Surgery – Rob Fahrni

On March 25th I had Ulnar Nerve Transposition surgery. I wrote about it, one handed mind, a few day after. (Wow, I just realized I posted that on April 1. No, that post was not an April Fools joke, but I digress.)

I hit the four week mark on Tuesday, April 22, and my recovery is ahead of schedule. My range of motion is at about 99% in my estimation. Fully straightening it is still accompanied with a bit of pain, but it’s not bad. Overall the incision has healed nicely, no infections, or other troubles.

I love modern medicine. Surgery was on a Tuesday. I left the hospital with gigantic cast-like wrapping on my arm. I couldn’t move it, it was fixed in a 90 degree angle because your ulnar nerve likes that relaxed position and would allow the nerve to cool down. The first couple days were the most challenging, my nerve was not a happy camper, and I’ll be honest, at times I wanted to cut my hand off. By Friday I was feeling pretty darned good and visited the hand therapist for my first session.

Session One

I didn’t know what to expect on my first visit. I’d already gone through therapy with this group in an attempt to fix my issue without surgery. I couldn’t imagine doing nerve glides just yet. The arm was a bit too tender and swollen for that. Session one was all about getting the bulky wrapping off my arm and replacing it was a much lighter version I could remove if necessary. They even used a nice removable wrist brace because anything touching my hand could cause the nerve to go crazy. By using this removable brace I could seek relief when the nerve flared by removing the brace. It was quite nice. That was all for the first day.

Session Two – Crumpling Paper

My second session was at the seven day mark. We took the brace off the arm and I received a massage just above my elbow on my triceps muscle, which was surprisingly nice. Then we moved on to some simple exercise to make sure scar tissue didn’t form around my newly relocated nerve and prevent it from moving properly. The first exercise was to move my arm downward from its 90 degree angle to 45 degrees and move my open palm left and right, without pain. The second exercise was to make sure my head was properly aligned over my shoulders and tilt it to the right, which pulls on the nerve from the other direction. Done for the day, sent home with homework to do these exercises throughout the day. Pain free movement was the operative word.

One Week + One Day

At just over a week I visited the surgeon for a check-up. The doc removed the soft cast and said “Take that thing off, but wear it to bed.” So, that’s what I did. I was able to do some light typing after that, but couldn’t push too hard or I’d anger the nerves in my palm. It was really nice to have it off. Unfortunately I didn’t think to grab any pictures of the different cast setups.

Session Three and Beyond

By the end of my second week my arm was feeling really great. When we hit session three I was able to do all sorts of “advanced” stuff. I think you’d be surprised how much your ulnar nerve is isolated and used doing very simple things. I got to crumple paper, play with coins, use the rainbow arch, and rub my elbow in rice. Yes, rice, it’s a texture thing. The nerves around my elbow didn’t like to touch things after surgery. It was actually quite unpleasant when I rubbed up against something. Moving the rice around with my elbow allowed the area to become accustomed to being touched again. I was also instructed to rub the area throughout the day with various different textures to help with the process.

I’ve been doing so well the therapists have decided to cut me lose until after the six week mark. At that point we’ll begin strengthening.

Coins and Puzzle

Lately, as in the last few days, I’ve experienced a sensation I’ve never experienced before. I’m not sure this has anything to do with the surgery, but I’ll run it by my doc. I’ve been getting a strange sensation at the base of my neck, then it spreads out and down both arms, almost like a cramp. My arms become very weak and I get sick to my stomach. It’s not a pleasant experience. Knowing my body it’s a stress thing, but I guess we’ll find out.

Oh, One More Thing

I started this process in hopes I’d get feeling back in my left hand and fingers (pinkie and ring finger, and half of my palm.) That hasn’t happened, yet. According to the doc feeling may never return. It will take six months to a year to know for sure.

In the meantime I need to get back to writing software.

Brother, can you spare a hand?

