- Diseases, Disorders & Conditions
Ulnar Nerve Release
A Terrifying Experience
When the fingers of my left hand began to go numb for long periods of time, I became frightened. After seeing my doctor and going through treatment, it became clear that I would need to undergo a Ulnar Nerve Release if I was to regain feeling in my fingers. This procedure is becoming more and more common, as people are suffering from all types of repetitive stress injuries.
First, Some Backstory
A little history to my story.
Having been born in the early 80s, I'm part of one of the last generations that remembers a time before technology took over our lives. There wasn't a computer in every home, very few had a cell phone (remember those? they looked like bricks!), and home video game systems were still pretty new.
But everything has changed rapidly. Now everyone has their own electronic leash, otherwise known as a cellphone. Computers are used for nearly every job out there and you most certainly have at least one for home-use. Video games have advanced beyond our wildest imaginations. Constant usage of these devices is creating an epidemic.
Not only are we reliant on technology but it is also harming us. Everyone knows about "carpal tunnel" and "repetitive stress injury". "Cell phone elbow" is another common one. I'm sure everyone who reads this knows at least one person affected. Maybe even you yourself have had problems.
A Common Problem?
Have you ever had problems with carpal tunnel and/or tendonitis?
Heed the warning signs.
I've had a lot of jobs in the data entry field. This usually means a lot of time spent sitting at a computer, entering information. Which means a lot of typing. In some ways this is good, as it means I've got loads of experience and am proficient in typing (which means being fast with little-to-no errors.)
In the summer and fall of 2004, I was entering loads of information into a database. Six hours a day, five days a week. Sometimes I even worked Saturdays. It was a big job with a lot of responsibility.
I started to have problems with my left arm. My pinkie finger would feel numb sometimes, other times I would feel that "pins and needles" sensation like it had gone to "sleep". My elbow would sometimes ache. I had already been diagnosed with carpel tunnel syndrome but that mostly affected my right wrist. I found it weird that my left arm was hurting, mainly because I am right-handed. I mean, I can do lots of things with my left hand but it is not my dominant hand. So why was it hurting so much?
I saw my orthopedist and he sent me to have some tests performed. I had a nerve conduction study but the results didn't show any damage to my nerves and everything seemed to be functioning normally. It was decided I was probably just hurting from a repetitive stress injury due to so much computer work.
I ended up taking anti-inflammatory medication, has some physical therapy, and worked through the pain. Eventually my job came to an end and I moved on to something else. In time I completely forgot about it, as my arm no longer bothered me.
What is a Nerve Conduction Study?
A simple overview
A nerve conduction study (or NCS) is a common test that is used to evaluate the function of the motor and sensory nerves in the body, especially the ability of the nerves to conduct the electrical impulses.
Nerve conduction studies are used for determining and evaluating paresthesias (meaning numbness, tingling, burning) and/or weakness in the arms and/or legs of a patient. Common disorders that can be diagnosed by nerve conduction studies include:
- peripheral neuropathy
- carpal tunnel syndrome
- ulnar neuropathy
- Guillain-Barré syndrome
- facioscapulohumeral muscular dystrophy
- spinal disc herniation
The test includes motor and sensory NCS, which is performed by electrical stimulation of a peripheral nerve via electrodes placed on the patient's body. Each patch gives off a very mild electrical impulse, which stimulates the nerve, and the results are recorded. A F-Wave and H reflex study is also part of the test. A F-Wave study uses the supramaximal stimulation of a motor nerve to record the potential action from a muscle supplied by the nerve. A H-reflex study uses the stimulation of a nerve and records the reflex electrical discharge from a muscle into the limb.
Electromyography ("myography" means "an instrument for recording the contractions and relaxations of muscles") is often done at the same time as this test. An electromyography is when needles are placed into the muscles and a recording of the electrical signals is made. During the test you will actually hear the sounds of the electrical impulses, which is quite fascinating. Unfortunately, this part of the test can be painful and patients can experience muscle soreness.
