.

You say both surgeons are highly regarded, but because you didn't get the result you wanted...and are doing your own thing...it's the surgeons fault? Grossly flawed treatment??? I'm sorry but a damaged nerve is a damaged nerve.

Why is it the surgeons responsibility to get you into physical therapy? This, in my experience, is usually scheduled before the surgery is even done. Yet, here we are in August and you still haven't gotten it scheduled for yourself!

Are you on any of the medications now available for nerve pain?

I'm sorry if this sounds b*tchy...but I'm confused since you seem to 'know so much about what is the right thing to do' but blame the surgeon. What you are 'playing doctor' with could cause more harm than good.

I slept on the sofa, propped up a little, with my 'surgical arm' on the 'inside' and to keep me from turning onto that side. I slept with a pillow under the upper arm, with my elbow slightly bent and my wrist where my thigh meets my torso. Those powerful electric shock type pains are unbelievable, but they actually mean the nerve is 'waking up'. That thought helped me endure them.

Ice wraps were a huge help to me. Look for the 'sheets' that may be found for coolers, sometimes in the camping sections of stores. I used them frozen at first, but now I keep them in the crisper drawer in the fridge.

You mentioned me in your post.
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

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/6/2018 1:27 PM (GMT -6)   
Pitmom,

I mentioned you in my post because I enjoyed reading your posts as I found them very informative. I referred to you in a most respectful way.

My ulnar nerve hurts if I don't sleep perfectly comfortable. I asked a physical therapist about sleeping position, and he was of little help.

My surgeon's treatment plan was flawed because my ulnar neuropathy was very bad, but not extremely painful when I became his patient. Four weeks after becoming his patient, the nerve became very painful from napping in the wrong position. My ulnar nerve so so compressed, I didn't bend my elbow much for 2 months. The surgeon knew this.

If one nap can make the nerve hypersensitivie and very painful, then physical therapy had zero chance of working. My condition deteriorated very quickly 4 weeks after I became his patient. My hand got sweaty, lost dexterity (shaky), muscle twitching between my thumb and index finger

That's why I still didn't get the outcome I wanted. My nerve became very painful and hypersensitive 4 weeks after I became his patient. Surgery should have been done before that happened.

If a patient's condition can deteriorate so much, so fast from a nap, then delaying surgery with physical therapy had ZERO chance of working. And I'm still suffering a lot for it.

I also have considerable nerve muscle atrophy in my hand that alarmed my surgeon on March 7 surgery date, but that he didn't seem to notice on January 7.

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/6/2018 1:32 PM (GMT -6)   
I mean muscle atrophy he didn't notice when I became his patient on January 30. Also, please take it easy on me. I was in physical therapy for 2 months after surgery (doctor's referral), but he didn't discuss nerve desensitization.

pitmom
Veteran Member


Date Joined Jan 2015
Total Posts : 2407
   Posted 8/6/2018 2:28 PM (GMT -6)   
We cannot go back and change the past. I was injured in March of 96. Was put in P.T. Had shoulder surgery in June. More P.T. Didn't even have the EMG done on the ulnar nerve until July. Finally had the surgery done for it in August. I'm quite familiar with 'delayed treatment'.

What I find so aggravating is the changes in protocol in the years since my 'job' was done.

I was casted post op, for 6 weeks. The swelling was so bad, they had to cut the cast like a clamshell to make room! Once the cast was completely removed, I was put immediately into physical therapy for range of motion. Once the stitches were removed, the desensitization began. Ice, massage and something my P.T. called 'points'. Not one other ulnar nerve patient that I have seen on this forum describes anything like it being done with them. Perhaps this is the reason not many are getting the good results I got.

The index finger and thumb point to a radial nerve problem, rather than ulnar. Have you had your carpal tunnel looked at?

I'm sorry if I came off gruff. We've been having horrible heat and humidity here and I have become rather short tempered. I apologize.

Apparently, when I edited my previous reply, I forgot to remove the comment that you had mentioned me in your post.
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

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/6/2018 3:03 PM (GMT -6)   
Hi Pitmom,
No worries. Thank you for your reply. Maybe my posts weren't clear, but part of it was venting frustration because my surgeon recommends that I see other doctors who are needed only because he delayed surgery.

I know, you too, are familiar with delayed treatment. Your posts give me hope.

I'm not on pain meds except for Naproxen. I see a neurologist later this month. Sometimes my elbow nerve burns terribly.

