Post op complications, ulnar nerve compression, surgeon doesn't know, help please!

[cheyriver]

Here is some background. Sorry this is so long..

I had surgery for ulnar nerve compression, left elbow, on May 1st. This is my third surgery for this problem. First surgery- decompression. Second surgery- medial epicondylectomy ( I think the small bone in this area was removed or shaved down?) and third surgery decompression.

My other surgeon retired so I am going to a plastic surgeon (not a hand surgeon) that is new graduate, 11 months experience. I've gone through two surgeries with this new surgeon.

The surgeon used dissolvable stitches.

The surgeon discovered that the nerve close to the funny bone area was curled or kinked, lot's of scar tissue. I'm not sure exactly what was done but from what I understand decompression.

Since surgery I've experienced many problems with excessive swelling. The swelling wasn't disappearing even though I raised my arm, iced the area etc. After 5 days it became bad along with pain and fingers were tingling. I headed to the ER. They figured the surgery dressing was on way too tight, there was some bleeding, and they reapplied another lighter bandage.

I did see the surgeon a few days later for my first follow up and she heard what happened and said similar. The nurse took off the bandages I noticed around the funny bone area, part of the incision area was bumpy or raised and a small gap that was bleeding. I figured maybe this was normal, nothing to worry about. They reapplied a small gauze pad over the incision.

By the next day my swelling was increasing again. I raised it up on pillows, iced the area. This went on for another four days. My arm, hand, fingers were purple-pink color. Fingers were tingling.

I had an appt with my family doctor for something else and he saw my arm and took off the dressing. It was full of blood. The incision was bleeding in about four spots. They looked like small gaps, sores. The rest of the incision was reddish looking but he didn't think it was an infection, almost bloody thin line along the incision. He cleaned it and applied another dressing. Family doctor said he had no idea but he would contact the surgeons office to get me in sooner.

The swelling is about double the size of my normal hand.

So today I saw the surgeon. She seemed quite angry that I was wearing a dressing and asked me why. I explained to her the above and was told she never heard directly from my doctor. She took off the dressing, it was bloody and still oozing. She said I don't understand this! You had surgery two weeks ago. I used dissolvable stitches. I've never seen this or had this happen with a patient before.

She asked if I had been bending my arm too high etc. I told her no that I followed your directions and only bend it slightly. I'm careful with it.

Basically I was told "I don't know and I'm not worried." And next I was told to phone her if I have any more bleeding or swelling.

My question...

Is it possible for excessive swelling to disrupt the incision or cause problems that I am experiencing? Or possibly something else? My hand, fingers and elbow are still swollen.

I did have the small gap in the incision near the funny bone area 5 days after surgery that was bleeding at the time. Since then four more areas have opened up along the incision line.

I also had an MRI that was scheduled by my family doctor previous to surgery to rule out neck or back problems in case that was causing any of my symptoms. It came back clear, no problems. Then I had surgery on my elbow, turned out nerve was curling up.

I'm healthy otherwise. I don't have diabetes, heart problems or any other disease.

Thank you for your help!

Shelley

[Nana4&cntn]

Shelly,

I think your films should be sent to an Orthpaedic Surgeon, and an appt made for you. The reason I say this is most GP's have very little experience with the sublities(sp) of reading a neck and spine MRI.

As far as the surgical site on your elbow, it sounds as though the incision is opening up on it's own. I think I would get a second opinion. You are at risk for a major infection. There is a possibility that if it opening, it will have to heal fron the inside out. I can'e even imagine the amout of pain you are in. I think your surgeon has a very cavilier attitude regarding your recovery! Have you checked to see if you have a fever? You may also want to submerge your entire are in icy water. I would use bottled water. Or possibly pour alcohol or hydrogen peroxide over the incision. The HP would be better as it will identify germs or infection.

I really would get to another surgeon with your records, swelling that lasts as long as yours has is not a good thing! You need someone who is not biased like your surgeon is. Your healing or lack ther of is NOT normal.

I don't mean to alarm you, but it has been 16 days since your surgery.

Take care and keep in touch,
Kathy

[cheyriver]

Thank you Kathy for your help!

I forgot to add in regards to the MRI.. there was some specialist who looked at the film and then sent a letter to the doctor with the results, numbers or whatever they use in MRI's. My GP read the letter and it indicated that there were no problems with my neck/spine, everything normal.

As for the incision, I noticed 5 days after surgery that small gap near the funny bone area( it wasn't wide open, pulled apart, but not deep) at my first follow up. I recall the surgeon saying oh bleeding a bit but no other comment made by her. First follow up was 5-6 days after surgery.

She said today you had surgery two weeks ago, shouldn't be bleeding!

