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Ulnar nerve surgery success?
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By RobR
Feb 5, 2008

Hi every one I am about to have surgery on my left elbow to relocate the ulnar nerve which has been irritated for almost a year now. I am basically looking for climbers who have had similar issues (forearm elbow and hand tingling, aching, sharp pain and numbness) and how they resolved them. If you have had any of the surgery options which one did you settle on and why? Also did you recover 100% after the surgery? Any experience is greatly appreciated thanks.

Rob


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By marc rosenthal
From San Antonio, TX
Feb 5, 2008
The artist at China Ranch, Nevada

Rob,

I have this condition in my right hand. I gave had the symptoms you describe, particularly, the tingling in my fingers on my right hand. The pain and irritation continued for 2 years while various doctors prescribe ibu and motrin, wrist brace (more for carpal tunnel than this), etc. When I began to notice loss of control in fine motor activity (I started having difficulty pinching, holding on to objects, etc), then my surgeon decided it was time to do the surgery. He made an incision along the line of the nerve but up high almost on my elbow. He said the surgery was meant to relieve the pressure of the areas surrounding the nerve by cutting through the areas and moving the nerve over into a position where it doesn't have pressure on it. I think I understood that.

My surgery was in early October 2007 and I have just recently started climbing again. I still have some tingling, and I doubt that results will be immediate for you. Typical time for the nerves to heal and get reaquainted is 1 year or more. Once your surgery has healed you can start the hand, arm, and wrist therapy.

After 4 months, I was told I could start beefing up my light exercise routine and climb again. I am careful and I don't push too hard. I seem to have some limits for how long I can climb, usually 2-3 hors at a time. I have started with 5.5-5.7 range. Will my recovery be 100%? Only time will tell.


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By Avery N
From Boulder, CO
Feb 5, 2008
Canadian Rockies Ice 2008.

Rob,

In short, I have had cumulative trauma disorder which includes cubital tunnel syndrome (ulnar nerve inflammation). I had bilateral ulnar nerve releases, instead of flipping it around (which scared the hell out of me, after reading some journal articles). Needless to say, neither were successful, and perhaps the flip would have worked.

I found some interesting journal articles that reviewed/compiled various types of surgeries and their success rates, as reported in the various literature. I may be able to dig that up, if you want.

Also look at this thread
and this thread

What types of doctors have you seen? What non-surgical options have you tried thus far? I'd definitely run the full gamut before considering surgery.

Avery


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By saxfiend
Administrator
From Decatur, GA
Feb 5, 2008
Relaxing at the P1 belay of Fruit Loops at Rumbling Bald.

RobR wrote:
Hi every one I am about to have surgery on my left elbow to relocate the ulnar nerve which has been irritated for almost a year now.

I had this exact surgery several years ago to relieve cubital tunnel syndrome brought on by repetitive stress (computer work, not climbing). The surgery was a complete success; I've had no problems since.

JL


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By RobR
Feb 5, 2008

Hey guys thanks for the quick replies. Marc it is great to hear you are recovering and JL it is awesome to hear that you have recovered fully, very encouraging. Avery so far I have seen my general practitioner, a general orthopedic and a hand specialist orthopedic (the one I have scheduled the surgery with). I have also done about 2 months of therapy with a certified hand therapist. During the therapy I had a iontophereisis (electrophoresis with dexamethazone, like a low impact cortisone shoot) this made it better but only temporarily. Avery you also mentioned you were scared off from the flip surgery. I would love to see those journal articles or could you explain specifically what worried you, low success rate, bad after recovery symptoms? Also for you guys that had the flip, was it to above or below your forearm muscles? Thanks again and here's to hoping I can climb again 2008.

Rob


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By John McNamee
Administrator
From Littleton, CO
Feb 5, 2008
Artist Tears P3

Rob,

I haven't had my Ulnar nerve relocated but I've had surgery on my right elbow, including "cutting away bone" to make room for it. My elbow was so bad I couldn't even ride a bike or place my elbow on a hard surface. It was painful.

The surgery went well but I screwed up on the recovery and it put me out of action for about a year. So don't do what I did, which was to go climbing too soon. In my case it was 6 weeks after surgery. I ended up having to have more treatment, etc, etc...

My elbow is fully recovered now and better than it has been in many years. Now I've just got to fix my knees!

Take plenty of rest and don't go back to work too soon.

If you want more details please email me.

