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Hello I Have Attached A Report Regarding My Arm Which

Posted on Sun, 21 Oct 2018

Question: Hello I have attached a report regarding my arm which had a decompression done of the ulnar nerve 6 months ago and a AIN nerve transfer In the forearm to the Ulnar nerve. I still have a enlarged ulnar nerve at the elbow region and I'm not sure If this will stop or prevent any recovery due to it being swallon but it isn't impinged or compressed. The anastomosis also can't be seen clearly on the film so I don't know if that is intact and also that part of the nerve is swallon aswell. Why are these two area s swallon and will this hault axon recovery? As six months i am now with no improvement at all

Answered by Dr. Dr. Praveen Tayal (1 hour later)

Brief Answer:
These can halt the axon recovery.

Detailed Answer:
Hello,
Thanks for posting your query.
I have gone through your query and understand your health concerns ,
I have seen the attached report. The enlargement of the nerve at the elbow region can be due to an inflammation or fibrosis. The inability to differentiate the nerve in this area suggests a nerve damage.
The swelling in the nerve at the area of right wrist can be due to fibrosis caused by the surgery itself. The anterior interosseous nerve was not seen separately. It is difficult to comment whether the anastomosis is intact or not.
The thickening of nerve and change in the appearance can hinder the normal growth of axon sheath and normal nerve conduction.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Wishing you good health.
Regards.
Dr. Praveen Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (2 hours later)

Yes Dr But I didn't have any nerve pain before or after the surgery and I don't have any nerve pain now either is this a bad thing? What can cause this nerve to be swelling now is that due to my tricep that makes the nerve unstable? Will this mean my nerve will have to be transposed? How can swelling alter the axons? I thought only if it was compressed it can? I'm scared that the ain nerve transfer still hasn't worked 6months later and that the ulnar nerve is swollen at the wrist aswell.

Answered by Dr. Dr. Praveen Tayal (10 hours later)

Brief Answer:
Details below.

Detailed Answer:
Hello,
Thanks for writing again.
A nerve pain or sensations like pins and needles or burning sensations are suggestive of a nerve regeneration. Not having any sensation till date suggests that the nerve has not healed. The swelling of the nerve can be due to surrounding muscle tissue, an inflammation or fibrosis.
Ultrasound does not show the molecular level details. We cannot detect for sure the cause of swelling until a biopsy of the area is done but that can cause further damage to the tissue.
The swelling is an abnormality and interferes with normal nerve growth and function.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (8 hours later)

So nerve pain doesn't indicate nerve healing? As I have read many I people have had nerve pain during this. How does the swallon nerve interfear with the axon growth? I thought that only if the nerve was compressed or crushed or cut that Would interfear with the axon growth. So what options do I have left? They won't do a nerve biopsy in the country of Australia. Shouldn't the nerve transfer of the AIN nerve to the Ulnar motor nerve started to work now? as it has been six months.

Answered by Dr. Dr. Praveen Tayal (3 hours later)

Brief Answer:
Nerve pain indicates a nerve healing.

Detailed Answer:
Nerve pain does indicate a nerve healing. A swollen nerve indicates an abnormality that can be related to a nerve damage or inflammation in the area and can cause difficulty in healing and reconnection. The nerve transfer should have started to work by now. The inability to feel any sensations in the area suggests that the nerve transfer has not worked for you.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (4 minutes later)

Yes Dr I have had no nerve pain at all this whole time since the surgery there has been nothing. What is causing the swelling as I was decompressd in the elbow so my nerve would it need to be transposed? Why hasn't the nerve transfer worked? I've read that there is normally good results with a a AIN nerve transfer. Did that anastomosis fail or come loose and is that possible?

Answered by Dr. Dr. Praveen Tayal (1 hour later)

Brief Answer:
Late nerve transfer decreases the chances of success.

Detailed Answer:
The success of a nerve transfer depends on how soon after the injury or compression the nerve was transferred. It also depends on the blood supply of the nerve. The chances of loose anastomosis or inaccurate anastomosis is very rare. Since the nerve has not responded for last six months, the chances of success with transposition now are also very less.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (16 minutes later)

No Dr The nerve transfer of the AIN nerve to the Ulnar nerve was done on the same day my decompression was done at the elbow. The decompression and transfer were exactly two month's from the initial onset of numbnes and of course within a few weeks my hand lost muscle and strength. I got to surgery as quickly as it was possible as I had to be evaluated first which can take a few weeks. Shouldn't the nerve transfer started to have taken effect? as it was done 10cm from the hand in the forearm. My surgeon said it was done tension free but I moved my hand and fingers back and forth the first week can this damage the anastomosis? Also my surgeon said he wouldn't transpose my nerve at the elbow if he didn't have to so only a decompression was done. Now that I know there is swelling of the ulnar nerve will that mean I will have to get the same nerve transposed?

Answered by Dr. Dr. Praveen Tayal (11 hours later)

Brief Answer:
Details below.

Detailed Answer:
If the nerve transfer and and decompression was done on the same day then the nerve transfer should have shown the effect by now. Moving the fingers back and forth are not likely to affect the anastomosis.
The swelling does not suggest that the nerve is disconnected. Whether it needs a transposition or not can be decided only by a neurologist after a proper examination.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (8 hours later)

The coaptation site was 10cm from the wrist even with the rule of 1mm a day something different should of started to happen by now. The anastomosis site was where the ain meets the pronator quadatrus, could making a fist break the anastomosis? as I made a fist the first couple weeks as I was told to move all fingers into that position of the hand. I'm worried that I did break it but it couldn't have broken. There is no neuromas at the anastomosis as that would have shown on the ultrasound and there would be pain aswell. How would the Neurologist decide whether it needs that wouldn't a hand surgeon decide that? Originally I was told that during surgery they would check if it needed to be transposed or not so my surgeon chose not to but the tricep makes it unstable according to the Radiologist. Does the unstable nerve effect function? Would a nerve conduction studies show activity in the ulnar nerve at that region?