In 2005, the pain in my left arm flared up again. But I pointedly ignored it. I have a naturally high pain tolerance and tend to not heed warning signs my body gives me. I did some more data entry work but I tried to counter-act the pain with pain medication and using wrist braces my orthopedist gave me.
In 2006, my arm had had enough.
I was again doing data entry but found that even short periods of time on the computer caused my left pinkie and ring fingers to go completely numb. And soon the lower part of my left palm began to get "pins and needles". My left forearm would ache for hours; sometimes the pain felt like it was burning beneath my skin. My left wrist ached as if the joint was swollen up. My left elbow started to hurt all the time.
The day my left pinkie and ring finger went numb and stayed that way was the day I got frightened. My body was giving me signs I could no longer ignore.
I was terrified. Because I could not feel my fingers, I was afraid I would hurt them somehow but not know it. I scheduled an appointment with my orthopedist immediately.
September - November 2006
I can't go on in pain any longer.
My orthopedist took an x-ray of my left wrist. When I was 2, I broke my wrist and damaged the growth plate. As I grew older, and because the plate was damaged, I have a noticeable gap in the bones of my wrist. It has developed arthritis as well as carpal tunnel.
But that was not the cause of my pain. I was sent for a second nerve conduction study, and I requested that I have both arms studied in case my right arm also had problems. I actually saw the same doctor for the test but had no memory of the first one; this was a little awkward. But as the test progressed, it was clear that my left arm was having problems with the nerves and there was damage.
Having sticky electrodes placed on your skin is nothing much. They can make you want to itch and the stickiness stays after you remove them. Receiving electrical stimulation isn't painful, especially if you've ever had physical therapy. The hardest part was the electromyography. I don't have a fear of needles (I've got multiple tattoos and have had plenty of injections in my lifetime) but having needles, even small ones, stuck in your muscles hurts. For me this was the coolest part of the test. You get to hear the electrical impulses your body makes via your nerves to control movements and motor functions. There is something so fascinating about being able to hear something you normally never get to. (I asked if they would give me a recording of it but it didn't happen.)
The diagnosis was compression of the ulnar nerve of the left arm.
After my orthopedist received the results of the nerve conduction study, he prescribed me Tramadol for the pain. By that point, I was in constant pain to the point of being drained. While the Tramadol would relieve the pain, it also made me a zombie. I could barely function let alone get out of bed while I was taking it.
One of the hardest months of my life was November 2006. My maternal grandmother was moving from her home of 35+ years to her new condo. We had to pack all the contents of her old home, condense them down, and have movers truck them to her new home. And here I was, out of my mind from pain and the pain relievers that were supposed to be helping alleviate that pain.
I remember the day the movers came to pack the guest room bed I was sleeping in. I managed to drag myself out of it, gather my belongings and my suitcase, and dragged them into the alcove off my grandparents' bedroom. I went back to sleep and didn't wake up until the next morning. And that was because the pain in my arm was so terrible it woke me up.
The stress and anxiety I felt over my arm made my Costochondritis flare up. It also wreaked havoc with my anxiety disorder. When you live in chronic pain, you become depressed. Everything was set in a vicious circle and I was beginning to wonder if there was ever going to be light at the end of the tunnel.
What is the Ulnar Nerve?
A simple overview
In humans, the ulnar nerve is the largest unprotected (meaning unprotected by muscle or bone) nerve in the body. It is also the only unprotected nerve that does not serve a purely sensory function (meaning it is not specifically meant to perceive changes in the environment, like nerves in your skin do.)
The ulnar nerve extends from your spine via the brachial plexus, down through the shoulder, upper arm, along the elbow and runs parallel along the ulna bone (the bone in the medial (middle) of your forearm) and is directly connected to the little (pinkie) finger and the adjacent half of the ring finger. It supplies the palmar (palm) side of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.
