Cubital Tunnel surgery two week review

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right-armIt’s almost two weeks since my cubital tunnel surgery, nerve transposition on both elbows, and I’ve recovered very well.  I’m really quite good with physical stuff, it’s the emotional stuff that I’m hopeless at.  I haven’t forgotten that.  The worst part of this surgery was most definitely my histrionics before the surgery.  But that’s part of a much bigger problem that I’m working on and fodder for another post.

 

Every surgery, and every body, is different.  Therefore every person will recover at a different pace, and will feel a different degree of pain.  I need to remember that, as everyone does. Some very well intentioned people warned me not to get both arms done at once. My surgeon herself said she does it rarely and only in select cases, but she was confident I would cope.  And I am very glad that I had both arms done together. One surgery, one anesthetic, one anesthetists bill and one hospital bill.

left-armYes, getting one arm done at a time would be easier in terms of being able to function, particularly as I’m the only adult in my household.  But it was only the first 48 hours that were difficult.  After that I was using both arms normally, though they became fatigued and painful quickly, and I had to rest often.  So I was limited in how much I could achieve.  Nothing new there.

The first 48 hours were painful, after that, the surgery incisions and nerve pain were no more painful than the day to day arthritis pain.

There was a lot of nerve pain, shooting pains down the outside of my lower arm, still some numbness, some electric shock pain and the feeling like hitting your funny bone pain, but all of those things also happened before the surgery, so it wasn’t anything new, albeit a little more intense and more frequent.

But now, that has completely resolved in my right arm.  No more hand numbness, no more pins and needles, no more claw hand. The only pain comes from accidentally bumping the incision site.  I already have much better grip strength and can move my fingers individually again, or mostly.  I didn’t realise how useless my hands had become.  Now that I have most of my right hand back, I can really appreciate the loss of function I was dealing with.  I think her pre-surgery assessment of getting about 60% back is pretty accurate. I wasn’t expecting 100%, and I am very happy with the results.  And it may still improve over time.

The left hand has not improved, but there is plenty of time.  It can be a slow process – several weeks, or even months.  My outside left palm is very tender – it actually feels as though it has been cut. Initially I kept checking it, I thought I must have sliced it open on something. It feels exactly like that, and even a light touch is painful. My surgeon said it is probably the nerve and muscle reactivating after being dead for so long, and is probably a good thing. She told me if that didn’t resolve over the next few weeks to come back, because there’s a small chance that the nerve is damaged and that pain won’t go away without further intervention.  I very much appreciate her honesty.  I don’t worry when doctors tell me the truth. I worry when doctors brush over things and tell me it’s my imagination.  My ortho tells it like it is and that’s why I trust her.  Every surgery has risks.  I’ll deal with that if it happens.

I’m hopeful my left hand will improve.  Even if it doesn’t, it won’t get worse.  And having much improved use of my right hand is more important, even if I’m unlikely to be able to play guitar again.  Guitar isn’t exactly a life skill. It’s purely for pleasure.  It is a loss, however.

I’m not much into crafting, knitting or crocheting or that kind of thing.  But I doubt knitting or crochet would be comfortable for any length of time with my left hand.  But, as always, if you love to do something, you will find a way to do it.  It’s not worth the pain for me, but it may well be for others.   I was comfortable driving by day five.  And I was at the gym walking on a treadmill within a week.  I can’t do much upper body work, and my elbows can’t bear weight yet.  But I have full range of motion, and can stretch, and move light weight. I can lift and carry a three litre bottle of milk just fine, and life is pretty much normal.

She removed the dressings to see how I was healing.  And it was the first look I got at the incisions. Before surgery I didn’t even ask her about how big the incisions would be, didn’t matter.  But they are larger than I thought – about 6 – 7cm each.  They haven’t closed completely, so she put some steri-strips on to hold it together.  Being on prednisone tends to make you heal slower.  Having said that, they look good to me.

I asked her about the cause of the cubital tunnel syndrome, and interestingly she said that while the constant rheumatoid arthritis inflammation certainly played a large part, she felt my joint hypermobility was the real culprit.

I know I have joint hypermobility syndrome. My son has it much more severely than I. My daughter has it to a milder degree.  My elbows and knees hyperextend and I used to be able to bend my fingers back to beyond right angles and bend my thumb down to my forearm. I can’t do that with my hands anymore, RA has stiffened all the joints and taken that mobility away.  But some of my other joints are still lax.  Years ago when I was having a cortisone shot into my hips the technician commented on my hypermobility, and asked me whether my joints subluxed.

In my elbows, because they hyperextend, the nerves had first been stretched by having to extend too far, and then impinged and compressed by the inflammation.  She said they were a total mess and congratulated me on having two opposing joint diseases to really screw things up.  (She admitted hypermobility syndrome and RA together isn’t that rare, that’s just her sense of humour.).   She said the surgery was definitely required to tighten the nerves and give them free motion.  And we’re both pretty happy with my right hand, and we’ll just accept that the jury is still out on the left.

I also asked her something that I’d noticed and been wondering about for years, but never remembered to ask.  It has happened four times now.  After every surgery, my arthritis becomes more mild for a few days, even up to a week or more.  I thought it was to do with the general anesthetic, and this is why the ketamine treatment was most interesting to me.  The ketamine infusion essentially involves being lightly anethetised for a week to reset your pain sensitization and your opioid tolerance.

My ortho explained it though. Nothing to do with the anesthetic. They give a very strong anti-inflammatory drug before surgery.  Everyone gets it.  It’s to aid in recovery and reduce inflammation in the throat from being intubated.  Added to that, because I have adrenal insufficiency, I got a big dose of I.V. steroids before surgery and after.  So those steroids would have helped me along as well.

Mystery solved.  Not some amazing side-effect of anesthetic.  A shame, really.

And that was the appointment.  Quick and simple.   She told me not to bother with the usual 6 week follow up appointment.  She could see I’m using my hands normally, so there was no need to see me again.   She has no concerns and told me to call if I had any problems, particularly if the nerve pain in my left hand doesn’t resolve.

And then she told me she’ll see me next time, but not to come back too soon, and sent me on my way.

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