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

In response to the carpal tunnel release. My experience after my second surgery to release my right ulnar nerve I ended up getting a release of my carpal tunnel. My doc didn’t completely cut through the ligament and partially cut it. I had very little pillar pain and didn’t really lose any grip strength but my doc said it was pretty unusual how quickly I bounced back 

Kurt Owens wrote:

Here’s my experience so far with ulnar nerve and carpal tunnel issues: I have gone to a surgeon for bilateral ulnar nerve inflammation and beginning bilateral nerve damage from carpal tunnel, and he was pretty bad. He scheduled a subcutaneous so I mentioned that I’ve heard submuscular is better for climbers and then he just said “you’re probably right. You also don’t have any subcutaneous fat. We’ll do submuscular.” I decided he wasn’t conscientious enough to do it right. He was also very wrong about the carpal tunnel surgery and I’m glad I didn’t let him do it. He scheduled the regular carpal tunnel release in which they sever the ligament above the nerve. He reassured me there would be no loss in hand strength from that. However, after reading a lot of studies at home, I found out that there is indeed permanent hand strength loss after carpal tunnel release compared to a healthy hand (just not compared to a highly nerve damaged hand right before surgery). Turns out there are multiple different proven techniques for repairing the ligament so your muscles do not shorten. The ligament is also important in carpal bone stability and is one of the pulleys for your finger tendons. I highly recommend anyone with carpal tunnel look into that before agreeing to the regular surgery. I ended up deciding to look for a plastic surgeon who did a hand fellowship who could do the ligament reconstruction and would actually know the research. All the while I was keeping my elbows straight at night, and stopped exercising my wrists like I had been. The hand pain went away, so I never got any surgeries. I still have the ulnar nerve issues, but so far keeping my elbow straight at night has stopped any worsening. My issue has not to do with inflammation, but my nerves snapping over my elbow bone every time I bend it. It’s audible when I do a push-up. I still presumably have the wrist nerve damage too, but I haven’t had pain again. I should probably still have it tested again to make sure it’s not progressing. I don’t have carpal tunnel braces, so I need to get some. I really hate the idea of getting the ulnar nerve surgeries, cause I’ve already been off climbing more than a year due to breaking my foot and having surgeries. I don’t want another really long recovery, arm scar tissue, and loss of function, but I probably will have to get it sometime. Just sharing in case my story with my doctor could be helpful to someone, and cause I’m gonna be dealing with this issue.
TLDR: Do your own research using published  papers online, not websites. If you’re skinny, subcutaneous may not be best. If you’re getting carpal tunnel surgery, find someone who will reconstruct the ligament because you will lose pinch strength & wrist stability otherwise.

Although you should always first try conservative therapies first, there's some questionable info thrown around in this post. 

Ashley J wrote:

Try not to get discouraged. I'm also a thin person and am noticing changes slowly, but just remember that this is short term pain for long term gain. Just think about how great it'll be when this fully heals. I could not have dealt with "good enough" for the rest of my life after in-situ! When you say "bulge" are you referring to the inflammation? I'm 4 weeks ahead of you and I still have visible inflammation, which I was told will likely hang around for 6 months or so and just to be patient and work on draining it.  I also have sensitivity still but again, it can take up to a year to settle down so I'm just trusting the process and each month the sensitivity does improve. I was told to use different materials and temperatures to help desensitize the area. 

I think that healing at this rate is more common than being able to climb 6 or 8 weeks post-op. I was told not to do anything like that until a minimum of 3 months after and even then, I was told to take it easy. Even at 4 months post op, there's no way I would climb  right now because my body needs more time. Just have to be patient!

My PT does a lot of work on the shoulder and neck while giving me exercises for my elbow and arm strength. I also had pretty bad muscle wasting in my hand (and arm in general), so he had me order this hand putty and instructed me to use it for a minute at a time a few times a day until I build strength up and then I can use it for slightly longer each time. It has been a game changer and my hand muscles have improved significantly! I highly recommend it. Play with it like you would a stress ball in the palm of you hand and also squish it around with just your fingertips. Make sure you order "soft" as there are different consistencies. It might feel too hard at first but it softens up with the oils on your skin the more you use it. Also, only use a small piece each time and don't overdo it. Start easy I hope this helps!