Have you ever heard of someone saying they hit their "funny bone"? The irritation of this nerve, especially when you hit it around your elbow, is where this saying comes from.
The Ulnar nerve can become trapped or pinched in various ways as it proceeds down the arm from the Brachial plexus to the ring and middle fingers. A common condition is caused by cubital tunnel syndrome, when the tunnel that runs along the inner outside of the elbow compresses the ulnar nerve.
When the ulnar nerve becomes pinched it often exhibits as tingling in the little (pinkie) and ring fingers. Patients can also experience the "pins and needles" sensation.
Medical Knowledge Quiz
Have you ever heard of the ulnar nerve?
The Beginning of the End
A choice to make.
When I got home from moving my grandmother, I called my doctor. The first words out of his mouth were: "How do you feel about surgery?"
I had run out of options. The ulnar nerve of my left arm was so compressed it was causing chronic, debilitating pain. My condition of life was being severely affected. I'd run out of treatments; pain medication, cortisone shots, and physical therapy could no longer help me.
My last option was to have a surgical procedure called an Ulnar Nerve Release or a Cubital Tunnel Release. My surgery was scheduled for December 2006.
Under the Knife
December 11th, 2006
The day of surgery dawned with gray clouds and weak sunlight. Because patients with latex allergies are scheduled early in the day (to prevent cross-contamination) my surgery was scheduled for around 9am. I had to be at the hospital around 7am, to be admitted and prepped for surgery.
I was tired of feeling miserable and hurting. The pain in my left arm had intensified to such a degree that even touching my skin hurt. It felt like my arm was burning inside. Moving my wrist for normal activities, little every day movements, was getting harder and harder. I was so worn down I often felt like crying.
I was so ready for surgery.
I checked into the hospital and got into a gown. (Does anyone ever enjoy wearing hospital gowns?) My mother and grandmother were with me. We sat around in the hospital room, watching TV and waiting.
(Yes, that is me before surgery in the picture. Why not have a little bit of fun before going under the knife? Life's too short to be too serious. Please note my fuzzy orange and black striped socks.)
Eventually I was wheeled down to the pre-op room, where they readied my IV and got everything ready for surgery. My orthopedist, who is one of the best doctors and so very awesome, came and wrote "YES" on my left arm. He didn't want to make any mistakes.
Because it was close to Christmas, the nurses were having the surgeons and doctors make paper snowflakes to decorate the rooms. My doctor came back, handing me a piece of white paper and some scissors. "Do you know how to cut paper snowflakes?"
So there I was, an IV in my arm, dressed and prepped for surgery, cutting a paper snowflake like I was in kindergarten. Really, these types of things happen to me so often I'm used to it.
Then it was time to go. They wheeled me in on the gurney into the operating room. I remember the overhead lights had orange enamel on them. Everyone commented on my socks. I was moved to the operating table and the anesthesia was started.
Everything went black.
What is an Ulnar Nerve Release?
A simple overview
Once the severity of your diagnosis is determined your surgeon will decide the best option for treatment. There are four types of nerve decompression:
A simple decompression is used to decompress the nerve. The nerve itself is not manipulated or moved. This is the most common of the decompression procedures.
A simple decompression with epicondylectomy is when the nerve is released from compression and a portion of the medial epicondyle (an epicondyle is a rounded protuberance at the end of a bone that serves as a place of attachment for ligaments, tendons, and muscles) is removed. This is usually done when the ulnar nerve dislocates (moves) from its normal position when the patient flexes their arm. Usually confirmation of the dislocation is made during surgery.
Subcutaneous transposition requires a 3-4 inch incision to decompress the ulnar nerve and then the ulnar nerve is moved under the skin to the front of the elbow. This is another common procedure, but may leave the ulnar nerve vulnerable to external trauma.