Since September 2013 I’ve had a problem with my left hand. My pinkie, ring finger, and half of my palm have been numb most of the time and hypersensitive the rest. I figured it was a RSI of some sort and set about figuring out how to fix it. I Googled around and found some information on my exact symptoms. I thought if I followed the exercises it would fix itself.

You’re going to need surgery

In November I finally went to a doctor, yes, I waited two months, I wouldn’t recommend doing that.

I was sent to a Neurologist. She performed a nerve conduction study. Ever have one of those? I wouldn’t recommend it. The doc pokes little probes into your skin and sends a current into it. It made my hand and arm jump about, but not as good as it should have. Her conclusion? “You need surgery. You have severe nerve damage.” Swell. She goes on to tell me the damage is in my elbow, my ulna nerve. She asked how I damaged my arm. I have no idea how it happened, it just happened.

Let’s try therapy

I was referred to a surgeon. You know what surgeons like to do? They like to cut. They are a hammer and everything is a nail.

I met with the surgeon in early December to figure out my next steps. I liked this guy instantly. He has a great bedside manner, very personable. His assistant took pictures of my hands and took my vitals, this is something they would do each visit.

I gave the doc the lowdown and he talked to me about the results of the nerve conduction study and decided to give me a steroid shot, directly into my left wrist in hopes my symptoms would clear up. It could have been swelling, and this approach may fix it. Great!

A couple weeks later, I was back for my follow up. No change in symptoms. Bummer. We talked for a bit and the doc had a recommendation before going the surgery route. “Let’s try therapy.”

When do you want to have surgery?

I like therapy. I learned how to sit properly and how to adjust my workspace so I wouldn’t develop other physical issues. I purchased a new hands free headset, I spend a lot of time on the phone, and purchased a GeekDesk so I could set my desk at the proper height and work standing up once in a while. I propped my display up to the proper height and stopped using my laptop keyboard.

I went to therapy twice a week for a month or so. I learned how to do all sorts of exercises to deal with my condition. It was all about realigning, or freeing up, my ulna nerve so it wouldn’t be pinched and my symptoms would disappear. I even changed how I sleep. Moving from sleeping on my left side to my right.

It didn’t work. I met with the surgeon and he asked, “When do you want to have surgery?” Truth be told, I didn’t. I tried to talk him into waiting until July. “July? Why July?” I explained I was busy at my day and night job. He explained that I risked further damage to my ulna nerve. The worst outcome? Losing the use of my left hand. Clearly I didn’t want that to happen. We scheduled surgery.

Let’s make a smily face

March, 25. That was the big day. Surgery. I’d finally get this darned thing fixed. The day came. I was in pre op and the doc stopped by. He asked which arm we were working on, he knew of course, but he had to hear me say it. I must have been asked that question a dozen times. He took out a Sharpie said “Let’s make a smily face” and proceeded to draw two points about five inches apart on the inside of my elbow, and placed his initials on the inside bend of my elbow.

That was around 4PM. I woke up at 7:30PM. I was groggy and my throat was a bit sore. They had to put me fully under. Apparently I started wiggling a bit during the surgery. I was supposed to receive a nerve block and be put into “twilight sleep” a wonderful concoction of drugs that leaves you awake, with no memory of the event. I guess I needed a bit more help. The nurse said the doc had to go a bit deeper than expected, I have no idea what that means, but there you go.

Back to therapy

It’s been a week since my Ulna Nerve Transposition (NSFW). I’m pretty excited to get the splint off my arm, it’s a real pain in the butt. Therapy starts Friday and I get to bend my elbow, with my newly relocated ulna nerve, for the first time in a bit over a week.

I’m hopeful my hand will return to normal in due time. It can take up to a year for the nerve to fully repair itself, and after all this there is a chance it may never repair itself.

Only time will tell.

UPDATE (02/04/2014): Yes, this post was written with one hand, on my iPhone using WordPress for iOS.