I hope your day improves for you. Thank you for your replies.

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 894
   Posted 8/6/2018 3:11 PM (GMT -6)   
Q22:
It seems inconceivable that that medicine would fail any of us in a time of imminent need.
The Hippocrates Oath to “do no harm” seems devoid of meaning.

Not all physicians are competent. Just as not all physical therapists are competent. I have worked with both physicians and PTs where I questioned how it was they passed the state licensing exams.

I have been harmed by medical care more than I have benefitted. Medical harm can and does happen.

I have to monitor my thoughts to filter accumulated negative emotions and anger toward the medical profession who I entrusted my care to. I have not reached a place of peace, and doubt I ever will, but I try not to let what is eat away at me.

Your “job,” henceforth, is to be protective of your health. Research physician report cards and reviews. Research your condition(s) and become aware of options in treatments and established best practices. If you feel uncomfortable with a physician/ancillary clinician or suggested plan of care, take notice of your intuition and make a course correction.

You live in your body and know it best. I am also a firm believer that our body will let it know what it needs, if we listen with focus and attention.

Your ulnar nerve will need time (months) to desensitize. Nerve desensitization is a gradual process. But there is progress to be found. The body is amazing in its innate ability to heal. Have faith in your body that it will restore your ulnar nerve to a better place.

I absolutely would caution you not to have additional surgery, at least in the short to medium term. A nerve that is already irritated does not take well to additional insult or trauma (surgery itself is a form of trauma).

An occupational therapist who specializes in the hand might be a beneficial partnering. Hand surgeons often have established relationships with hand occupational therapists. Your medical insurance carrier/provider should be able to offer you with a listing of names of in-network hand occupational therapists.

You have good potential for bettering and improvement. Keep faith and hope.
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)

pitmom
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Date Joined Jan 2015
Total Posts : 2407
   Posted 8/6/2018 4:09 PM (GMT -6)   
Back when my surgery was done, the orthopedist put me on Elavil which I believe calmed the nerve a bit. Nowadays, gabapentin is prescribed.

I'm trying to dig through memories...I've had 9 surgeries all together...between both shoulders, the left elbow/carpal tunnel, both wrists...so remembering who did what and when and how did it help, if at all...gets a bit jumbled now and then.

I remember being prescribed Celebrex, Mobic, Naproxen...all of them anti inflammatories...none which touched the nerve pain itself.

You mentioned falling and injuring your wrist...has the shoulder been looked at? The cervical spine? Problems in either of these areas can also wreak havoc on the nerves of the arm/hand.

I had considered revision surgery at one point...in the hopes that it could improve on what I was left with...the surgeon was the top guy in my area who had done revision surgery on one of my wrists...he was honest with me and told me perhaps a 30% chance of improvement...I decided the odds were not good enough for me. This was probably around 2003 or so. I was still working...as a cashier at this point...overuse of my arm/hand would leave me in misery by the end of my shift. Other conditions led to me being declared disabled from working as of 2006, so stressing the arm/hand has been slashed to a minimum, which has helped immensely.

Snow shoveling, gardening, scrubbing the walls, painting them, etc. will get it into a painful flare but I just either ice it or wrap the heating pad around it (if one doesn't work, I try the other), take some Aleve (naproxen) and a Benedryl to help me relax. If my daughter is around, I get her to massage it. Even now, bumping the area where the nerve is now buried can give me the 'funny bone' feeling!!

I know the ulnar nerve subluxates in the right elbow now, if I push hard on anything. I even had to change banks because mine had doors that were just too heavy to push or pull. The epiconyl (sp?) on both arms is hyper sensitive and painful.

When looking for a good physical therapist, you might want to consider one that does a lot of work with golfers...they tend to have similar problems to ours. If you have a golf center near you, take the time to visit and chat with the patrons...perhaps one or two of them can send you in the right direction.
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

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/7/2018 6:12 AM (GMT -6)   
Thank you all for your replies. They are very helpful.

Pitmom, are you still on disability now? I agree entirely that work affects the elbows A LOT. I usually feel much better at home than at work. My elbow sometimes really burns at work, even if I use it very little. I felt much better (still debilitated, but much better), until I had a flare up about 3 weeks ago. I'm a computer programmer and do a lot of one-handed typing, especially since I got this flare up about 3 weeks ago.

It seems like something isn't right in my elbow, as if the nerve rubs on something and feels very tender. I'm starting to think that contributed to this flare up, but my surgeon won't listen to me.

