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Archive for the ‘Life Outside of Work’ Category

Cubital Tunnel Surgery

I am now one week post-op from my ulnar nerve transposition surgery. I ended up with a lot more surgery than I expected. Although my doctor was honest with me about the fact that he wouldn’t know what type of surgery I would need until he opened my elbow to look, he expected, based on his clinical examination, to be able to do a simple in-situ release procedure. There were no outward signs of nerve subluxation (jumping from one side of the bone to the other), so most likely the nerve just needed a little more space. When I awoke from the anesthesia, however, the first words I heard were, “you had a sub-muscular transposition.”

I had read quite a bit about cubital tunnel syndrome and its treatment options before my surgery, but everything I saw said that if the nerve was subluxing and an in-situ release wasn’t possible, the alternative was a subcutaneous transposition. Basically, they move the nerve to the other side of the arm, but let it ride on top of the muscle. I did see references to the other possibility – cutting the muscle off the bone, sliding the nerve under it, and then sewing the muscle back in place – but it always said something along the lines of, “this is necessary for athletes, such as baseball pitchers, who place extreme demands on their arms.”

I am far from being an athlete. In fact, I am a weakling, and therein lies the problem. Apparently, a subcutaneous transposition doesn’t work when your arms are very thin. So, when the doctor released the nerve and saw it flip-flopping around the epicondyle, he had no choice but to give me the baseball pitcher version of the surgery.

Bottom line, I went in to surgery expecting a week of elbow immobilization and came out facing a month of full arm and wrist immobilization followed by a couple months of physical therapy. I will see the doctor tomorrow to learn more details. In the mean time I am mourning the loss of my summer as I try to learn how to get stuff done in work and life without the use of my dominant hand.

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Cubital Tunnel Syndrome!

This was supposed to be a professional blog, but since I’ve neglected it for so long I thought I’d get myself in the habit of writing by posting about something more personal: cubital tunnel syndrome. Actually, since academics are prone to repetitive stress injuries from long hours at the computer, this may be more relevant to professional life than it first appears.

About one month ago I spent a weekend slamming out a project that had me on the computer most of Friday, Saturday, and Sunday. On Sunday night, just as I was going to bed with a clear conscience after finishing everything I needed to do, my fourth and fifth fingers started to tingle. I knew right away it was not good, because it was so persistent. When I had carpal tunnel syndrome several years ago I would get a lot of numbness and tingling, but if I shook my hand it went away for a while. The tingling I felt this time didn’t go away no matter what I did.

On Monday I took large doses of ibuprofen in the hope of calming the inflammation, but by the end of the day I realized my right had was quite disabled. I had trouble brushing my teeth, turning keys in locks, and using silverware. I was able to see my doctor on Wednesday, and he explained that my symptoms indicated the ulnar never was compressed or irritated. (Dr. Google had told me the same thing!) He prescribed 12 days of Predisone, but said if I wasn’t feeling close to normal in about five days I should call him back and he’d refer me to a neurologist for testing.

The steroids helped some but nowhere near enough, so I got a referral for nerve testing. Then I waited. The first two neurologists I contacted could not give me an appointment earlier than two months out – an eternity when your hand is partially paralyzed and muscles are at risk of atrophy! – but my doctor’s staff kept trying, and I eventually got in to see a neurologist last week. The ulnar nerve can get pinched anywhere from the neck to the wrist, so an EMG was needed to figure out where the pinch was happening. Mine turned out to be the most common case, impingement in the cubital tunnel of the elbow.

While I waited for the appointment, I switched my computer mouse to my left hand and started sleeping with a soft splint on my elbow so I wouldn’t bend it at night. (These ideas came from the Internet, not as direct instruction from a doctor.) These conservative measures have definitely helped quite a bit, especially for the three middle fingers, but my hand is still not working as it should. I can’t unlock the trunk on my car, for example, because I don’t have the thumb strength to turn a big key in a heavy-duty lock. Worst of all, I cannot play my flute, because my little finger doesn’t have the reach or strength to press down the low C key. The neurologist has referred me to an orthopedic surgeon to get the problem fixed, but he is also booked up for two weeks, so once again I wait.

The video below shows the comparison between my mostly healthy left hand and my weakened right hand attempting to abduct the fingers against resistance. Although this test looks much better now than it did a few weeks ago, you can see that my thumb and fifth finger (and the other fingers to a lesser degree) lack strength, and there are divots and wrinkles in my hand where a working muscle should be.

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