SOUTH GRAND — When he got up from having the nerve in his right elbow relocated, the pressure that had  been such a problem was gone. There was no ache, no odd crowded sensation when he bent the joint. His elbow felt … normal.

“I woke up from surgery feeling like I was a million times better,” Kyle McClellan said. “Like I could go out and throw that same day.”

Before the 2007 season, McClellan, the Cardinals’ rookie righthanded reliever, had the same procedure on his pitching elbow that Albert Pujols had Monday. It is called a transposition of the ulnar nerve — essentially moving it out of a trap that compresses and irritates the nerve that runs through the elbow. The news of the surgery is covered by colleague Joe Strauss in this morning’s paper, and the well-documented history of the Most Important Joint in St. Louis is collected and explained back in this blog entry, “Pujols’ Elbow 101″. It is considered a minor procedure, and when Cardinals team doctor George Paletta went into Pujols’ elbow to shift the nerve he did not stray near the bone spurs and ripped ligament that has caused such hand-wringing despite Pujols putting up six of the best years of his career while playing with the tear.

Paletta also performed the surgery on two other current cardinals — McClellan and Russ Springer.

Trapped Ulnar Nerve (Source: eOrthopod)

Springer’s condition is the most similar to Pujols’, as both experienced numbness in the hand and fluctuations in grip strength. Paletta, in a teleconference with reporters Monday, described how Pujols’ nerve was “jumping its track.” Springer’s did the same, causing discomfort and irritation as he pitched. When Paletta performed the transposition of Springer’s nerve, he did so using part of the muscle to create ringlets that guide the nerve — or hold it in place. (No such ringlets were used with McClellan and Pujols because there have been advancements in the procedure since Springer’s surgery.) Earlier this season, Springer went on the disabled list with tingling and numbness in his fingers, and he quickly diagnosed it as something that would get better with rest. He said it was related to the transposition of the nerve and not anything that had him worried. He was ready to throw before his 15 days on the DL were over.

“Nerves do not like to be trapped,” Paletta said. He had described earlier that Pujols’ case, like Springer’s, was one “in which the nerve pops in and out of the groove it rides in. Every time, he bends or straightens the elbow, the nerve pops in and out of the groove.”

When Boston ace Josh Beckett had some nerve irritation in his right elbow this August, he visited with Dr. James Andrews — the same specialist Pujols consulted with before agreeing to this surgery — and several reports said Beckett had been presented with transposition of his nerve as a possible fix. According to MLB.com, Atlanta reliever Rafael Soriano may have to have the nerve moved if he continues to have discomfort in his elbow. Former Braves closer Chris Reitsma, Cleveland starter Jake Westbrook and former Cleveland outfielder Ellis Burks all had their nerves transposed and were able to return to the field afterward. Burks had the procedure after experiencing numbness and tingling in his hand. Like Pujols. Paletta said a nerve conduction test on Pujols was striking enough to confirm that something was bothering and dislodging the nerve.

McClellan’s was slightly different.

“My nerve,” he said, “was trapped … squeezed into the shape of an hour glass.”

It is not uncommon for a pitcher who has had Tommy John surgery to encounter trouble with the elbow

Transposing the Ulnar Nerve (Source: eOrthopod)

in his rehab and, in a followup surgery, have the nerve relocated to correct the discomfort. Back in 2002, reliever Doug Brocail had difficulty recovering from the ligament transplant surgery and had to have the nerve transposed. He returned and has made more than 250 appearances since. McClellan, coming off Tommy John surgery, had a similar sensation. The scar tissue from the surgery was choking the nerve. All the tissue had collected in his elbow and was pressing on the nerve (hence, for example, the use of the word decompression in the Cardinals’ official release on Pujols’ surgery). When McClellan would bend his elbow to deliver a pitch he “could feel this pressure in there, like the elbow was swelling.” He didn’t have the tingling or the numbness that Springer and Pujols described, but he did have this overstuffed feeling in his elbow. During surgery, his nerve from removed from the traffic jam of scar tissue and replaced in a friendlier thoroughfare.

That “pressure” had vanished by the time he walked out of Paletta’s operating room.

McClellan then went through the rehab process that Paletta said will be similar, at the beginning, for Pujols. Three weeks of nothing. Three weeks of rebuilding strength. Six weeks before starting a throwing program. (Pujols, as a position player, will have a quicker return to throwing at his position than a pitcher for the same reasons he can have a tear more severe than Chris Carpenter’s and not require Tommy John like Carpenter did.)

McClellan had the transposed nerve at the end of the 2006 season, and he said that allowed him to have his usual offseason before 2007. It was the first time in years that he was able to do that. And by spring training, his elbow was healthy and he was throwing at full strength.

“It was a real simple procedure, and a real easy recovery,” McClellan said. “It made all the difference.”

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