Answered by Dr. Dr. Praveen Tayal (37 minutes later)

Brief Answer:
Making a fist will not affect anastomosis.

Detailed Answer:
Simple movements of the hand like making a fist are not likely to affect the anastomosis. A neurologist can evaluate whether is functioning or not. A nerve conduction study can help in detecting the point upto which the nerve is functional. An unstable nerve can affect its function.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (10 minutes later)

OK this is good then in that aspect.. Would it be warranted to open my forearm up just to look at the anastomosis site? I'm not sure if that can be done. I will need this to be done to assess function as my nerve could be swollen due to post surgery still it's not identified and my arm can't be opened to look just at a nerve. What is generally expected times of nerve transfers to start working?

Answered by Dr. Dr. Praveen Tayal (1 hour later)

Brief Answer:
Details below.

Detailed Answer:
The surgery site is not opened just to look at the anastomosis site. Usually after a nerve transfer you can expect tingling or burning after a week or so. Gradually the nerve function returns to normal in 6 weeks.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (4 minutes later)

Why can't it be opened just to look as I believe six months with no results would warrant to be opened to look wouldnât it? I was not sure a nerve transfer would produce those effects in such short time. Is it possible that it working just I'm not noticing anything from a clinical aspect?

Answered by Dr. Dr. Praveen Tayal (12 hours later)

Brief Answer:
Repeat surgery is not a wise option.

Detailed Answer:
After a surgery there is fibrosis at the scar site and if reopened all the structures can be adhered together and can cause an extensive tissue damage. This can even further cause a nerve damage. If the nerve is normal or not that can be identified only after electric stimulation or biopsy. Taking a piece for biopsy will make the nerve shorter and will create tension in anastomosis. A repeat surgery can be done for research purposes but will not return your nerve function.
If the nerve starts working then a clinical improvement is always seen in next few days.
Regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Praveen Tayal (17 hours later)

Dr I have my latest nerve conduction studies and they have no improved. This nerve transfer should of started to work by now I don't know why it isn't. I'm considering to be opened up to see the nerve biopsy because something has gone wrong the nerve transfer should have shown some differences by now.?

Answered by Dr. Dr. Praveen Tayal (5 hours later)

Brief Answer:
There is no improvement since XXXXXXX

Detailed Answer:
I have seen the recent nerve conduction study results. They do not show any improvement since XXXXXXX There is severe neuropathy which is not likely to improve now after such a long time. Even the biopsy will also confirm the same findings. There is no benefit of going for an extra procedure without any clinical benefit.
Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. Praveen Tayal (22 hours later)

So even in months to come there will be no improvement at all when the original native axons reach my hand? I did loose all axons in the beginning due to motor damage of the nerve. There should still be time as I have read this takes many months to improve. XXXXXXX was one month after surgery. My surgeon will not opt for a biopsy as he said it's too invasive. Should I continue just to wait?

Answered by Dr. Dr. Praveen Tayal (4 hours later)

Brief Answer:
There is no other option.

Detailed Answer:
There is no other option except to wait for the improvement. In case the axons grow, it will show an improvement.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (8 hours later)

Yes that's all I can do as my surgeon said to me that my nerve was badly compressed in the beginning which was acute the onset and I deteriorated rapidly so the only option was to give me a AIN nerve transfer to ulnar nerve motor component end to side and wait for the native axons to reach my hand as he said the AIN nerve won't provide intristic function back it's just to keep the hand alive due to the fact that the muscle wastage it was too far wasted for the ain nerve to make my hand better. He said that nerves grow 1mm a day at best and some even slower so the AIN won't give me function back to my hand until the native axons regenerate to the hand. I asked my surgeon as could the anastomosis have come loose and he said that it was done tension free and wouldn't be physically possible unless someone had gone in and disconnected it. He said exploratory surgery is not useful as it will traumatise the nerve more and this will not be help ful just to visualise the anastomosis. He said this particular injury can take up to 18 month's to recover from and that I am not even half way given I'm 35 and a male he said nerves grow slow for males Would you agree with the hand Surgeon's statement to me?

Answered by Dr. Dr. Praveen Tayal (14 minutes later)

Brief Answer:
Your surgeon is correct.

Detailed Answer:
Your hand surgeon is correct in saying that the nerves are slow to grow and it might take a long time for the axons to grow. Due to trauma in very few cases the nerves do not regenerate also. But this is very difficult to detect the rate of growth prior to the surgery. An exploratory surgery is not advisable at all. Do not worry and just relax.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (1 hour later)

Yes my surgeon did say soon as the nerve was released it sprung out and had no visible damage to the outside only the inside as I had muscle wasting and sensory loss so I must wait the time it reaches my hand. I'll try to relax Dr but it is very hard as I am mentally suffering XXXXXXX due to not having this function of my dominant hand.

Answered by Dr. Dr. Praveen Tayal (13 hours later)

Brief Answer:
Do continue with exercises.

Detailed Answer:
i can understand your distress. But right now we can only wait. Meanwhile do continue with the exercises so as to maintain some tone of the atrophied muscles.
Regards.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar