Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.


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Old 02-20-2015, 03:51 AM #1
tos1234 tos1234 is offline
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Default Ulnar nerve transposition surgery after unsuccessful TOS decompression surgery?

Has anyone had ulnar nerve transposition surgery? I am seven months out from tos decompression surgery with Dr. Donahue but unfortunately doing worse after the surgery. I spoke with a hand surgeon (Dr. Susan McKinnon at WashU) and she said she could do an ulnar nerve transposition that could get my life back on track. The emg and nerve conduction studies at the elbow though were normal and two other hand surgeons have refused to operate. I don't want to do an unnecessary surgery but I am at the point where I have been so disabled by TOS that I can no longer work or carry my one year old son. I am considering a spinal cord stimulator because of the chronic pain. I would love to talk to anyone who has has the ulnar nerve transposition surgery to find out if it helped or not. Prior to surgery did you have abnormal nerve conduction or emg findings? Your advice and experiences are deeply appreciated!
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Old 02-20-2015, 06:33 AM #2
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What are your symptoms, and where is your pain located now?

Usually if it is the ulnar nerve causing the problem those tests would show that.
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Old 02-20-2015, 05:50 PM #3
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85 percent of my symptoms are ulnar neuropathy with Burning of the bilateral Elbows and pain and parathesias in the fourth and fifth fingers. I also have shoulder pain, index finger and thumb pain, and forearm pain but the ulnar symptoms are the worst by far.
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Old 02-20-2015, 11:31 PM #4
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Dr D. doesn't have any ideas on the cause?
Has anyone mentioned scar tissue? Some people just seem to produce more or aggressive scar tissue than average.

Are the sx steadily increasing as time goes by. or has it been about the same level the whole time since the surgery?

I had pretty bad ulnar sx for awhile early on from my RSI injury, but it resolved with being off work, expert PT , and resolving the muscle spasms & trigger points..

I wonder if you can try treating the shoulder pain, and have a knowledgeable PT person manually check for trigger points and spasms..

Do you know what caused your TOS? Nerve, Vascular or disputed?
Im guessing nerve as it usually has the more difficult recovery.
Unfortunately sometimes surgery doesn't help much..
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Old 02-22-2015, 06:42 PM #5
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Great question tos1234. I am really curious if anyone has had the ulnar nerve trasposition as well. I have had 2 tos surgeries without improvements in symptoms. I am now wondering about having this done as the majority of my symptoms are in the elbow and forearm. Did you have a positive Emg for the ulnar nerve.
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Old 02-22-2015, 09:58 PM #6
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Quote:
Originally Posted by tos1234 View Post
Has anyone had ulnar nerve transposition surgery? I am seven months out from tos decompression surgery with Dr. Donahue but unfortunately doing worse after the surgery. I spoke with a hand surgeon (Dr. Susan McKinnon at WashU) and she said she could do an ulnar nerve transposition that could get my life back on track. The emg and nerve conduction studies at the elbow though were normal and two other hand surgeons have refused to operate. I don't want to do an unnecessary surgery but I am at the point where I have been so disabled by TOS that I can no longer work or carry my one year old son. I am considering a spinal cord stimulator because of the chronic pain. I would love to talk to anyone who has has the ulnar nerve transposition surgery to find out if it helped or not. Prior to surgery did you have abnormal nerve conduction or emg findings? Your advice and experiences are deeply appreciated!
Hi there, mine is a long & complicated story!
I had Lt Ulnar nerve Decompression (not a transposition - where they move the nerve to the front). They just cut the muscle to make more room for nerve. I had a positive ncs/emg test in 2007 and had the surgery 6 mos later w a ortho. Hand surgeon. I seem to get slight relief in elbow but the numbness in forearm and last 2 fingers never went away. When I went back to surgeon still complaining of elbow pain she did another emg which was now normal.
What makes thing complicated is I had a herniated C5/6 disc on mri, which 3 surgeons said to have surgery and 2 said it wasn't bad enough so I had multiple Injjections & pt w no relief of neck, shoulder, upper back or arm, elbow, finger pain.n In 2011 when saw a neurologist, had new mri, he said I needed to see a surgeon. I went back to the 1st surgeon who said I have spinal cord compression & need a discectomy/ fushion ASAP, which I had 2 wks later. Didn't help any of my sx, except the locking up of my neck. The neurologist mentioned tos, so I found Dr Donahue, saw him in Oct 2011. He dx me Bilateral ntos Lt worse than Rt due to having extra C-ribs and severe narrowing of subclavien artery in costcoclavicular space & mild narrowing in scalene triangles. I had Lt. surgery in 3/1/2012. I saw the most improvement at the 2 yr mark postop w neck/shoulder/upper back pains but cont. to have elbow/fingerpain & numbness and developed CT, worse in Lt wrist, 6 mos. Postop. Dr D says I could have double crush (when u have compression up above its more easy to get pinched lower in arm).
I really think my CT and Ulnar N comp are a separate problem from the TOS, due to having an abnormal Ncs/Emgs in both arms (Median, Ulnar, Radial) last spring. Not related to repetitive work.
My advice to u is hold off doing any surgery til u have abnormal Ncs/Emg. Ease your pain by wearing elbow brace at nite, using Rx Lido. Cream, there's others and try neurotin if not already. Dont talk on phone or use computer to long!
I think 7 mos is way too soon to see if tos surgery helped. It took me 6 mos to just recover from surgery. Dr D says at least a yr, sometimes longer.
Hope this helps
Best Wishes
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Old 02-23-2015, 09:54 PM #7
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I have always felt there was a problem with my ulnar nerves. I had Lt sided TOS surgery with Dr. Pearl. I started getting excellent relief after pinning and stretching areas under and around my armpit. One day I started messing around with my triceps and found a ton of trigger points that took weeks to get rid of. I would raise my arm out in front of me and feel for sore areas. I squeezed them between my fingers and they would twitch like crazy. Every time I got rid of them, my scapula relaxed and my neck completely relaxed as if I didn't have TOS. This led me to believe that my triceps and ulnar nerve were central to my TOS.
Eventually I got rid of the TPs but they would return every couple of days (but less than before). I noticed that the TPs that came back the most were in the tricep muscle just above the elbow. After feeling around this area, it felt like there was scar tissue near the ulnar nerve ---- from the elbow, half way up the bicep. I knew it wasn't muscle tissue because it didn't flex when I flexed the bicep or tricep. One day I squeezed that stuff and eventually I felt it go "crunch, crunch, crunch". I did the same thing on the other side. Immediately, there were weird feelings all over my forearms and the forearm muscles twitched for 2 days. This resulted in good things and bad things --- my neck felt great, but my forearms felt strange and a little weak sometimes. Also, other TOS sx seemed to flare up a little bit. I have found a way to be gentler with the areas and this has resulted in excellent relief with few sides.

I remember reading a book a long time ago called "It's Not Carpal Tunnel Syndrome" by Suparna Dumany. At the end of the book, they guy reveals that the Terapist (Suparna) found areas near his elbow that she was able to "crunch" and he was mostly cured.

I am working on getting an MRI of the elbows to see if there is scar tissue. If so, I will see Dr. Brown at UCSD to see if he can do Neurolysis of the area (from near the elbow to half way up the bicep).

FYI -- my nerve tests were negative except for Dr. Machanic's in Denver. I think that an ulnar nerve transposition may not be as effective as it could be in our cases if there is scar tissue.

Please keep us posted.
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