I saw the same surgeon 2 weeks ago, that I originally saw for my first opinion. He thinks I inflamed something and prescribed Naproxen. He also won't see me anymore because I had surgery with another surgeon.

His nurse told me to go to my surgeon's emergency room if I'm in a lot of pain, but he doesn't have one. It's simply an orthopedic clinic, and I can't get in until September 11.

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 894
   Posted 8/7/2018 8:17 AM (GMT -6)   
Q22:
Your nerve pain is real. Whether the peripheral ulnar nerve was compressed by bony structure at the elbow or compressed between contracting muscle, whether the nerve is hyper-reactive from surgical handling and surgical trauma, whether the nerve is encountering transient re-entrapment from positions assumed during sleep, whether the nerve is buffering inflammation due to demands from your keyboard work as a programmer . . .

The nerve will be best served by the grace of time to allow for innate healing and quieting of excessive nerve impulse firing. 8-9 months.

You do NOT want to pursue exploratory surgery as a possible option in the short and medium timeframe.

A nerve that is irritated and inflamed by injury and surgical repair will not take well to an additional insult (surgery). You could well find yourself in a worsened state post-operatively with even higher nerve irritation and neuropathic pain, aka reflex sympathetic dystrophy also called central regional pain syndrome. An additional exploratory surgery would be akin to disrupting a nest of bees.

Focus on rest for the arm with low intensity movement/range of motion, fabricated resting splint, desentization techniques, and pharmaceuticals as indicated (muscle relaxants; neuromodulating neurotin or gabapentin or preganalin or elavil or similar; anti inflammatory agent Mobic or Relafen or similar.

Pitmom’s suggestion of scouting golfers and soliciting their opinions on a competent physical or occupational therapist has merit. So, too, your medical insurance provider will have a listing of in-network occupational hand therapists.

Allowing the peripheral nerve to soothe and quiet along the length of its distribution is of prime importance.
Karen

pitmom
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Date Joined Jan 2015
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   Posted 8/7/2018 8:35 AM (GMT -6)   
I don't know what exactly is involved in a 'release' surgery. Mine was a 'transposition' where they actually buried the nerve under muscle tissue. It no longer runs in the channel of the elbow bone. Instead, it is more on the 'inside' of the joint. I cannot have venipuncture done in that area at all! As the muscles contract and relax around the nerve, it gets irritated. Not to mention that any nerves that were connected to it were either severed or disturbed when it was moved!

All of this takes time to heal.

I have to position my forearm very carefully on the edge of the desk or tables. I even have to be very picky about what vehicle I choose as the armrests can cause pain!

I no longer ride in the car with my elbow propped out the window.

Position is everything...even this many years later. Temperature is important also, because if I'm tensing my muscles from being cold...it irritates the nerve!

I've adjusted pretty well and most of what I 'must' do is second nature to me now...it's a bit of work to try to think of everything in detail...which is why it's coming out in bits and pieces...hoping something of my experience will prove helpful to you or anyone else reading these posts.

I had a carpal tunnel release done on my left wrist. The only difference I notice honestly is I don't swell the way I used to. I still get the 'over tightened spring' feeling if I have to use a strong grip. My hand doesn't get numb anymore. So, I guess it's considered a 'successful surgery' even though it's still easily fatigued and sometimes painful. It's not the 'result' I'd hoped for, which is why I haven't had it done on the other wrist, which is my dominant hand, and has already had 3 other surgeries on the back side done for ganglion cysts and scar tissue removal.

I don't think the doctors quite understand our disappointment from our end of things. They see it that they released the nerve, the incision healed without problems, so in their minds it was 'successful'. What we are left 'feeling' is 'not their problem'. It sucks.

I hope you find a physical therapist that knows how best to help you move forward in the rehabilitation process. Hopefully, the doctor you will be seeing will be able to give you a prescription that will help calm the nerve down a bit. Things are getting crazy in the realm of pain management...you might want to get an appointment with a pain management specialist.
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

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/7/2018 10:16 AM (GMT -6)   
Seashell,
You mentioned that peripheral nerve injuries take time, and that healing progress fluctuates. Maybe a nerve becomes more painful and causes cramping as it starts to wake up? I also read that it can take up to a year to see any improvement.

Also, my surgery date was March 7. When should it be ok to maybe have a revision surgery as I'm considering going to the Mayo Clinic at some point as they are in my insurance network, and I live about 300 miles from Rochester, MN.