Submuscular transposition is used to expose the ulnar nerve and muscles near the elbow. The patient's muscles are cut and the ulnar nerve is placed beneath them. The muscles are then re-attached. Submuscular transposition is commonly used in patients who failed a previous, simpler decompression. Some immobilization and a longer recovery is required.
More and More Commonplace?
Have you or someone you know had ulnar nerve release surgery?
Everyone keeps commenting on my socks...
I woke up in the recovery room. The nurses would check on me but I mostly drifted in and out of consciousness. I remember at one point my orthopedist came in to check on me and tell me the results of my surgery.
Everything had gone as planned, except one small surprise: I had had an anomaly.
In addition to my nerve being compressed, I had an extra fibrous muscle-like tissue band constricting my ulnar nerve. This tissue was never meant to be where my doctor had found it. In fact, it was so rare my doctor had never seen it outside of a medical textbook in over 30 years of practicing. He was actually excited about finding it, even if he had removed it from my arm, since I didn't need it.
I remember wishing him a slightly sarcastic and very sleepy "Merry Christmas", as if I'd given him a present.
Eventually I was taken upstairs to the hospital room. By now I was more conscious but I was pretty nauseous from the anesthesia and most of my concentration was devoted to making sure I didn't throw up. I was pretty uncomfortable on top of everything, as my arm had been set in a bent position with plaster supports and thick bandages. I also had stitches that would need to be removed in a week.
(Again, that is indeed me in the picture, this time post-surgery. I'm actually hamming it up for the camera, but I was indeed groggy and most uncomfortable. You can see the blue sling my left arm was in. I really hated that sling.)
I was discharged a couple of hours later, when I was conscious, keeping fluids down, and about as ready as I ever would be. I got to spend the night at my parents' house, since I was still pretty out of it and down to one working arm.
But my surgery had been successful!
A week later I had the splint removed, the stitches pulled (that hurt!) and I could honestly tell the doctor I had begun to regain feeling in my fingers. My wrist and arm no longer burned with pain and I was well on the road to recovery!
Down the Road
Since I had surgery...
It's been a few years since I had my ulnar nerve release surgery. I've regained roughly 90% of the feeling and sensation in my fingers and arm, and have not suffered much permanent damage.
Pain will always be a part of my life unfortunately. Because I have carpel tunnel as well as tendinitis and arthritis, it's just something I've learned to deal with. There will always be good days and bad days with my arm.
Because I am using a computer a lot, for work and personal use, I find that when I overdo it and do a lot of typing, my arm reminds me that I am not supposed to be doing that. Sometimes the pain stretches all the way into my shoulder blade. Roughly a year after surgery, the bursae under my left shoulder blade was so inflamed I ended up having to get a cortisone shot. Talk about pain. I don't want to ever have another one of those any time soon!
There is still noticeable weakness in my pinkie and ring fingers. I find that I have to be extra aware sometimes when using them to hold onto something. There is also a loss of strength at times and sometimes I will go to do a task that I wouldn't have had any trouble with before I was injured. It's frustrating.
I've also noticed how much atmospheric pressure can affect you. When someone says they can feel a storm in their bones, they're not kidding. When the weather turns rainy and storms a lot, my arm aches. I guess the silver lining is I'll always know when to take an umbrella with me.
I find a lot of the time I have to force myself to take a break and set limits for computer usage. Part of this is being sensible and realizing I am not invincible. And part of it is protecting myself from future damage to my arm and nerves.
Although major surgery is something no one should undertake lightly, I am glad I chose to go ahead and have it. I am most fortunate to have an orthopedist who only considers surgery when it is the last or best option. I am also lucky to have healed so well that my scar is barely noticeable. (Of course, I have lots of other scars and I've always considered them as signs of living life.)
Food for Thought
Repetitive stress injuries, carpal tunnel syndrome, and other problems are steadily growing every year. If people don't take heed and learn, they might find themselves facing serious health issues and surgery.
© 2009 missbat