I recall her writing in her file.. no infection.

I recall something else today. When the dressing was removed, I noticed on the gauze pad some yellowish stains. I am wondering if that is pus. Also there was old blood and fresh blood. I looked at the incision and didn't notice pus. Unless the yellow stain was some other fluid?

I don't have a fever. I've checked several times off and on.

The openings are not gaping wide. There small but open. Open enough to bleed.

I will apply some HP on it. Earlier in the week I washed it with mild soap and cool water.

To seek a second opinion from another surgeon.. it will take 8 months to a year for an appointment. I live in Canada and we have long waits to see specialists.

I agree about the surgeon and her attitude.

[Nana4&cntn]

Shelly,

The yellowish drainage is a normal thing, I have had it after each of my back surgeries. If it does continue, don't hesitate to go back, especially if you get a fever.

I am so sorry about your health system, we are fighting against the type of coverage you have. I think the waits are just rediculous! The same with England and Australia. A person could die before getting into see someone! I am sorry for the tangent, I just think it is wrong, there needs to be a better way to treat people!

Take care, I hope you heal soon!
Kathy

[cheyriver]

Thanks Kathy!

I didn't realize that about the yellow drainage, thanks for letting me know.

The only time you get in to see a specialist/surgeon fast is when your issue is urgent or an emergency.

The wait times are horrendous if non urgent.

I'm still quite swollen and if it continues I will have to phone the surgeon.

The incision openings are not really deep or wide. Just strange because I never experienced this before with past surgeries.

My neighbour is a nurse and she's heard of something called wound dehiscence. Apparently sometimes surgical wounds can open up. Not sure the cause or if this is my problem. I guess I could check it out.

[Nana4&cntn]

Shelly,

Have you googled dehiscence? From the things you have described you have many of the symotoms! One of the things stated was previous scar tissue, have you had surgery in the same site? Check it out!

Take care,
Kathy

[cheyriver]

Shelly,

Have you googled dehiscence? From the things you have described you have many of the symotoms! One of the things stated was previous scar tissue, have you had surgery in the same site? Check it out!

Take care,
Kathy


I looked at one website about dehiscence but didn't say much. I will have to google this to find more information.

Yes I've had surgery in the same site. I've had three surgeries now in the same site. All of them for ulnar nerve compression/cubital tunnel syndrome.

[Nana4&cntn]

Shelly,

The reason I asked was one of the problems that can lead to dehisence is scar tissue from previous surgeries at the same site. Check out the lonk below.

http://www.upmc.com/HealthManagement/ManagingYourHealth/HealthReference/Diseases/?chunkiid=99918

I hope this helps,
Kathy

[cheyriver]

Shelly,

The reason I asked was one of the problems that can lead to dehisence is scar tissue from previous surgeries at the same site. Check out the lonk below.

http://www.upmc.com/HealthManagement/ManagingYourHealth/HealthReference/Diseases/?chunkiid=99918

I hope this helps,
Kathy

Thanks for the link Kathy :)

It does sound similar to the problem I am experiencing.

My hand is still quite swollen. My fingers feel a bit stiff although I try to move them. I noticed now I have slight redness/bruising in the web area between thumb and finger which is new.

Within a few days if the swelling hasn't improved I will have to call the surgeon.

I haven't looked at the incision since my last appt with the surgeon but I will check it out soon to see how it is.

[Nana4&cntn]

Shelly,

You really need to take that bandage off and look at it then rebandage it. It really sounds as though it is infected! Call your surgeon tomorrow! Please:)

Kathy

[cheyriver]

I took the bandage off. There is still bleeding from 4-5 five small areas. I don't think its infected. The rest of the incision line is reddish but more bloody looking but not leaking.

Hand is still swollen.

I tried phoning the surgeon. It's a holiday here and nobody answered at her office. I tried another number without luck.

Tomorrow I will call. Hopefully she will talk to me or see me without any trouble.

[cheyriver]

I phoned today and her office arranged for me to come in. She mentioned she is not worried about the bleeding. When the bandage was removed today my incision was still leaking blood.?? Swelling is normal after surgery for awhile but the excessive swelling I have is not. I will be going for an ultrasound in the next few days because she is concerned about a blood clot. Other than that no other ideas, causes were mentioned. I suppose if the ultrasound comes back normal hopefully she will look into it more.

She reapplied a gauze pad and a tensor bandage to keep the swelling down. I have to keep my arm elevated (which I have been doing for a few weeks now)

I'm suppose to see her near the end of May for a follow up but if there are any more concerns to call her.