I was feeling much better prior to this flare up. Now, I feel worse than I did weeks after surgery.

Thank You.

Post Edited (Q22) : 8/7/2018 9:27:20 AM (GMT-6)


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16804
   Posted 8/7/2018 11:46 AM (GMT -6)   
Q22, it does take a year, sometimes longer for nerves to completely heal. Nerves have to heal on their own & no one can truly give a definitive time frame. Most drs stick with the one year mark. If this were me, I would wait the year. Jumping too soon may yield results worse than what you have now. Nerves are very tricky & unpredictable.
Susie
Moderator in Chronic Pain & Psoriasis Forums

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 894
   Posted 8/7/2018 12:59 PM (GMT -6)   
Q22:
I am glad that Pitmom is weighing in on this conversation with her narrative and personal experience.

I am a visual learner. To help illustrate the peripheral nerve exquisite sensitivity and pain that you are experiencing, picture:
a. A downed high voltage power line. Erratically sparking with powerful bursts of electricity.
b. An inconsolable child, high pitched wailing and screeching.

Absolutely, it is oft the case that a traumatized/injuried peripheral nerve will be more sensitive during recovery, with a higher level of experienced pain. What you are experiencing - more pain, more sensitivity, more bursts of electrical “zings” - is a common finding.

Variables that affect the degree of neuropathic pain:
a. A peripheral nerve that has been compromised/compressed for a prolonged period before surgical release will fare less well than a nerve that was compromised for a short period.
b. The degree of impulse disruption. A nerve that is completely compressed or severely compressed (75% of impulses fail to be transmitted distally as assessed by EMG or objective muscle atrophy of affected musculature) will fair less well than a nerve that is partially or moderately compromised (able to transmit 50% or more of generated impulses or externally applied low amp electrical voltage).
c. Intervening variables: History of anxiety; sensory processing disorder; low vitamin B12; seizure disorder.

Desensitization of a peripheral nerve is a process that occurs over time.

I would certainly encourage you to pursue a consultation with a physician at Mayo. It can take several months to schedule a new patient consultation with some specialities, so you may want to be proactive and start the referral and scheduling process now for an appointment 3-4 months in the future. Take care on researching a physician who can address your needs. Ex. A plastic/reconstructive surgeon, often who specialize in the arm/hand or a neurosurgeon.

I would encourage you to refrain from entertaining an additional surgery for 8-9 months from your original operative date to allow for natural quieting of the nerve. You do not want to inflict additional surgical trauma on an already reactive peripheral nerve.

Exceptions that would warrant prompt surgery:
a. Noticeable muscle atrophy of any of the muscles supplied by the ulnar nerve, suggesting acute entrapment.
b. Loss of fine motor control. Ex. Dropping a set of key, unable to manipulate a pencil.
c. Symptoms suggestive of cervical impingement. Ex. Widely radiating pain from the shoulder to the hand/fingers; problems with fine motor coordination (ex. unable to touch the top of your thumb to the tip of each finger in rapid succession).

In the interim, things you can try/experiment with to see if there is benefit for you and your angry peripheral nerve:
a. Swaddle the affected area of the arm with stretchy Coban or kinesotape or an ace wrap. Mild compression that envelops the affected area of heightened sensitivity. Constant sensory input through swaddling is based on the same principle when soothing a crying infant with a comforting wrap. Constant sensory input limits the nerve to fire erratically owing to the effects of the gate theory. Presenting an influx of incoming stimuli floods the available transmission channels, dampening an expression of errant nerve firing. It is analogous to an incoming telephone line where all of the incoming lines are blinking with calls on hold. The telephone operator can only answer and respond to one call at a time.

b. Brush the skin of the affected area with fabrics of different textures (discussed in a previous post). You are re-educating the nerve, introducing the nerve to normal and familiar stimuli. The nerve becomes more “behaved” through repeated tactile stimuli.

c. Cool/warm therapy. Apply a cool, wet washcloth to the area. Remain in place 2-3 minutes. Rest for 5 minutes. Apply a warm buckwheat pack or warm, wet washcloth to the are. Remain in place for 2-3 minutes. This technique reprograms the autonomic nervous system and temperature regulation to the area.

Pitmom has discussed that her therapist employed a modality she called “points.” I suspect this was a modality where a low voltage electrical stimuli was applied at different points along the distribution of the peripheral nerve. This modality is very helpful, as it provides an external stimuli to the nerve allowing it to relearn how to transmit a purposeful impulse.

