Cubital Tunnel Syndrome/Ulnar Nerve Issues

Burrish

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I saw another thread but figured I'd just post here since this is more of a blog post.

I've had two surgeries for this problem (12-ish years apart) and wanted to offer my thoughts and get thoughts from other drummers who have/have had this problem.

I had in-situ decompression on both elbows (at the same time) twelve years ago, which was moderately successful. I was back at full-strength drumming within a few weeks, but keep in mind that my getting back that quickly was more a result of simple decompression being a much less invasive surgery than transposition, and my nerves weren't in terrible shape. I personally never experienced clawing of the hand or severe weakness, and it was mostly numbness/tingling of the pinky/ring fingers before decompression. Subcutaneous transposition was done on my left arm a bit over four months ago, and this recovery has been a *much* different beast.

My biggest concern with the subcutaneous version of this surgery was/is the sensitivity of the nerve being just under the skin as opposed to under the muscle. Getting comfortable in bed or on the couch can be annoying if your arms brush against your side on a regular basis. It's gotten a bit better since the October '20 surgery, but it's definitely still an issue. I still wonder if, being relatively thin, subcutaneous transposition was the best option for me. (my surgeon insisted he had worked on thinner people who all had success) I went with subcutaneous transposition because the recovery is typically much shorter than with submuscular and has similarly successful results. If I had known then that it would be 4+ months for recovery, I likely would have gone with submuscular, as the nerve is more protected and follows a straighter path when under the muscle.

Regarding drumming, my pain would primarily occur when practicing a lot of rudiments/finger control since that activity involves more of the ulnar nerves in addition to the muscles in the rest of the arm/shoulder. I'll put it this way: if I'm playing Rock or something with more volume/arm motion, my ulnar nerves really didn't become irritated or were only minorly affected after a show. When playing Jazz/Fusion or lots of rudimental practice, it's a different story since (obviously) there's typically more finger control/detail.

That said, I realized that I have a lot of squeezing tension in my arms when I'm playing heavier, which no doubt contributes to the issue. (along with a lot of typing for my job and exercise)

Two weeks ago, I went to the practice room after four months of not going. I could have gone earlier, but I wanted to be extra-careful after a surgery like this and not be tempted to overdo it. I got on the throne and had two practice days where I was only using my right arm and legs. Hats, ride, kick and snare is all that was set up, and I really didn't hit the snare since that's mostly a left-handed activity. Unfortunately, my right hand was clearly overused since, after two days, it was extremely painful as a result of the combination of compensating for the left over the last several months and doing that much practice after that big of a lull.

The pain hasn't gone away and is getting worse on the right elbow/hand, so I'm seeing a different hand specialist today. My left arm actually has more bouts of temporary numbness than pre-surgery, so I have a ways to go on that one as well.

All of this is to say that I understand the pain those of you who are experiencing this have gone/are going through. Missing out on drumming for this long is excruciating, and trying to keep a positive outlook truly is difficult when the days seem to take forever.

If you've had this surgery, which type did you have and what have been your recovery experiences? Are you back to drumming without pain?

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gretschdrummer

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My first surgery last January was useless
Surgeon barely went into my elbow and wiggled the ulnar nerve around and closed up
My mistake for going to him
As my neighbor who is a retired ortho surgeon told me he was terrible

Btw I have it in both hands
Both pinkies are basically numb

Going for a revision operation next month

This guys a Washington university professor md PhD who spent an hour with me and actually laughed when he saw my scar saying what did this guy do cut you with. A Steak knife?

I’m going to have a transposition done
To help the funny bone nerve that is obviously being crushed somewhere

Hopefully I’ll have much better results

What’s your thoughts?
 

Burrish

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@gretschdrummer

Sorry to hear that your first surgeon was basically incompetent. I read for years that getting a surgeon who specializes in hand surgery and has done many ulnar procedures was massively important for this problem.

The two surgeons I used have great reputations and are renowned in their areas, so I was confident. My subcutaneous recovery, as mentioned, hasn't been great and my opinion on the whole thing is currently in flux.

Which transposition are you getting?
 

gretschdrummer

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Not sure

He’s being brutally honest with me in that predicting revision surgeries can be notoriously difficult

But he has had good results but he can’t promise

But he laid it on the line and I’ve opted to do it

One hand at a time

That candor I appreciated so my eyes are wide open going in and it’s not termed serious surgery so that’s a plus

He has to get in there with a long 12 inch incision to see where the compression is first then transpose it either of the 2 ways

Be careful in all surgeries
I should have done some research before

Avoid surgery “centers” per se
They are paid to do surgery’ you go there you will be cut on almost immediately
 

Burrish

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Glad you're working with what sounds like an honest physician.

It's interesting that you mention him talking about revision surgeries, as the doctor I saw yesterday said the exact same thing. He said that he felt my left arm (one that just had subcutaneous trans) still needed more time to heal before even considering further revision.

I'm having an MRI on my right arm, next week.

Good point about surgery centers. I'd much rather have a doc flat-out tell me he/she won't do a surgery if it's not absolutely necessary, which is actually what the doctor who did my decompression told me when I went to see if he'd do a transposition back around 2013.