Thanks for the thoughtful post, Ashley.  Regarding the bulge, I'm referring to the nerve running on the inside of the elbow in the same way I see nearby veins.  That said, there still appears to be swelling in the area, so perhaps things will get better in that regard.  Do you currently experience intermittent numbness associated with any activities/arm positions?  

Unfortunately, my right arm has become much more painful in recent days, which is likely because of overcompensation for the left.  I have an appointment with a different hand surgeon to see what he thinks and to get the opinion of someone other than my original surgeon...   

Burrish wrote:

Thanks for the thoughtful post, Ashley.  Regarding the bulge, I'm referring to the nerve running on the inside of the elbow in the same way I see nearby veins.  That said, there still appears to be swelling in the area, so perhaps things will get better in that regard.  Do you currently experience intermittent numbness associated with any activities/arm positions?  

Unfortunately, my right arm has become much more painful in recent days, which is likely because of overcompensation for the left.  I have an appointment with a different hand surgeon to see what he thinks and to get the opinion of someone other than my original surgeon...  

If your surgery was initially on your left hand and your right is having symptoms I recommend you hold off and wait for use of your left to come back before jumping to have surgery. After three total surgeries, each time the free arm had nerve pain. The last surgery I just waited it out and didn’t have a second surgery done on my arm, it was the correct call 

Burrish wrote:

Thanks for the thoughtful post, Ashley.  Regarding the bulge, I'm referring to the nerve running on the inside of the elbow in the same way I see nearby veins.  That said, there still appears to be swelling in the area, so perhaps things will get better in that regard.  Do you currently experience intermittent numbness associated with any activities/arm positions?  

Unfortunately, my right arm has become much more painful in recent days, which is likely because of overcompensation for the left.  I have an appointment with a different hand surgeon to see what he thinks and to get the opinion of someone other than my original surgeon...   

Hey, I have numbness around the elbow, which is expected and will always be there, but I don’t have any numbness in my fingers or anything like that. My nerve is slowly getting better and better. I wonder if your nerve is still compressed slightly. I also cannot see my nerve under my skin but I still have swelling and again, I’m a month ahead of you, so that may take some time to go down still. 

My right arm got pretty bad once I stopped taking a nerve blocking med but I did a ton of physio and it’s much better now. It still bothers me sometimes but my pt said it’s going to heal slowly and can take a year. Nerve flossing and stretching your wrist (to stretch the nerve) made a world of difference. I really recommend finding a physiotherapist who has experience with this and even better, works with surgeons for hand therapy rehab. That’s who I found and he’s by far the best pt I’ve ever been to. 

Ashley J wrote:

.... I wonder if your nerve is still compressed slightly. 

This is what I'm afraid of.  I don't know if ultrasound can show something like a compression point or if there's any way to tell if scar tissue is causing this without another surgery having to be performed.  I might feel a bit better if I saw stories of folks who still had periods of finger numbness post-surgery, but it really seems to be mostly pain and swelling.  I have those too, but I feel like the numbness shouldn't be happening, especially since, in theory, there's no longer a major point of compression.  These bouts of temporary numbness are worse than pre-transposition.  Can't help but wonder if the fascial sling is the potential new point.   

Yeah, David, I'll take time and let the right arm settle down a bit, which it has in the past couple of days.  Nothing worse (relatively speaking) than feeling useless with two bad arms...I'm sure you understand.  Must...embrace...positivity... 

Burrish wrote:

This is what I'm afraid of.  I don't know if ultrasound can show something like a compression point or if there's any way to tell if scar tissue is causing this without another surgery having to be performed.  I might feel a bit better if I saw stories of folks who still had periods of finger numbness post-surgery, but it really seems to be mostly pain and swelling.  I have those too, but I feel like the numbness shouldn't be happening, especially since, in theory, there's no longer a major point of compression.  These bouts of temporary numbness are worse than pre-transposition.  Can't help but wonder if the fascial sling is the potential new point.   

Yeah, David, I'll take time and let the right arm settle down a bit, which it has in the past couple of days.  Nothing worse (relatively speaking) than feeling useless with two bad arms...I'm sure you understand.  Must...embrace...positivity... 

An EMG would be able to tell you if there’s compression and an MRI could pick up inflammation of the nerve. I’d definitely seek a second opinion because I don’t think you should have numbness in your hand anymore. Sorry you’re going through this!