There are any number of supportive techniques and therapeutic modalities that may benefit you - lowering the pain you experience and giving you a degree of hope that recovery is possible.

Nerve pain is it’s own entity. Nerve pain is uniquely different than bone pain or soft tissue pain. Nerve pain is high in pitch and high in intensity. Nerve pain is uniquely disrupting to one’s day to day life.

All to say . . . Anyone with neuropathic pain will be empathetic to your plight. Look for rehabilitation options that seem to have a good degree of “fit” to your situation. A good therapist will always listen to a patient’s feedback and constantly adjust the plan of care based on what treatments/modalities are working and working well and those treatments/modalities that are of marginal benefit or no benefit at all.

Sending healing wishes,
Karen

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/8/2018 6:15 AM (GMT -6)   
Thank You Very Much everyone for taking the time to help me. The information you provided is very helpful, and I will refer back to it often.

I will post back here. I have an appointment with a neurologist (the best in town) on August 28. I will also schedule with an occupational hand therapist. Will also look into the best hand surgeon at the Mayo Clinic, but hopefully I won't need to go there.

Post Edited (Q22) : 8/8/2018 6:33:17 AM (GMT-6)


Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 8/28/2018 6:13 PM (GMT -6)   
Hi Everyone,
Thank you again to everyone who replied. Just a quick update:
I saw a highly rated neurologist today, and we're going to take an MRI of the elbow. He said it will help show nerve issues. He offered nerve meds which I declined for now. They can have side effects, and I didn't have nerve meds before surgery when the pain was much worse.

Maybe this will help someone: He said that an EMG does not detect damage to small fibers of the ulnar nerve. I would think that applies to all nerves. The small fiber damage causes the burning.

I feel better since the flare up almost a month ago, but it's still very debilitating. The electric zaps have decreased a lot. I start occupational therapy tomorrow to hopefully desensitize the nerve.

pitmom
Veteran Member


Date Joined Jan 2015
Total Posts : 2407
   Posted 8/28/2018 6:34 PM (GMT -6)   
Hello again Q22.

Thanks for the update. I'm interested in what the MRI will show.

Glad to hear that the zaps have lessened.

Hopefully O.T. will help even more!
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

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 9/1/2018 8:54 AM (GMT -6)   
Hi Pitmom,
Always nice to hear from you.

I will post the MRI results. The hospital has not called to schedule yet, so I need to follow-up with them. They usually call promptly to schedule.

The OT mentioned trying TENS or electrical stimulation, but was leaning towards TENS. I did mention the points you posted about, and that you felt it contributed to a better outcome for you.

Darla
Regular Member


Date Joined Jun 2018
Total Posts : 150
   Posted 9/1/2018 9:12 AM (GMT -6)   
Q22, sorry if this is an obvious thing that I am missing in all the information, but are you saying that an MRI will show the small nerve damage of the elbow? I am curious. Thanks.

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 9/1/2018 9:24 AM (GMT -6)   
Hi Darla,
That's an excellent question.

That is the impression I was under, but I can't say for certain now that you asked. The neurologist mentioned it would image the nerve too, but now I don't know to what extent. He mentioned that a follow-up surgery could be done if warranted by the MRI.

I just read another forum, and it seems an MRI might not detect small fiber nerve damage.

Post Edited (Q22) : 9/1/2018 8:36:19 AM (GMT-6)


Darla
Regular Member


Date Joined Jun 2018
Total Posts : 150
   Posted 9/1/2018 9:59 AM (GMT -6)   
OK, thanks, Q22. If you find out along the way please post. I have had ongoing nerve issues in my elbow. I am a fairly recent post-op for neck surgery so I am waiting for them to resolve but I have had a few releases and I can't say I am much better really. Thanks again!

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16804
   Posted 9/1/2018 10:51 AM (GMT -6)   
Q, I did a search & found an excellent article from the National Institute of Health regarding an MRI of the elbow. They described how the MRI should be done, very informative article. And according to this article it will show nerves because of the approach used. You can do a google search for this article, if you have trouble finding it let me know. The EMG studies are like checking electrical impulses on an electrical board. Yes, if there is slowing of a nerve it will detect damage.

I am glad you got in to see the neurologist.
Susie
Moderator in Chronic Pain & Psoriasis Forums
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