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Why Don't I Still See A Difference Seven Weeks After Ulnar Nerve Transposition Surgery?

Posted on Tue, 20 Apr 2021

Question: Hello Dr I have had ulnar nerve transposition surgery and a right anterior interosseous nerve transfer to ulnar nerve end to side anastomosis, on my right arm. Now I am 7weeks post surgery and there still seems to be no difference. Recent nerve conduction studies show absolutely nothing on the right hand. How long is nerve timing estimated at? As I am desperately needed to have some function In the right hand.

Answered by Dr. Aashish Raghu (23 minutes later)

Brief Answer:
Nerve stimulation?

Detailed Answer:
Hi there

Thanks for the query

I have read your query and understood your problem.

After the surgery did you experience any tingling and numbness in the affected skin area?

Has any motor function returned?

Usually it takes upto 6 months to see effect.

You can discuss with the surgeon regarding nerve stimulation which can help in nerve regeneration.

If possible par upload your Discharge summary or MRI for a clearer picture before I can comment further in your recovery.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr.Aashish Raghu

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Aashish Raghu (2 hours later)

I feel the numbness and tingling the whole time even the burning sensations in the ulnar aspect of the hand. I only have very little motor function as the intristic muscle function of the hand is paralized and there is a constant clawing of the fourth and fifth fingers with muscle wasting. What is nerve stimulation and how is it beneficial? The discharge summary consists of the description of ulnar nerve transposition with submolecular position and an anterior interosseous nerve transfer to ulnar nerve end to side anastomosis in the right forearm. The MRI is only with a description of osteoarthritis and compression in the elbow. How long does the average anterior interosseous nerve transfer take to work and what is noticeable?

Answered by Dr. Aashish Raghu (1 hour later)

Brief Answer:
Answers

Detailed Answer:
Some reports state TENS or Transcutaneous electrical nerve stimulation does help in speeding nerve regeneration and synapse formation. Do discuss this with a Neurologist for better insight.

All studies of patients with injuries similar to yours have seen recovery after 9-12 months. So you may expect the same. Sensory function will be noticeable first in the form of tingling numbness and then return of sensation followed by motor function because ulnar nerve contains more sensory fibres than motor fibres.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Aashish Raghu (1 hour later)

Ah yes I have heard of this as the electrodes are placed on the outside of the skin however no Neurologist has offered it to me. How does it actually speed the nerve regeneration up? Is this 9 month's for the nerve transfer to start working as I wasn't aware it was that long.

Answered by Dr. Aashish Raghu (5 minutes later)

Brief Answer:
Answer

Detailed Answer:
Nerve stimulation isn't mainstream therapy yet as it is still in the research phase in treating nerve repairs. It is postulated to speed up the formation of new nerve fibres and their connections to each other.

It usually takes 9-12 months to see good response after such surgery.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Aashish Raghu (35 minutes later)

Yes I understand more on that now however I've not heard of it in clinical practice only in physiotherapy practices. Why is it known as a supercharge end to side operation as 1 year is estimated for the original axons to reach the hand. So from the wrist to the hand is 9 month's?

Answered by Dr. Aashish Raghu (2 minutes later)

Brief Answer:
Answer

Detailed Answer:
I am not familiar with this term supercharge.

The distance is not too important rather the bulk of the nerve, the quality of the nerve ends, the content of the nerve, the timing of surgery ( a delay of six days after trauma can put you at a delay of 3 months following repair).

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Aashish Raghu (26 minutes later)

Supercharge is the name of the procedure of the anterior interosseous nerve transfer to ulnar nerve. I thought you would know this as you are a hand surgeon. This is suppose to reinnervate the intrinsic muscles of the hand before the native axons regenerate as I had a very bad compression and this is now my result. Is it possible to get the muscle back in the hand once the nerve signal reaches it?

Answered by Dr. Aashish Raghu (1 minute later)

Brief Answer:
Answer

Detailed Answer:
Yes I am familiar with this procedure.

Reinnervation of the muscles in the hand will depend on all the factors mentioned earlier and the delay in recovery as mentioned earlier. You'll will begin to see changes in 6 months.

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

Above answer was peer-reviewed by : Dr. Vaishalee Punj