Cheers

John


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By Avery N
From Boulder, CO
Feb 5, 2008
Canadian Rockies Ice 2008.

Rob,

I think the general rule of thumb when it comes to this surgery is 'avoid it, unless you have to'. I think the chance of 100% recovery without side effects is a bit of a pipe dream; but there is no doubt it will make many folks better.

I don't have the details in front of me, but I think there is a couple-% incidence of issues with the surgery that can make it way worse (as in further nerve damage, not able to use hand, permanent tingling, etc). Something like a 1 in 50 chance, if I recall correctly... and those odds aren't fantastic, in my book (let's see -- 1 in 50 chance my hand might not work again... hmmm).

Basically, if the surgeon nicks a nerve, it's wrecked and not going to heal (and as I understand, these are all located under the fascia strictly by 'feel'). The other big risk, if I recall correctly, is that on occasion the nerve loses some of it's vascularity after being moved -- for a number of reasons. If the nerve becomes avascular, then it can be permanently damaged -- quickly (i.e. before they can reschedule a surgery). So, I think the risks are real, and would exhaust all other options before surgery.

That being said, I understand that this surgery is now more successful than it once was.

The other thing to realize is that as the ulnar nerve runs naturally, it is pretty well protected. Even so, I bet you've hit your ulnar (funny bone) before, and it didn't feel good. One of my concerns about flipping it around is that it is no longer protected in the same manner. I'm always knocking off ice on my arms, jamming them in cracks, etc... so you can see my concern. I would be interested to hear from others with the 'flip' surgery, as to if it makes climbing more difficult due to lack of protection.

I do recall that when I was researching this, I read some forums where folks had permanently damaged theirs after relocation by 'bumping' it... not encourging.

What, or what do you suspect, is the cause of your issue? For me, I think it is triggered by repetitive keyboarding for work... but, I think my posture has helped to promote the issue, as poor posture lengthens the path of the nerve, thus causing it to become pulled too tightly > pain/inflammation. So, what do you think is causing yours? Is it something you can manage?

Have you had NCS/EMG? What were the results? Did they find a spot of compression (this would help indicate the surgery would prove successful). For instance, mine showed no inhibition or sources of compression.

Have you tried acupuncture, myofacial massage, anti-inflams, cortisone injections... ? What exactly did they diagnose you with? If cubital tunnel, have you tried bracing your arms straight at night, etc?

Anyhow, PM me your e-mail, and I'll try and dig up those literature reviews and articles. You can also search abstracts on pubmed.gov, but will not be able to get most articles unless you are affiliated with academia or the medical profession.

Avery


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By RobR
Feb 6, 2008

Thanks again guys for the replies, it is great to hear from people that have been through similar issues. I saw my surgen again last night and he feels that my anatomy makes me especialy prone to this injury (the insides of my elbows protrude alot). I guess the main question now is wether or not the flip surgery will leave the nerve more or less protected than it is now. For you guys that had the flip surgery was the inside of your elbow (medial epicondial) protruding signifigantly? And do you feel the nerve is now better protected than it was before? Also did your doc warn that the relocation might make you suseptible to reinjury?

Rob


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By marc rosenthal
From San Antonio, TX
Feb 6, 2008
The artist at China Ranch, Nevada

Rob,

In my case, there was nothing protruding from the arm. My surgeon did not mention anything about flipping the nerve to another side, albiet less protected. He said he moved things out of the way in order to release the pressure on the nerve. I still have some pain where the incision was made, just on the inside of my right arm and just left of the elbow. The cut is about 4" long. I haven't banged it recently but I have been trying to be real careful. compared to those times when I couldn't put my elbow down on anything flat, it is way better.

I hope I get 100% recovery but I think that might take a long time.


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By Avery N
From Boulder, CO
Feb 6, 2008
Canadian Rockies Ice 2008.

So, one of the sites I had bookmarked years ago, lists these as the types of Cubital Tunnel surgeries. Identifying which type you had may help Rob. If I recall correctly, I think #2 is the most common practice today.

I opted for #1, the least invasive.

(1) simple decompression by opening the cubital tunnel
(2) Anterior subcutaneous transposition
(3) intramuscular transposition
(4) submuscular transposition of the ulnar nerve
(5) medial epicondylectomy

Rob, I'll send you my list of bookmarks... contains some interesting patient forums specific to nerve issues, as well as other useful sites that outline in detail the steps of the procedures, etc.


