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Old 06-27-2007, 10:08 AM   #1
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After ulnar nerve transposition - how long was your elbow swollen, other recovery ?s

I'm trying to get some perspective on what the normal range is for recovery after ulnar nerve subcutaneous transfer. When I speak with my doctor in one breath he says he's never seen a case take this long to start recovering, and in the next breath he says my reaction is completely normal. I can't make those two statments "go" together. I'm starting to wonder if I need a second opinion, or if my expectations are unrealistic.

I'm going to summarize my concerns and questions, feel free to ask for more info if you need it:

May 15 I had my surgery - carpal tunnel syrgery and ulnar nerve surgery on the same arm. The surgery itself went fine, and restored feeling and coordination to all my fingers.

But nine days later the pain level went through the roof. It felt like I had large ants walking on and biting my incisions HARD - I would literally jump when it started. I went in, they found no infection so I was prescribed higher pain meds (a derivitive of morphine).
I discovered that same night that Benedryl worked better than my pain meds in controlling that particular pain. I could take a single Vicoden ES every 4 hours if I took the Benedryl, but needed the Morphone if I did not take the Benedryl.
Called the doc, doc said it could not be an allergic reaction because the pain would have been even worse if it were, but he didn't know why the Benedryl helped. (Don't allergic reactions come in degrees? Not everyone has the same degree of reaction to everything...)

I have allergies to lots of things - Percoset, higher doses of Vicoden ES, steri-strips, surgical tape, several foods, etc. It seems odd to me that he is not willing to consider the possibility of an allergic reaction to something used during the surgery, like perhaps the sutures (external or internal, or both)?

Got my external stitches out and started physical therapy. But the incisions weren't closed yet, removing the tape across them made them open up again. My physical therapist said I had an excessive amount of swelling in my elbow, but if the doctor wasn't concerned then neither was she, she gave me compression bandages to wrap around my arm to force the swelling down some. I was already keeping it raised and iced all day every day, she told me to continue that.

My hand incision closed after 2 weeks and one day, which was considered in the range of normal. But my elbow incision didn't close for 3 1/2 weeks.
The physical therapist had never seen an elbow incision take 3 1/2 weeks to close. She asked my doc, and he replied he hadn't seen it take that long either, but since it was closed now it was OK. ???

Similar issues with only Benedryl working to control my elbow pain since then. The ony pain left is in my elbow - when I take the Benedryl the ant-biting type pain subsides into a general ache that Advil is enough to control. That's been consistent from 9 days post surgery to now (6 weeks post surgery). My hand pain left about the same time the incision closed.

I'm still in the compression bandages for my elbow, and it has been 6 weeks since the surgery. You can see the swelling easily, it's not just a little, its all the way around the elbow for the length of the incision and several more inches each way. You cannot distinguish the different bones in the elbow -the swelling looks like my elbow is made out of play-doh, rounded and puffy all over.

All that to ask - is this normal? Is this close to what you experienced or what you were told to expect? I'm 6 weeks post surgery. Are there any hints or tricks you can pass along?

And finally - should I be getting a second opinion about the swelling and continued pain?

 
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Old 07-04-2007, 07:45 AM   #2
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Re: After ulnar nerve transposition - how long was your elbow swollen, other recovery

Aurorapup,

I had Ulnar nerve transposition just like yours...subcutaniously.

It was my 4th arm surgery to the left arm and I will always have ulnar nerve damage.

My elbow was swollen and brused bad. I was splinted for 3 weeks and was not allowed to drive for that time.

I had internal stitches. Did you say you had staples in your elbow? I don't understand why some surgeons do that. But they do.

My last 2 surgeries were done by a very renown doctor in a teaching hospital. One of the best ortho's in the US. Love him to death.

Anyway I had my subcutaneous nerve trans on March 15th this year and I still have pain.
After the surgery I was put on a very long acting very addictive drug because nothing else worked. I have to tell you that I am also a recovering addict and alcoholic with almost 3 years sobriety.
I went to Pain Management and am wondering if that is something that may be an option for you.
I am no longer on any pain meds anymore.
I was told by my ortho and the PM doc that sometimes after the surgery a patient will have a total flare up that may last a while. I am not a doc but I do know that every persons body is different and has a different reaction to these things.
They call it practicing medicine because there are no guarenties.....
If I were in your shoes I would get with the doc again and just let hem look.

I did not go to Physical therapy for like 6 or 8 weeks. I had a simple home thing that I did. But you had essentially to things done at once.
So I am not sure.
I know that my doc was very very adamint about telling how carefull I needed to be because he did not want that nerve to be torn out of its new resting place.
Please remember that they had to cut through many things to get to the deepest layer of your skin, and move that nerve.
All your little receptors are very sensitive and excited at this time.
For me I have had some very serious surgeries on my wrist and arm and my situation would vary some.
I still have loss of sensitivity in the elbow area and I never got back all the feeling in my pinky and ring finger. From the ulnar nerve trans it was successful at taking away the grueling agonizing burning nerve pain that I had and for that I am soooooo very grateful.
Nervers only regenerat about and inch a month. So be patient.
I too had a swollen elbow for a long time.
Please feel free to ask me anything that you want to know and vent at me if you need to....Chrissy

 
Old 07-05-2007, 10:36 AM   #3
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Re: After ulnar nerve transposition - how long was your elbow swollen, other recovery

