Cubital Tunnel Syndrome

Elbows. I’ve always had a mixed relationship with them. As a child I was often told off because I had very pointy elbows for nudging people with! When I was 10 I fell off a horse and both fractured and dislocated my right elbow, leading to a diagnosis of arthritis just before my 18th birthday as a result of the injury. And now I have a new issue in both elbows, cubital tunnel syndrome.

I’ve actually been waiting since 2012 for this to be sorted out, long before my Cushing’s or clots. It started at night; I would get woken up with my ring and little fingers going numb and tingly. It wouldn’t happen every night but gradually it got more and more regular. I decided it needed investigating after it happened whilst I was walking home with shopping one day and my hand went numb. It would happen in both arms but the left was worse, surprisingly to me as my right is already so useless.

I think this was actually the first time I saw my amazing GP, Dr. Ishaque. She instantly suggested cubital tunnel syndrome and sent me off to have a nerve conduction test. This consists of electrodes being placed on your hand and various points of your arm and a machine passes a current between them to test if the signal through your nerves slows down at any point. It doesn’t hurt but it does feel very weird. I didn’t ever actually hear what my results were in 2012 and at the time, not having had any major medical issues, I just presumed that no news meant nothing was wrong so I didn’t chase it.

I should have chased it. The cubital tunnel syndrome got worse, particularly once Cushing’s set in. I would get woken up multiple times at night by both hands and after only five minutes of reading or using my phone I would get the tingling and my left hand began to get weak; so weak in fact that at the height of my Cushing’s I couldn’t even cut my own food up. I mentioned it again to the GP and had another nerve conduction test in 2019. I saw the same neurologist and I mentioned I’d never had the results of the previous test. She went to dig them out and it showed back in 2012 I had slowing of the nerve signal over both elbows, confirming cubital tunnel syndrome. The new test showed exactly the same thing unsurprisingly.

I had to get an MRI done on my neck as it was suspicious that it was in both elbows so it was a possibility that the ulnar nerves were in fact trapped higher up but no, I genuinely just have two dodgy elbows. The right one makes sense as the deformity from the arthritis is probably causing the entrapment, but we’re not sure why it has happened in the left one. Cubital tunnel syndrome is basically where your ulnar nerve is compressed at the elbow joint; if you knock your funny bone that’s actually the ulnar nerve and the cubital tunnel that causes that horrible feeling.

The actual surgery got delayed of course. That second conduction test was done in March 2019, with the neck MRI in July 2019. My Cushing’s pituitary surgery was in September 2019 and so of course I had my consultant appointment in November 2019 where they confirmed I needed surgery on my elbows. Having only had major surgery two months previously they obviously didn’t want to do it right away and nor did I so we put it on hold for 6 months. Unfortunately that meant it was May 2020 and smack in the middle of the covid pandemic. I had calls roughly every six months to check if I was going to go ahead with surgery; the one in summer 2020 made me laugh at how optimistic they were as they said the pandemic was almost under control so surgery should start up again soon. How wrong they were!

Surgery finally got the go ahead in September 2021. I got to go in and see the consultant face to face and confirm that I wanted to go ahead with it plus sign all the consent forms. I still had to wait though, partly due to them messing up with booking the surgery and also due to the ongoing staff shortages due to covid. The consultant had said he would make sure my pre-op was with an anaethetist due to needing to discuss bridging my blood thinners and also my need for steroid cover. My surgery date came through, 13th October with the pre-op and covid test on 10th October; with a nurse. She was very good and hunted down the only anaethetist who was still in that day but they had to cancel it there and then in order to discuss me at the next meeting. Sadly this didn’t happen the following day as they’d said it would so I had another booked and cancelled date of 7th November, a Sunday as they were trying to rush through the backlog. Someone clearly kept looking at my notes and seeing cubital tunnel decompression and booking it as an ‘easy’ surgery without looking further into the notes.

I suffered a total of five cancellations; Saturday 4th December due to staff all being put into ICU to cope with an influx of covid patients, 4th January due to ‘staff shortages’ which I can only assume was due to covid and 20th January, also due to moving staff to work in ICU. Each time I got my hopes up as the numbness, pain and weakness was getting worse, and each time I felt defeated. I began to dread hearing my phone ring, expecting it to be another disappointment.

Finally this date came through, 3rd Febuary 2022. I didn’t tell anyone except my boyfriend, parents and manager to avoid jinxing it. I held my breath every time the phone rang, dreading a cancellation. The hospital scared me when they called on 29th January to check nothing had changed since my second pre-op I’d had done in December. I went in for my covid test on 31st January and worried myself sick that I’d somehow have caught it but finally the day came.

The last time I had surgery here was in the old part of the hospital to relieve some of my arthritis symptoms. This time it was in the new area and it’s much improved. I had to be there for 7am then we had a choice of waiting rooms; the quiet one near reception and the TV room behind reception. I chose the TV room for some extra entertainment and spent the morning switching between paying attention to the TV and reading my book.