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By RobR
Feb 7, 2008

Cool guys thanks for all the help and experience. Out of Avery's list I am looking at getting number 4. The surgon that I have feels this will serve me best in the long run, even though it is the most invasive and has the longest recovery, six months. Is there any one that has personal experiance with either the intramusciular or submuscular transpositions, number 3 or 4? Also, for every one that has had this sort of problem and surgical recovery how has it afected your climbing in the long run?


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By scott e. tarrant
From Fort Collins
Feb 7, 2008
kate!

i just scheduled this surgery (#4 on Averys list) a couple weeks ago. mine was a more traumatic injury in that the ulnar nerve "subluxed" (i think that's the word he used...i am in medical lingo nightmare right now) on a climb on October 23rd (no previous problems) and the pain since has been slight to considerable but always present. I cannot do a pull up (oddly enough i can do a few pull downs with light, sub 150 lbs, weight...with only slight pain) or even dead hang with palms facing me. i have not climbed since.

Avery- I would love more of the info you have bookmarked. I am scheduled to get cut on March 3rd and could not be less excited or more frightened. I will consider any other option right now. i am not certain if it is fear induced but i would swear that the pain is getting less and less but my surgeon insists that "it is broken and the only option is to get it there and fix it". i have no tingling or numbness just a constant feeling similar to the first 30 seconds after you whack your funny bone and extremely sharp pains when i tax the joint (pull up) or when it comes into contact with any hard surface. it seems that climbing will not be an option if i don't get it fixed but the potential with surgery may be worse than becoming a 5.7 slab master

any help / opinions / advise would be greatly appreciated.


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By Avery N
From Boulder, CO
Feb 7, 2008
Canadian Rockies Ice 2008.

Scott,

I can send you those bookmarks if you want them. Just PM me with your e-mail. Your subluxing sounds serious. But if you really think it's getting better, then maybe postpone? Your doc's comments sound a little anxious-to-cut. If I recall from my prior reading, I do think subluxation with pain is in an indication for transposition.

Know that some people have ulnar nerves that sublux naturally, and don't even know it. Mine do after surgery, which I find annoying when I'm doing anything repetitive like working out. More annoying than painful for me.

Here is an article I found interesting. I can't locate my real copy of it, but did order a copy through interlibrary loan. Basically, a compilation and analysis of all of post-operative reports in the literature (combined, I think that was a few thousand patients from 1970-1997).

You can find the abstract on pubmed.gov

Title: Surgical management of ulnar nerve compression at the elbow: an analysis of the literature
Author(s): Bartels RHMA, Menovsky T, Van Overbeeke JJ, et al.
Source: JOURNAL OF NEUROSURGERY Volume: 89 Issue: 5 Pages: 722-727 Published: 1998


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By RobR
Feb 8, 2008

Hey Scott
It sounds as if you are in the same spot I was in the summer. Have you gotten an EMG stress test to see if there blockage. It is not the most comfortable test (think light tazering of your nerve) but from what I understand it is the only way to nonsubjectivly diagnose that the nerve is compressed. I have had a whole host of symptoms including mild tingling, numbness, aching and burning all over the interior side of my elbow forearm and hand. Also when I was climbing six months ago I would get very sharp pain in my elbow and the funny bone followed by intense burning in the forearm and hand. This intense pain is the only thing that has subsided with time although I feel it is just because I have not been climbing or road biking since early July. What have you tried so far to treat the injury? Also if you end up doing the surgery make sure you have the best surgeon possible. I am on my second surgeon after the first was a bit lackluster. I am also traveling for the surgery so I can have it done by a specialist that I trust. Feel free to keep the post going or PM me as my surgery is schedualed for the 14th and I am 99% sure I am going to go through with it.


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By scott e. tarrant
From Fort Collins
Feb 8, 2008
kate!

Avery,

i sent you a message with my contact info. THANK YOU VERY MUCH! i decided last night to postpone. i understand that given my situation i may eventually develop scar tissue over the affected area of the nerve bundle which could simply reduce the pain or could result in neurological damage but it is a slow progress so upon noticing numbness, motor function deterioration, etc, i can elect to pursue the more invasive, surgical option. i look very forward to your help in furthering my education on the subject.