I've had cubital tunnel neuropathy for almost 2 years. It's driving me a little bit nuts because I can't go to the gym and work out. I managed to get it onto control at the end of last year but it flared up again about a month ago. I'm thinking of getting the transposition surgery. But I've heard that you can have trouble with full extension of the arm. For example when you're doing a pull up. Has anyone who has had this surgery found that they have had any problems with this kind of physical action with their arm extended? Or any other limitations for that matter.

daniel jarrett wrote:

I've had cubital tunnel neuropathy for almost 2 years. It's driving me a little bit nuts because I can't go to the gym and work out. I managed to get it onto control at the end of last year but it flared up again about a month ago. I'm thinking of getting the transposition surgery. But I've heard that you can have trouble with full extension of the arm. For example when you're doing a pull up. Has anyone who has had this surgery found that they have had any problems with this kind of physical action with their arm extended? Or any other limitations for that matter.

I had transposition surgery after more than 2 years of neuropathy where the pain was so bad I could barely function. I'm 7 months post-op now and while i still have an achy arm at times, it's nothing like it was. I have no issues with range of motion. I can bend it fully and straighten it fully (but that came with 2-3 months of working on getting my ROM back. If you're consistent, it will come back). I'm only just starting to get some strength back in it after quite a bit of muscle atrophy in my arm, hand, and shoulder, so pull-ups are out of the question for me. Honestly, it was the best decision I made and I am at least able to use my arm on a day-to-day basis without pain and tingling. If i use it too much, the nerve get sore, but again, it's just a mild ache that taking an Aleve fixes. I also was warned that it will likely take a year to be "back to normal" so I'm just being patient.

Ashley J wrote:

I had transposition surgery after more than 2 years of neuropathy where the pain was so bad I could barely function. I'm 7 months post-op now and while i still have an achy arm at times, it's nothing like it was. I have no issues with range of motion. I can bend it fully and straighten it fully (but that came with 2-3 months of working on getting my ROM back. If you're consistent, it will come back). I'm only just starting to get some strength back in it after quite a bit of muscle atrophy in my arm, hand, and shoulder, so pull-ups are out of the question for me. Honestly, it was the best decision I made and I am at least able to use my arm on a day-to-day basis without pain and tingling. If i use it too much, the nerve get sore, but again, it's just a mild ache that taking an Aleve fixes. I also was warned that it will likely take a year to be "back to normal" so I'm just being patient.

Thanks Ashley. That gives me some confidence. I don't think I'm any where near as bad as you. My arm is currently not hurting at all. But i know if i lift a heavy groceries bag or move my arm in the wrong way it will flare up again. I've got no muscle wasting other than that from not being able to go to the gym. 

Did they do it subcutaneous? And did it leave a nasty scar?

daniel jarrett wrote:

Thanks Ashley. That gives me some confidence. I don't think I'm any where near as bad as you. My arm is currently not hurting at all. But i know if i lift a heavy groceries bag or move my arm in the wrong way it will flare up again. I've got no muscle wasting other than that from not being able to go to the gym. 

Did they do it subcutaneous? And did it leave a nasty scar?

Yup, subcutaneous and i have a 3-4 inch scar that's still pretty red, but I couldn't really care less about the scar. The one thing I will say is that you will have permanent numbness in part of your elbow after as a result of moving the nerve. I can't really rest my elbow on a table or anything anymore. It feels the same as when your face is numb from the dentist. Also, because the nerve is more exposed now, if you hit your elbow, you'll feel it more. It'll also be more sensitive to the cold at first while it settles into its new home but that will subside. All in all, I'd rather deal with the post of stuff than the pain forever!

Ashley J wrote:

Yup, subcutaneous and i have a 3-4 inch scar that's still pretty red, but I couldn't really care less about the scar. The one thing I will say is that you will have permanent numbness in part of your elbow after as a result of moving the nerve. I can't really rest my elbow on a table or anything anymore. It feels the same as when your face is numb from the dentist. Also, because the nerve is more exposed now, if you hit your elbow, you'll feel it more. It'll also be more sensitive to the cold at first while it settles into its new home but that will subside. All in all, I'd rather deal with the post of stuff than the pain forever!