Around 8.00 the nurses started taking some people for their blood pressure checks and I started worrying this meant I was near the end of the list. Oddly however I ended up seeing my consultant and anaethetist before the nurses, at around 8.30. The consultant (Mr. Li) was very good and answered all my questions regarding steroid cover then got the anaethetist to double check them with me (50mg IV during the operation, double dose for a day after then should be fine). I did worry when the anaethetist came over and said “I knew I had seven today but your name isn’t on here, let me write it in.” I started thinking I’d been forgotten and that if any of the earlier operations went wrong it would be mine that got cancelled. I had the big arrow drawn to indicate where they were operating then back to sitting around waiting. I think the nurse (Jamie) came for me around 10.00 to check blood pressure and then I got the good news that due to the steroid dependancy I’d been bumped up to third on the list. Not long after 11.00 I was taken to get changed into my gown and compression stockings, another final check with the nurse and then a male nurse, Sam, took me straight down to theatre eight where he stayed to chat with me and keep me from worrying.

The surgical team were all fantastic, chatty and cheerful. I had a student in there called Nono, who looked rather fed up with the anaethetist’s jokes of saying “This is my student, Nono” and expecting her to reply with “Yesyes”. They were all asking how I felt and asked about my pituitary surgery as well once I mentioned that. Due to operating on my left arm all the monitoring had to go on my right arm, including the cannula for the anaesthetic and steroids which meant the poor vein the A&E doctor destroyed in 2019 had to bear the brunt of it. Luckily it co-operated, albeit with a protest and before I knew it I was drifting off to sleep.

Steroids during an operation are amazing. I was in theatre for around an hour and a half, only half an hour less than my pituitary surgery, and yet I woke up so quickly. I came round in recovery at 12.45 with Shirley and (I think Mary?) as my nurses to look after me and within fifteen minutes felt completely wide awake and alert. I remember being confused as I came out of it as usual, mainly due to dreaming about Ultima Online and therefore expecting to wake up in my own bed. Pulse and blood pressure were fine so off to ward 20 for recovery.

In ward 20 I had two lovely nurses, Pauline and Laura. They were surprised that just twenty minutes after surgery I wanted to get up for a wee! I was very careful about it and was luckily next to the toilet so that helped speed up my recovery and discharge. They brought me a cheese sandwich and kept checking my obs over the next couple of hours. There was one lady already in there dressed and ready to leave and another lady looking rather nauseous. This poor lady had been in for something on her throat which won’t have helped how she felt and I had to keep telling her not to feel bad that she felt so rough as the only reason I was so lively was that I was pumped up on steroids! A couple of others came in after me; one a bit more perky and the other still very sleepy. While they were brought in I was allowed to get up and get dressed which I was surprised I managed to do by putting my left arm into the sleeve first. Everything else was manageable one-handed.

A very chunky bandage

By 15.00 I was allowed to go home so my boyfriend turned up with my wheelchair; we only live ten minutes walk away so we planned for him to just wheel me home rather than get a taxi. I was feeling so good I ended up walking it though. I was given some strong cocodamol in case the pain got too bad; luckily I’ve avoided needing that as I hate the stuff and have managed on paracetemol. I was signed off work for six weeks. I can’t do much with my arm of course; anything that puts pressure on it is painful so the most I can do is steady a slice of bread whilst buttering it with the right. I have been managing to touch type but can only do small amounts in one go and one night I ‘lightly’ knocked it against my chair, causing some angry exclamations! The bandage came off after 48 hours so then I just had a large, sticky pad over the incision which looks to be about 3-4 inches long.

Stitches at 2 weeks, this should have been much more healed by now

Cushing’s struck again though. I still heal slowly despite being low in cortisol now so of course when I went for my stitches to be removed at the 14 day mark the cut wasn’t healing at all. The nurse started to remove the stitches at one end, took maybe 2 out and just said nope, not happy to do it. That led to a whole new carry on at 21 days when I went to urgent care for them to be removed, as my GP nurse was on holiday. The urgent care nurse wasn’t happy she’d left the stitches in and said she should have removed them, then put steristrips over them. She was also not very happy as instead of multiple single stitches, the surgeon had done one continuous piece of thread right up the incision. This led to a very uncomfortable, slightly painful process as she had to loosen each stitch from where it had started to heal in, then pull the entire piece of thread through. She didn’t want to cut it in case she lost a piece. The middle still wasn’t fully healed either so I ended up with 20 steristrips over it. A week later however they came off just fine.

Tons of steristrips at the 3 week mark

As of writing this post I’m at the 11 week mark. I haven’t had a follow up yet and won’t for another week. I was due one at 7 weeks but I managed to get covid just the day before so I had to rebook. The arm is feeling a lot better overall though and I’m very happy with it. I’ve had it go numb less than 10 times in these 11 weeks, where previously it would be numb multiple times a day and wake me up as well. I do get a sort of tight, pulling feeling sometimes on the upper part of it so when I see the surgeon I will be asking about physio as that was mentioned before the surgery. I’m also keen to get the other elbow done sooner rather than later now; it’s more likely to be successful if it hasn’t deteriorated too much to start with. The scar is flattening out though I have a lump at one end and also halfway down it where the stitching was not done very well and the skin got puckered up. It has flattened from what it was so I’m hoping it will flatten out entirely at some point. I don’t mind looks-wise but it can catch from time to time. There’s also a slightly numb patch on the outside of the arm which I believe is quite normal since the nerve has been messed about with and irritated. It’s not completely without feeling but any pressure there is definitely deadened. I only notice that if I push on it with my other hand though.

Healing nicely at 4 weeks post op

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