RobR,

I have not had and EMG. I went to my family doctor and she immediately referred me to the surgeon. he immediately recommended the transportation. he was able to get it to sublux at will with simple extension and flexion. i know that i sound like a complete chicken shit but i have (embarrassingly) not tried anything to treat the injury. it has been an interesting look at myself because i am not prone to depression (have been described as pathologically happy and optimistic) but having not climbed now for several months has really gotten me bummed out and in many ways resigned...not very proud to admit this as i would normally be the "pulling oneself up by the bootstraps" kind of guy, find solutions, etc, but this diagnosis has sent me into a tail spin. i have found myself doing a lot more obsessing about all the climbing i will be missing... i never thought i was the guy who invested so much of my self and joy in the sport but i have never not been able to climb... and the fear of having to have surgery (i react really poorly to anesthesia and pain medications) that invested no time in working out solutions. This thread has truly helped in extricating my head from my ass and forced me to stop feeling sorry for myself...so thanks to all.
good luck with your surgery and recovery. Please keep the post going. let me know if you go forward with the surgery. where are you getting it done? we have a lot of good surgeons up here (aspen, co) but i am willing to travel if i have to pursue this option. my surgeon is very much an asshole and i cannot decide if that is a good thing or not...when i told him that i was rather frightened his only response was "all that matters is that i am not"... i mean that, from one side of my mouth, is the exact kind of confidence i want the dude to have but from the other, i want the dude to give some kind of warm fuzzy...


good luck and thanks!

scott


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By Avery N
From Boulder, CO
Feb 8, 2008
Canadian Rockies Ice 2008.

scott e. tarrant wrote:
i would swear that the pain is getting less and less but my surgeon insists that "it is broken and the only option is to get it there and fix it".


scott e. tarrant wrote:
my surgeon is very much an asshole and i cannot decide if that is a good thing or not...when i told him that i was rather frightened his only response was "all that matters is that i am not"...


Perhaps just me, but if a doc said those things and treated me like that, I wouldn't talk to them -- let alone permit them to cut me open. Find a doc you're comfortable with.


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By scott e. tarrant
From Fort Collins
Feb 8, 2008
kate!

yeah...after a bit more clear thinking i decided that confidence without humility and grace is far enough out of line with my standards that i have cancelled my surgery and have begun exploring all other options (which includes having scheduled a consultation with another surgeon). i must admit to having been a bit star struck. his walls are covered with pic's of olympic skiers, snowboarders, big mountain skiers...

no shit and in no way am i trying to blow sunshine up your skirt, reading this thread about you guys having taken control of your situation reminded me that i have the onions to do the same.

very much appreciated


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By RobR
Feb 8, 2008

Hey Scott
I know what you are going through with the depression, as I too felt really down about my diagnosis for awhile and it still definitely is not a happy thought in my mind. I think in a lot of ways climbing acts like a drug nurochemicaly (think of all the adrenalin and endorphins) and quiting cold turkey especially against your will sucks. I have also heard this from a lot of people in a wide variety of situations. I also completely agree with you and Avery that you should consult another surgeon, but also talk to him about the EMG stress test. My uncle who is a doctor told my that it is the only way to really know what area of the nerve is injured as it can be trapped in a few different places and the pain you are feeling may not be where it is trapped. In other word for me having it trapped in the elbow has caused symptoms all over the arm and hand, so going by just feel and symptoms seems like a bad idea to me. You are right to be worried about the surgery because the possible complications (loss of feeling, control and or severe pain in the areas affected by the nerve) are quite serious especially if you plan to continue climbing. That said however my experience has been that although my symptoms get better when I rest they come right back immediately when I climb or bike. This is very frustration because you can fool your self that you are improving when in reality you are not. In fact I just got back from my last attempt before the surgery to see if there was any improvement. After talking to my surgeon recently about being concerned that the six months (with some physical therapy) of rest I have done was not enough he said to pretend that I was not injured and see how I do. Well long story short, I went to a climbing gym and all my worst symptoms immediately showed back up again, not to mention getting schooled on 40' gym TRs a good 4 grades below my trad onsight limit. As far as surgeons go I am on my second one after the first just wanted to keep shooting me up with cortisone even though I understand from other doctors that in my case (after failing to get better with iantopherisis, a mild cortisone type treatment) this was a futile course of action. So I gave up on him and called an orthopedic that had treated me very well for a snapped collar bone, years before. He referred me to one of the partners in his practice who is a hand surgery specialist. Finding the right doctor is tough so I was happy to go with some one recommended by some one I trusted even though it means traveling to stay with my parents in CT for the month of the surgery. If you want I can get you the name of my doctor in CT or maybe some one else in CO can give you the name of a good hand surgery specialist also referred to as upper extremity. Maybe initially you could see a certified hand therapist (I think that is the correct term) for some physical therapy to if it helps and to give your self peace of mind that you have exhausted you alternatives before surgery. Anyways I feel like I am rambling if you need clarification or i missed something just post it I'll keep checking this post as much as I can.