I am 6+ years from my surgeries. I had many of the same issues with sensitivity even with rough clothing. My experience was both time and exposure cured this. So far out now everything seems pretty much back to normal. When I say exposure I mean don’t shy away from some general discomfort. The more stimulation the nerve gets the more they will adapt and repair (not medical advice, just personal opinion from experience and my own research). This type of nerve stimulation can be seen in “Dawn Wall” when Tommy C had to re acclimate his nub 

I'm having submuscular transposition done on my right elbow on 10/13, which is exactly one year from the subcutaneous surgery I had last year.  

I mentioned in an earlier post that the right elbow became more problematic since having to overcompensate for the left elbow's downtime.  Unfortunately, things didn't get better with the right arm and this needs to be done.  My left elbow isn't really any better than before a year ago and it's been frustrating.  I understand that watching surgery videos on YouTube doesn't make one a surgeon, but after watching revision videos from Dr Susan MacKinnon, I can't help but wonder if my surgeon last year created newer kink points along the nerve path.  

As I'm typing this message, my left pinky/ring finger are increasing in tingling and light numbness; that hasn't improved since before surgery.  The only thing I think last year's surgery *might* have done is keep the left ulnar nerve from getting worse, which is obviously fine, but I was hoping for an overall improvement and that simply hasn't happened.  

The reason I'm doing submuscular transposition this time is because I'm a pretty thin guy and am unsure that I was given the best advice by my last surgeon.  My left ulnar nerve looks like just another vein on the inside of my elbow and, for me, is just a bit too exposed for certain seating/laying positions.  

Once next month's surgery happens, I will have had all three types of this surgery.  (in-situ decompression (both elbows at same time twelve years ago), subcutaneous (left elbow last year) and submuscular)  Last year's surgery has kind of started a downward spiral for me and it's hard not to be a bit discouraged.  I'm a musician and am about to be on yet another multi-month hiatus from playing; I know all of you who climb are familiar with that kind of frustration.  

How is everyone doing?  How are the nerves?  

Burrish wrote:

I'm having submuscular transposition done on my right elbow on 10/13, which is exactly one year from the subcutaneous surgery I had last year.  

I mentioned in an earlier post that the right elbow became more problematic since having to overcompensate for the left elbow's downtime.  Unfortunately, things didn't get better with the right arm and this needs to be done.  My left elbow isn't really any better than before a year ago and it's been frustrating.  I understand that watching surgery videos on YouTube doesn't make one a surgeon, but after watching revision videos from Dr Susan MacKinnon, I can't help but wonder if my surgeon last year created newer kink points along the nerve path.  

As I'm typing this message, my left pinky/ring finger are increasing in tingling and light numbness; that hasn't improved since before surgery.  The only thing I think last year's surgery *might* have done is keep the left ulnar nerve from getting worse, which is obviously fine, but I was hoping for an overall improvement and that simply hasn't happened.  

The reason I'm doing submuscular transposition this time is because I'm a pretty thin guy and am unsure that I was given the best advice by my last surgeon.  My left ulnar nerve looks like just another vein on the inside of my elbow and, for me, is just a bit too exposed for certain seating/laying positions.  

Once next month's surgery happens, I will have had all three types of this surgery.  (in-situ decompression (both elbows at same time twelve years ago), subcutaneous (left elbow last year) and submuscular)  Last year's surgery has kind of started a downward spiral for me and it's hard not to be a bit discouraged.  I'm a musician and am about to be on yet another multi-month hiatus from playing; I know all of you who climb are familiar with that kind of frustration.  

How is everyone doing?  How are the nerves?  

How is your recovery from submuscular now, I had it done a year ago and likely need a revision soon. 

How is your recovery for submuscular transposition so far.

No probs at all. I had the same fear

Apologies since this isn't about climbing, but how have you all fared with typing since your ulnar condition started?

I'm in IT and have to type quite a bit during the day (and otherwise) and it's only a few minutes until the tingling/nerve irritation starts; I have to take frequent breaks.  

I'm *finally* trying out different ergonomic keyboards that don't require as much pronation to type, as having your forearm in a more neutral position lessens the tension of the nerve when your pinky/ring fingers are going at it.  Have any of you switched keyboards and/or payed more attention to your overall ergonomics?  Is your condition exacerbated when you're regularly climbing/typing a lot in the same day?  

No issues after CTS and ulnar n surgery and have not changed my typing or climbing habits.