Dear Dr. Roach: I had surgery three months ago to decompress my ulnar nerve. The entrapment was due to an injury from more than 30 years ago. There was extensive nerve damage and scar tissue. He also removed a neuroma and did a lot of scraping. I am still experiencing the burning/tingling/prickly sensation in my hand and soreness/aching where the neuroma was removed. I have tried ibuprofen and Tylenol, along with Curamin as a natural pain remedy, and a vitamin B complex. None of these has given me any relief. I am back to work, where I use a computer all day. I was told that the healing will take up to a year.
Do you have any recommendations for how to alleviate some of this discomfort?
Dear M.V.B.: Entrapment of the ulnar nerve in the elbow is called “cubital tunnel syndrome,” and it causes a range of symptoms, including pain, numbness and weakness in the hand and forearm. It is similar to carpal tunnel syndrome, where the median nerve is entrapped in the wrist; however, the symptoms in cubital tunnel are seen in the fourth and fifth (pinky) fingers, whereas in carpal tunnel syndrome, the pain is in the thumb to the fourth (ring) finger.
Surgery for carpal tunnel usually is successful; cubital tunnel surgery is much more difficult and, often, less successful.
The sensation you describe is that of nerve damage, also called “neuropathic pain.” There are many different causes of neuropathy, and specific treatments are available for only a few. Relieving pressure on an entrapped nerve is one specific treatment.
I have very little personal experience with this, having only once sent a patient for surgery. What I have read suggests about 53 percent of people experience improvement after surgery for it, and I agree that improvement may continue for 12 months or more. In the meantime, medications that work for neuropathic pain, such as gabapentin (Neurontin) or amitriptyline, may be helpful. Your surgeon, regular provider or a neurologist can help.
Dear Dr. Roach: Please help, as I am burned out on trying to get doctors to put proper thought into my son’s care. He has many disabilities and life-threatening conditions.
Does Pradaxa now have an antidote? As an older drug than the other NOACs, would you prefer it over Eliquis?
Dear G.G.: Dabigatran (Pradaxa) is an oral direct thrombin inhibitor, used for people at high risk for blood clotting, such as those who have had a serious deep vein clot or a pulmonary embolism — a blood clot that has moved to the lung. It is one of a few newer agents (often referred to as “novel oral anticoagulants,” or NOACs) that can be used in place of warfarin (Coumadin). The newer drugs have the advantages of dose reliability, a somewhat lower risk of bleeding (the study that showed this may have been flawed), freedom from frequent blood checks and fewer drug interactions. They are much more expensive than warfarin, and cannot be used in people who need anticoagulation for mechanical heart valves.
The Food and Drug Administration last year approved idarucizumab (Praxbind), a specific antidote for people who overdose on dabigatran or who have serious bleeding while taking it. Although bleeding events are rare, the ability to treat a life-threatening complication is a valid reason to consider dabigatran over apixaban (Eliquis) or one of the other newer agents (which are developing their own antidotes, but none has been approved as of this writing).
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