Rob

Also if any one has experience with having an submuscular ulnar nerve trans location I would love to hear from you.


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By Sandy C
Feb 16, 2008

Hi Rob,
I somehow stumbled upon this website while looking up info on ulnar nerve surgery. I have had pain for over 5 years and saw various specialist with different opinions and treatment. I recently underwent a brachial decompression first since I do have thoracic outlet syndrome bilateraly and recovered quickly but did not solve the pain in my forearm aching in elbow area and burning in the dorsal hand. So I opted to have the ulnar nerve transpostion and carpal tunnel release at the same time. My previous 2 emgs showed carpal tunnel and ulnar neuropathy. I am now 4, almost 5 weeks post op and still have pain, not the same pain as before the surgery but definitely worse. I am told it is post op pain and I should still be on vicodin, which truthfully does not take away the pain. Its generic so who knows. I see the Dr. in 2 days and I am realy concerned as I am a skin care therapist and need to use my hands and arms to do my job. Sometimes I wish I never got the surgery and sometimes I wish I had done something years ago. He said I had alot of scar tissue when he went in there. I read where the longer you wait the outcome is not as good. good luck and email with any questions.

Sandy


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By John McNamee
Administrator
From Littleton, CO
Feb 16, 2008
Artist Tears P3

It took me two years to fully recover from my elbow/ulnar nerve surgery.

The Surgeon thought I would be back climbing in 6 weeks.

You have to be very patience and enjoy your time away from climbing to give yourself the best results. After my first setback, when I realized the surgeon was being hopeful rather than realistic I didn't climb for 6 months and when I did start up I spent a lot of time doing 5.6s etc. Nothing where the full weight on was the arms.

My elbow is now pain free and the best it has been in years. So whatever you do give it plenty of time to come right and enjoy your break from climbing. Putting this sort of surgery off just cases more complications once you're cut open. I wished I had done this years ago.

Good luck everyone.


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By RobR
Feb 24, 2008

Hey guys,
I am now recovering from what hopefully was a successful transposition surgery a little over a week ago. Sorry I have not responded sooner but I have really just been resting.

Sandy it sounds as if you have few issues going on that may be making a treatment recommendation difficult for your doctors. My understanding of the ulnar nerve issue is that there is not just one best treatment or surgery so it is really dependent on what is causing the compretion. Mine seems to be from my elbows bowing inward. I also still have a good bit of pain but am less than two weeks out from the surgery.

John I think you may be right that it will take a longer than 6 months, but only time will tell. I am definitely not going to rush things and risk reinjury, it just doseint make sense. Glad to hear though that you have recovered fully, that was my mane concern with the surgery in the first place.

Rob


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By Avery N
From Boulder, CO
Feb 25, 2008
Canadian Rockies Ice 2008.

Good luck and get well, Rob! Hang in there, and keep us posted.


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By John McNamee
Administrator
From Littleton, CO
Feb 25, 2008
Artist Tears P3

Thanks for the update... now is a great time to start reading those old mags!

Keep us in the loop on your recovery and take it real easy.


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By KellieH
Mar 6, 2008

Hi Guys,
I'm not a climber. I just found this forum when looking for info on Cubital Tunnel. I was just dx'd the other day. Nerve cond. test and EMG next Monday.
I want to know how long the actual surgery takes. If it's outpatient. How long it puts you out of work, etc.
I'm the managed care coor. for a hospital and I earn my living typing. How bad is this going to interfere with my work??? I'm kind of nervous about it all but absolutely cannot stand the numbness and "weird" pain anymore.
I love to hear back. I can't seem to find anything that answers the above questions for me.
Thanks so much Kellie


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By Stich
From Colorado Springs, Colorado
Mar 6, 2008
Coffee after freezing our asses off near James Peak.

I just recently noticed pain in my left elbow, or rather to the inside of it. Glad you started this thread so I can keep up on this sort of thing.


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By Tyler Wick
From Bishop, CA
Jan 31, 2011
ECM

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?


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