12" incision.....wow. Huge scar, but he clearly wants to check every possible point of compression, which should certainly help with your peace of mind.

Look up Dr. Susan MacKinnon on youtube, as she appears to be an authority on ulnar nerve transposition/revision and you might be interested to see more of what they do in a revision.
 

gretschdrummer

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Glad you're working with what sounds like an honest physician.

It's interesting that you mention him talking about revision surgeries, as the doctor I saw yesterday said the exact same thing. He said that he felt my left arm (one that just had subcutaneous trans) still needed more time to heal before even considering further revision.

I'm having an MRI on my right arm, next week.

Good point about surgery centers. I'd much rather have a doc flat-out tell me he/she won't do a surgery if it's not absolutely necessary, which is actually what the doctor who did my decompression told me when I went to see if he'd do a transposition back around 2013.

12" incision.....wow. Huge scar, but he clearly wants to check every possible point of compression, which should certainly help with your peace of mind.

Look up Dr. Susan MacKinnon on youtube, as she appears to be an authority on ulnar nerve transposition/revision and you might be interested to see more of what they do in a revision.
Wow!! I met her at washu in St. Louis!!

She recommended dr Christopher dy here in st Luis

He did a fellowship under her training

She still practicing locally here
So I’m extremely confident going in!!
 

blikum

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I've had ulnar nerve transposition on both elbows. Basically tennis elbow, but in my case drummers elbow. I had the surgeries about 10 years apart. I recall it taking me 3 to 4 months before I was back up to full speed drumming. I did start back with the practice pad first then worked back up to the kit. And I had the surgery in the winter when I knew there were fewer or no gigs. This may not be the same surgery that you're looking into, but I think the rehab will be similar. But every body is different.
 

supershifter2

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I need both shoulder joints replaced. 2 ligaments in both shoulders are torn completely in 2. Bone spurs in both shoulder joints. All from heavy duty overhead commercial electrical work. I play with some pain and have some pain in daily activities. I might get my shoulders operated on, I havent decided yet. I also get numbness in both my wrist at times and the nerve doc says its from heavy lifting. I am not having my wrist operated on. About 2 months ago my flat right foot wobble and I tore the meniscus in my right knee. The doc said it can go without surgery. About an hour ago I got about a 3/4" long hair size splinter in my left bird finger from a wood gate. I dug it out. I have been in some kind of pain for the past 35 years and dont let it bother me. I will get my imbelical hernia repaired. If I can do without surgery I will. I have met many people over the years that had limb surgery that made them worse off. Mongos doctrine is if its stuck on your finger like a bugger and you can live with it then wear it.
 

Burrish

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Wow!! I met her at washu in St. Louis!!

She recommended dr Christopher dy here in st Luis

He did a fellowship under her training

She still practicing locally here
So I’m extremely confident going in!!
Ha haaa....good to hear that you're familiar and have essentially gotten her blessing! I looked up Dr. Dy and he appears to be quite solid....glad you got the referral!

I'm actually considering setting up a remote consult to get her opinion on my situation, though it obviously wouldn't be quite as effective since I wouldn't be there for an exam.

I look forward to hearing about how things go with your surgery! In the meantime, do nerve glides do anything for your pain? Outside of doing essentially no activity and time, I haven't really found effective temporary relief. NSAIDS really don't help with nerves, in my experience.
 

gretschdrummer

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I’m sure she can be done
She’s a professor here in St. Louis
And per se not in private practice

NSAIDs and glides do nothing for me

It comes and goes but mostly comes

Actually It might be to your advantage to come here directly and spend one night after consulting her

The way I look at it the revision surgery can only help it certainly can’t do any more harm
 

Burrish

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Actually It might be to your advantage to come here directly and spend one night after consulting her
I've thought about doing that, certainly. I'll first see what the MRI says next week and then come up with plans.

I'd be curious to know what your doc (Dy) thinks about subcutaneous vs submuscular. Are you seeing him again, pre-op?
 

gretschdrummer

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I've thought about doing that, certainly. I'll first see what the MRI says next week and then come up with plans.

I'd be curious to know what your doc (Dy) thinks about subcutaneous vs submuscular. Are you seeing him again, pre-op?
I've thought about doing that, certainly. I'll first see what the MRI says next week and then come up with plans.

I'd be curious to know what your doc (Dy) thinks about subcutaneous vs submuscular. Are you seeing him again, pre-op?
Yes
And he recommends this in all revision surgeries

 

gretschdrummer

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Yes
And he recommends this in all revision surgeries

Here’s another link

 

cdrummer

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I had issues with my hands/wrists years ago and stumbled upon an article in Modern Drummer on Active Release Techniques practitioners that work with musicians and athletes. It was life changing, and they brought me back to playing without any type of surgery, but rather through manually working with the tendons/ligaments/muscles along the entire connected chain (a lot of hand problems actually start in tense shoulders).

It can be painful, but it's well worth it, and with the exercises they teach you, you can keep it from happening again if you're diligent about it.
 


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