Aurorapup -

I had my surgery (ulnar only) on Feb 21st this year. My elbow was noticeably swollen for about a month afterward. It still seems larger to me than the other one, but it is not so much different now. I started PT at 6 weeks post-op and the therapist had me use gel strips over the incision - they worked great! My stitches were done under the skin (by a neurosurgeon) and the incision doesn't look so bad now (4 months post-op). I still have numbness around the incision and extending around the elbow itself. I'm told that is from the number of small nerves that were cut to get to the ulnar. My elbow also gets stiff very quickly if left in a certain position for too long. I have most (if not all) of the feeling back in my fingers and I'm working on getting the muscle tone back. My doctor says it could take 12-15 months for everything to get back to normal because the nerve regenerates very slowly. I didn't have any of the creepy-crawlies you describe, but I did have what I can only describe as "electric shocks" to the area around the incision for about 2 months afterward. I was told this is due to the nerve regenerating and starting to send signals again. While extremely unpleasant, I guess it's a good thing to be sending signals again. Hope you are feeling better soon.

 
Old 07-05-2007, 03:27 PM   #4
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Re: After ulnar nerve transposition - how long was your elbow swollen, other recovery

JPino, your "electric shocks" sounds fairly close to what I feel, except that i have that creepy-crawly feeling first. And my shocks continue until the Benedryl kicks in. So it's hard to tell if we're describing the same thing or not.

I see my doctor again next week - on the 12th. So hopefully he can give me more information then. I don't know if he'll want to discharge me or not, I'm still significantly swollen around my elbow. Looks like an elbow from an old claymation movie. Or like I've stuffed some kid's beanbags under my shirt. Bleh. I need my pain meds refilled, too. Pain Managment doesn't sound like a bad idea, Chrissy. I'd prefer it over these pain pills that leave my brain foggy.

And I think I need to be sure that even if he discharges me, that I have a better understanding of what to expect for the next couple months, and what to do if it doesn't happen that way. I don't like this limbo feeling.

I do feel grateful that I have all the feeling back in my fingers. I don't have any residual numbness or tingling with them, they were back to 100% within days of the surgery. I must have had my surgeries before there was extensive damage done.

Now if I could just get this darn swelling under control...

 
Old 07-09-2007, 06:24 PM   #5
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Re: After ulnar nerve transposition - how long was your elbow swollen, other recovery

Wow you guys are lucky!!!

I still can't use my ring and pinky finger like I used to. I still have numbness and tingling in those fingers and sometimes in my palm. I don't really recall to much shocky stuff but I was on serious pain meds for a long time. Surgery in March and no meds for the last 3 weeks. I have no more burning feeling though. Detox off those meds is a hard thing in itself....
The burning for me was so bad and it was constant. All the time. It drove me crazy and it would even make me vomit sometime becasue it was that bad.

Thank God I got on something that helped my pain. It took it almost completley away....But I had to get off the stuff. I always hated the way they made me feel. They so interupted my life but then again so did the pain.
I wanted to see if, and how much pain I still have. Some, I think is permanent and some is from the fact that I really have not used my entire left extremity for 3 years. I have soreness and nagging pain in my neck and shoulder form the therapy. I am slowly gaining strength back but I think it is going to be years before I have it.
I already have faced the fact that I have permanent nerve damage and will probly always hve the numbness and tingly in the ring and pinky fingers. That has been that way for almost a year. Never got it back after the 3rd surgery.
I also have a loss of sensation on my elbow as well. Don't really know if I will get that back or not.
I only type with 8 or 9 fingers because I think I am depressing the keys and when I go back and look I have not actually typed them. I have to proofread everything. I am not even that good and proofreading my own writing so bare with...
I think for all of us it will be a time thing for sure....
well it is time for me to go ice my elbow shoullder and neck so check at you all later...Chrissy

Last edited by skych; 07-09-2007 at 06:29 PM.

 
Old 07-11-2007, 09:44 AM   #6
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Re: After ulnar nerve transposition - how long was your elbow swollen, other recovery

Aurorapup - good luck with your doctor tomorrow. I don't go back again until the end of August. One more question for you: did you find that you have shoulder pain in the arm where you had your ulnar surgery? I blew it off at first, thinking I was just sleeping differently trying to keep pressure away from the elbow and hand.............but it hurts any time I lift my arm above the shoulder or try to reach behind my back. I hate to call the doctor's office if I don't have to. When I go back in August, we already have to address the carpal tunnel I have in both wrists (ugh!!)

Chrissy - sorry to hear you are still having so much trouble with pain. It's probably because you went so long before the ulnar surgery. I was warned about that before I had mine done. I had already started losing muscle tone in the hand and was told it would be very hard to get it back the longer I waited. Still, my insurance company made me jump through hoops and it was almost 6 months before they approved my surgery. I still do PT exercises with the hand every day and it bothers me some, but I try not to think too much about it. Hope you're feeling better soon.

 
Old 07-11-2007, 01:08 PM   #7
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Re: After ulnar nerve transposition - how long was your elbow swollen, other recovery

JPino, No, I don't have shoulder pain at all. For a while though, I did have upper arm pain about halfway between my shoulder and elbow on that side. Turned out I had a couple large muscle knots that happened because I wasn't using that arm normally for so long, and because the cast I had was so heavy. A few massages from my physical therapist and they relaxed. Now that you mention it, I think they're coming back, so I'll mention it at my next visit. The massages there really felt good. Maybe you could try that?

If you don't have PT, or the therapist won't do massage, try looking in the phone book. You should be able to find a short session cheap enough to try, and a single session would let you know if it was worth going back.

 
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