Bigger surgery or smaller?

March 1, 2011 6:14 AM

Followup to this and this: I need surgery on my elbow to move the ulnar nerve, which is getting trapped by heterotopic ossification (extra bone inside the elbow arising from an old fracture.) Here's the wrinkle: there are two different surgeries I could have, and I have to choose which one I want -- today.

Surgery 1 is an ulnar nerve transposition -- it takes about an hour and sounds pretty routine.

Surgery 2 involves going into the elbow from a different direction and removing a bigger chunk of the HO, which is blocking movement of the arm; this would allow me to rotate my forearm enough to turn my left palm up, which I haven't been able to do for the last six years. But this is a 2-hour surgery, less routine, bigger incision, and a small risk of damage to the nerves serving the other part of the hand, which are currently doing OK. There's also some chance that the HO will recur.

My instinct is to choose option 1; I've lived six years with limited forearm rotation in my non-dominant arm and it just doesn't bother me that much. But I worry that I'm being foolish by not improving my range of motion, given that I have to go through surgery anyway.

Short version: get only the surgery I definitively need, or a more ambitious surgery that could improve a long-standing loss of function that I've gotten used to?

posted by escabeche to Health & Fitness (4 answers total)

You sound like you are leaning toward the less invasive procedure; they both sound like reasonable choices from what you have said. One question I would ask the surgeon is if you could go back and have the second surgery if you are unhappy with the results of the first.
posted by TedW at 6:35 AM on March 1, 2011

This is second hand information but my sister's husband had a terrible car accident a couple of years ago and the forearm bones were crushed at the elbow. This resulted in nerve damage to his palm and hand. Botched surgeries since then have resulted in constant ongoing issues. My instinct is to suggest you take the risk averse option available to you. See how that goes, first.
posted by infini at 6:35 AM on March 1, 2011

A lot of it comes down to how much you trust your orthopedic surgeon. If not completely, get a second opinion; that should help narrow down exactly how much risk there is in the second surgery.
posted by The Michael The at 7:10 AM on March 1, 2011

Conclusion: I had the smaller surgery. So far not much improvement in the nerve, but based on the results of the EMG the surgeon told me to expect to wait 12-18 months for full recovery.
posted by escabeche at 6:19 PM on June 26, 2011