Cubital Tunnel Release Surgery

Hi Susie,
I performed various Google searches, but can't seem to locate the article. Did it say if the MRI shows damage to small fibers of the nerve? The neurologist said an EMG does not detect that.

Q, I stand corrected, lol. I have gone back & looked at many articles at the major health facilities. What I did was google MRI & small fiber neuropathy & came up with the same as Karen. I looked at an article by the Cleveland Clinic & skin biopsy & QSART is the gold standard for dxing it. After reading several of these articles, I think if your neurologist is suspecting this as your issue, you need to discuss the above testing. The article I read in the beginning was an older article. When I get time I will search archives here at HW & see if I can find anything.


I just googled "how to diagnose small fiber nerve neuropathy" & the Cleveland Clinic's article is listed. I urge you to do this & read their article. You may want to print it off & show it to your neuro.

Hi Everyone,
My occupational therapist fitted me with a custom rigid arm splint to wear during sleep. My first impressions are that I don't like it. It will certainly prevent your arm from bending, and won't slip down, but it's very hard, and gets uncomfortable to wear. My arm felt very nervy after about 5 hours the first night. She added a little cushioning around the elbow, but none anywhere else.

In my opinion, these custom splints should have internal cushioning.

I have a Hely Weber generic night brace too, and that would be far more comfortable.

Post Edited (Q22) : 9/8/2018 8:10:12 AM (GMT-6)

Q22:
Wearing the newly formatted splint for a full night’s sleep may be too lofty of a goal, at least initially. I would suggest wearing the splint for a shorter period of 2-3 hours at a time, building tolerance and wear time from there.

Wearing a sleeve of cotton stockinette can also be immensely helpful. A thin sleeve of stockinette absorbs normal perspiration and moisture and prevents chaffing. Cotton stockinette is available from
Any medical supply or home care company. It comes as a roll in widths measuring 2” up to 8”. Cut the length of stockinette needed and allow extra to roll back as a shirtsleeve cuff at both the proximal
And distal ends.

Almost every custom molded splint will need a few initial “tweaks” to remold areas of undue pressure, friction, or bony prominence. Most often, problematic areas can be mitigated by using a heat gun to reshape the polypropylene. Foam padding with an adhesive backing can also be affixed to areas of the splint with a cutout to unweight specific pressure points. Make a note of problematic areas or use a felt pen to identify areas of discomfort or concern when meeting with the therapist in follow-up.
Karen

Hi Again,
I'm writing to post an update and hopefully get insight on a possible outcome.

My ulnar nerve decompression surgery was 10 months ago. The pre surgery nerve pain was horrible.

I never really had tingling or numbness, but the nerve pain in my elbow is still debilitating, although it has improved in the last 10 months.

An OT hand therapist I'm seeing for wrist tendonitis said she believes the nerve will eventually calm down, but it might take years. I believe a general timeline for cubital tunnel release nerve healing is up to 2 years, but does that also apply to someone who is 50?

I sometimes get a sharp ache in my elbow when using my arm for light activities. My funny bone is sensitive, but much more so when the nerve is symptomatic.

I don't get the electric shocks anymore, but the nerve sometimes twitches somewhat hard.

My hand is somewhat shiny, so I believe I have some small fiber neuropathy. An EMG performed again in December showed some delayed response, but was within normal range.

Thank you.

My memories are a bit fuzzy as my surgery was back in 1996. I cannot tell you how long it took for the nerve to finally calm down, but it was more than 10 months for sure! Even now, I must be careful how I rest it on the edge of the desk, as hitting the fleshy part of the forearm can produce the 'funny bone' effect. Any activity that requires a strong grip of the hand (weeding, plumbing repairs, wringing out anything wet, etc) will cause an extreme ache (think flu times 1000) from the muscle compressing the new nerve path. Wrapping it in a heating pad and taking ibuprofen seem to help the best. When I inquired about revision surgery, with a surgeon I trusted implicitly (he had done a revision on my wrist) he told me the odds of it helping were 30/70. Not good enough for the amount of pain I knew I'd experience post op.

My pinky and ring finger are still numb. I still have mild tingling/burning along the nerve path. As I said, bumping it can make it flare...the old groove is still very tender, too. All in all though, I have good function and that is the most important to me.