[Nana4&cntn]

Shelly,

I don't get it, why couldn't do the ultrasound today? I am praying the swelling goes down soon. I know how uncomfortable it is. I am very happy to have the healthcare we do here. They were pushing for Nationalized Health care here and most folks were against it. We have private and subsidized here.

I really wish things could be different for you there.

Take care and keep me posted,
Kathy

[cheyriver]

Shelly,

I don't get it, why couldn't do the ultrasound today? I am praying the swelling goes down soon. I know how uncomfortable it is. I am very happy to have the healthcare we do here. They were pushing for Nationalized Health care here and most folks were against it. We have private and subsidized here.

I really wish things could be different for you there.

Take care and keep me posted,
Kathy


I find it strange in regards to the ultrasound. The surgeon marked the form as urgent. The secretary was sending the form by fax said hopefully you will get in late this afternoon or evening and someone will call you. If not by tomorrow I should have the test. I tried phoning the ultrasound clinic later but nobody answered.I haven't received a call so I will be phoning in the morning.

Free healthcare is one thing but the wait times to see specialists/surgeons and even waiting for certain tests are crazy if it's not an emergency.

Thanks, I will keep you updated. :)

[cheyriver]

Update..

I had my ultrasound yesterday. According to the technician and radiologists it came back normal, no blood clots.

I still have swelling and hoping it goes away soon. I am glad there is no blood clot but if I continue to have problems I hope the surgeon will look into it.

One thing I have noticed.. with ulnar nerve compression it can or does affect the ring and pinky finger such as numbness, tingling etc which I had. I have also had many injuries to these fingers which cause them not to bend all the way to the palm of my hand. These fingers always stay in a slightly bent position.The past few days they are bending a bit more. I am guessing maybe the swelling is causing this.

[Nana4&cntn]

Shelly,

I hope things are doing well for you, and the swelling is gone and your hand is healing.

Take care,
Kathy

[cheyriver]

Update..

I did see the surgeon this past friday. The nurse took the gauze off and I am still bleeding from 4-5 small areas. The surgeon said it's 'strange' that I am bleeding this long afterwards. No concrete answers as to why but was told maybe I had a reaction to the dissolvable stitches underneath the skin. That is all I was told. I'm suppose to go back in a month for another follow up.

I'm still swollen and bleeding. I just hope this goes away soon because I'm tired of it. I never experienced this before with my other elbow surgeries.

[cheyriver]

Update..

My incision is still bleeding! I have been to the surgeon for 4-5 follow ups and the only answer I receive at each appointment is "I don't know."

In order to see another surgeon I need a referral from a family doctor.

So today I did see my fd and said that the surgeon doesn't seem to know, each appt the answer is I don't know. I'm not saying he's a bad surgeon. I realize doctors have bad days but but I feel uncomfortable with this surgeon, bedside manners etc.

My family doctor said he knows most of the plastic surgeons, they are a close knit grouup, understaffed and tend to be hyper. The surgeon you see is good, go back to your next follow up in a few weeks time. See what is said. See me a week later and [U]maybe [U I will send you to another surgeon.

I don't have an infection as in no pus, fever. The small sores/gaps look ulcer like, ooze blood and look inflammed. The openings feel irritated, burn. I keep it clean, apply antibiotic cream, gauze pad.

The only other option I have is to head to the emergency ward where other surgeons work and get referred that way. I hate to waste time at the ER when someone else may need it more than me.

[Nana4&cntn]

Shelly,

I know what a pain the ER is, but you should probably go. Are you in the US? The reason I ask is most ins policies now don't require a GP referral. If you are in the states or abroad if you have gaps, swelling and bleeding I don't know how much a plastic surgeon can do. Maybe a general or neurosurgeon would be better. I don't mean to be a downer, but you current surgeon just isn't showing much interest!

Please take care, I am keeping you in my thoughts and prayers,
Kathy

[cheyriver]

Shelly,

I know what a pain the ER is, but you should probably go. Are you in the US? The reason I ask is most ins policies now don't require a GP referral. If you are in the states or abroad if you have gaps, swelling and bleeding I don't know how much a plastic surgeon can do. Maybe a general or neurosurgeon would be better. I don't mean to be a downer, but you current surgeon just isn't showing much interest!

Please take care, I am keeping you in my thoughts and prayers,
Kathy

Hi Kathy,

I live in Canada. Here we need a referral from a family doctor in order to see a specialist/surgeon. If its an emergency then the doctor would get you in faster.

True maybe a general or neurosurgeon needs to be consulted with. It's a plastic surgeon who did my operation.

I'm so frustrated because I feel the surgeon is not listening and my family doctor wants me to wait. I hope this bleeding stops before my next appointment.

I may have to go to the ER if it comes down to it. It's getting ridiculous.