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Anyone have experience with this? This is essentially the ulnar nerve jumping in and out of its track in the elbow when throwing/flexing the arm. My 15-yr old son (pitcher/outfielder) is having difficulty with this. Shut down throwing a couple of weeks ago and met with orthopedic doctor last week. Will meet with him again after MRI later this week but just trying to do my homework. Anyone dealt with this problem?? Thanks!
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The nerve does lie on a groove and the slipping back and forth causes irritation and eventually can result in nerve damage. Repetitive motion in pitching doesn't help. There may be bone spurs there as well.

However, the problem may actually begin at the cervical or shoulder area, so make sure that a full examination is made to determine the exact cause. An MRI is done to check that the ulnar nerve is intact. And note, this is more common in patients aged 35-55 or those heavily involved in sports. Do not let any doctor tell you that surgery is necessary at age 15 (which would be ulnar transpositon), there are other steps to be taken first, which might include splinting, steroid injections or occupational therapy.

If discomfort is occuring while pitching, you might have to make sure he is pronating rather than supinating his pitches. In other words try to define why it is happening before you take a bold step.
I had an ulnar nerve transposition about 2 months ago...not sure if its the same thing. The reason I had to have it is because 2 days after putting a screw in my elbow, it irritated the nerve so much that half of my hand was numb. Now, 2 months after surgery, there is still a lot of numbness, however, it is said to go away in about 3-4 more months.
Originally posted by spartans2b:
I had an ulnar nerve transposition about 2 months ago...not sure if its the same thing. The reason I had to have it is because 2 days after putting a screw in my elbow, it irritated the nerve so much that half of my hand was numb. Now, 2 months after surgery, there is still a lot of numbness, however, it is said to go away in about 3-4 more months.

That's why they do transposition, to avoid nerve damage, which could bring about serious unreversible damage later on (numbness in hands besidesa the pain).
Not going to argue with you, my understanding is that one of those ulnar nerve bands (exterior I am sure) is repositioned during surgery. This is now common procedure for TJ patients. I don't know the specifics, but it's done so that the same site does not have to be opened again if cubital tunnel syndrome presents itself. Or if the nerve becomes aggravated from sliding back and forth over the groove and has to be replaced.

My son just recently had ulnar nerve transposition. In consult with Doc Altchek before surgery (as well as his team's doctor) about the nerve's (that band) new position, it was indicated that this is also done during TJS. If that is wrong, well I guess that Redsox8191's son's doc was wrong as well.

Had to do this over again as to try to explain myself better, something I am willing to do, while others don't think that they have to.
Last edited by TPM
You original post stated categorically that the ulnar nerve is flat out "rerouted" in all Tommy John surgeries. That is incorrect. It is rerouted in ulnar nerve impingement situations as discussed in an earlier post, and in SOME TJ surgeries, but generally only if there is evidence of ulnar nerve impingement. It is not done as a matter of course in all TJ surgeries. The philosophy that most surgeons have now is to keep the surgery as minimally invasive as possible. That's why some guys like Kremchek leave the original UCL in place if it is only partially torn.

There may have been a time when the nerve was always relocated, but not anymore. No need to risk additional scar tissue by cutting anymore than you have to. It "sounds" like your son required both UCL replacement and nerve relocation, but I have no way of knowing that. The same appears to be true of redsox8191's son. No one said that any doctor was wrong about anything. In fact I am sure that both surgeries were medically necessary. But just because they did the additional procedure of rerouting the nerve on your son and redsox8191's does not mean they do it on every patient.

The nerve does have to be moved aside for the surgery. That is not a new development. That has been the case since day one. No other way to get to the ligament. And the nerve can be damaged if the doctor is not careful. (In some cases it's probably unavoidable). TOmmy JOhn himself had significant nerve damage from the surgery. But moving the nerve aside to get to the ligament is totally different from rerouting it into another channel.

The original post was unclear. I think it is now, unless someone else corrects us both.
Originally posted by 20dad:
my son had tj in 06. his nerve was moved for the surgery but not rerouted. this is the reason for a bit of numbness in the ring and pinky finger.

i'm sure every day brings forth new tweaks to these surgery's.

This is my understanding why the nerve is rerouted away from the groove in the elbow where it normally sits. This is also why ML players who had older TJS are having nerve transposition, to correct tingling and numbness amd elbow pain, caused by the ulnar nerve.

Son did not have ulnar ligament (TJS) replacement, where did I mention that? I said he had nerve transposition, as he had the beginning of cubital tunnel syndrome. Yes, the nerve can be damaged, so make sure you know whose moving your nerve. But this is a relatively simple procedure and new procedure in arthoscopic surgery.

I will say it again, asked doc if the repositioning of that nerve was safe, two docs told him it's done in all of their TJS, to avoid issues later on (see above post by 20dad whose son had TJS).

Just don't say I am wrong because you feel you need to embarrass me, that link was back in 2009, bet there's been more advances since then.
Last edited by TPM
I can tell you that Dr OH at Mass General who learned under Dr Andrews (and still works with Dr Andrews on studies) said that in the east MOST doctors (those trained under Dr Andrews) will automatically re-route the ulnar nerve so that there are not complications down the road. They figure that while they are in there they might as well re-route it as too many times they have needed to go back in and re-route it down the road after the surgery. He did say that out west this is not the case as Dr Yocum (I think he is the west coast TJ expert) does not believe in re-routing the nerve unless there has been an issue. But Dr Andrews and his followers have found that too many needed the nerve re-routing after TJ not to be proactive and do it at the time of the TJ surgery. I can say that in my son's situation they would have done the re-routing during surgery anyways as his nerve was catching and popping out of the groove. But Dr OH did make it a point to say that he would have re-routed it anyways (an issue now or not) as he does this standard with all of his TJ surgeries.

So it appears to be a west vs east type of thing depending on who the surgeon studied under be it Andrews or Yocum.

So it is not 100% cut and dry as it depends on the surgeon and who's style of TJ surgery he follows.

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