I also feel very let down by the medical community. My surgeon was caught completely off guard as to how quickly advancing my case was. I asked him why he didn't opt for surgery sooner. I needed to understand his reasoning so I could feel more at ease about this. He said my EMG showed mild to moderate compression (he knew earlier that it showed significant compression). As I pressed him further, he VERY LOUDLY told me to F Off which I have on audio, and will use to report him to the Medical Board.

I would have long reported it sooner, but there are many other incidents that I'm reporting:
1) When I stood up after surgery, on nerve block, my arm immediately violently fell down, bumping the metal part of the bed when it came out of the sling.
2) The week before surgery, in excruciating pain, I called his office possibly daily, pleading for help, begging for surgery sooner.
His assistant was rude, and after I had called one too many times, she told me my surgeon said "Maybe I shouldn't operate on him tomorrow". A hospital would have long told me to go to the Emergency room.
3) On the day of surgery, shocked by nerve damage muscle atrophy in my hand that he finally noticed for the first time, he said "What the F". Two weeks later I mentioned that he was surprised by the muscle atrophy, and he said "It was more prominent".

There are more incidents, but I outlined the main ones.

Given that my nerve was that damaged (I went through a phase of "electrical shocks" 5 months after surgery) and for him to say "Maybe I shouldn't operate on him tomorrow", only to be shocked and say "What the F' the next day is horrible. So basically, I was lying on the operating bed in terrible pain, another well regarded surgeon I saw 6 weeks earlier highly recommend surgery, and he walks in and says "What the F".

That was cruel treatment by a medical provider. It seems he does not realize the he works for the patient, not the other way around. It seemed he felt very uncomfortable when I talked to him about my concerns, and eventually, like a Bully, VERY LOUDLY told me to "F Off".

By the way, I have an earlier email from him stating that I should record all future conversations. The entire conversation is on audio for the Medical Board.

The "F Off" appointment was unusually late in the day, and the office was dark. His medical note for that day says he literally spent an hour with me which is inaccurate. The entire audio is 45 minutes (which was still a lot of time, I just wish my first appointment wouldn't have been rushed). I going to demand that he updates the note my medical record as "literally an hour" is not accurate.

Post Edited (Q22) : 1/21/2019 7:25:50 AM (GMT-7)

I called the Medical Board. They said there is no deadline. I'm trying to get everything well-written as my busy schedule permits. The "F Off" incident occurred in September.

My surgeon said I should get a mental health evaluation to address my thought process. I have told several other providers about my experience with him. They are all empathetic, and not one said anything to even remotely imply that my thought process isn't right. All concerns I stated are reasoned facts.

I'm not going to include the audio in the initial Medical Board complaint. He doesn't know I have it, so I will give him a chance to either admit or deny the "F Off" incident.

The Medical Board said I can provide the audio after he responds.

Post Edited (Q22) : 1/21/2019 7:43:10 AM (GMT-7)

Hi Susie,
I realize doctors generally don't comment, but once there are indisputable, reasoned facts about misconduct including vulgarity, they do comment and understand.

I told 2 doctors and my chiropractor about the surgeon's vulgarity. One doctor immediately asked: Which doctor was this again? I also said I'm filing with the medical board, and he said: I don't blame you.

Another doctor agreed 100% that the vulgarity was very inappropriate, he added that some people hire lawyers for that.

My chiropractor also knows I'm filing. He advised me to just stick to the facts, and keep emotion out of it.

And to say "Maybe I shouldn't operate on him tomorrow" when a patient has been calling for nearly a week is very cruel. I never thought that would happen at a U.S. medical facility. I wasn't calling about subjective complaints as I still have unresolved nerve issues.

When I called them pleading for help, it felt screaming in a crowded room, and no one hears.

Post Edited (Q22) : 1/21/2019 9:48:44 AM (GMT-7)

Sometimes doctors seem to forget that they work for the patient, not the other way around.

My surgeon didn't like being asked about a decision he had made 6 months earlier, even though it significantly affected my physical and mental well being.

And, his services were not free. My health insurance company and I paid for them.