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Neurology (Expert Forum)
Hand: ulnar side has slight droop and weakness in grip strength
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Hand: ulnar side has slight droop and weakness in grip strength
by woodsskier3, Dec 07, 2005 12:00AM
Two year ago, I woke up two days in a row with an intense numb & burning in my middle and ring finger of my domiate hand. Since then I have had weakness in my grip strength of the ring and pinky fingers(It feels like something is missing in my hand). The initial assumption was that I had an ulnar neuropathy at the elbow. I do not recall striking my funny bone. However, I did open supply boxes at work by stricking the ulnar side of my hand.
About a month after the onset of my symptoms, I had an EMG. The doctor performing the found a slight conduction block across the elbow region by flexing my elbow at 90 - 100 degrees flexion (14.8 millivolts above and 12.6 below. The conclusion was that I had a very mild ulnar neuropathy. I was told to be concervative.
Unfortunately my symptoms did not improve and so I underwent surgery and had an ulnar release at the elbow with medial epicondylectomy.
Following the surgery, my symptoms did not improve. I have had 3 repeat EMG studies with different doctors since then and the ulnar nerve does not show a problem. I was told by a the last neurologist that it ws inappropriate to bend ones elbow to get a reading. He said this was adding "artifacts".
I have had ongoing ulnar sided pain and on x-ray my triquetrum is diplaced more dorsally. I have weakness in the interosseous muscles inbetween ring and pinky. There is a slight drooping of the dorsom of my hand exclusive to the ulnar side. I'm thinking that I could have had a wrist problem all along. Will a torn interosseous ligament or other wrist ligaments cause grip weakness?
About a month after the onset of my symptoms, I had an EMG. The doctor performing the found a slight conduction block across the elbow region by flexing my elbow at 90 - 100 degrees flexion (14.8 millivolts above and 12.6 below. The conclusion was that I had a very mild ulnar neuropathy. I was told to be concervative.
Unfortunately my symptoms did not improve and so I underwent surgery and had an ulnar release at the elbow with medial epicondylectomy.
Following the surgery, my symptoms did not improve. I have had 3 repeat EMG studies with different doctors since then and the ulnar nerve does not show a problem. I was told by a the last neurologist that it ws inappropriate to bend ones elbow to get a reading. He said this was adding "artifacts".
I have had ongoing ulnar sided pain and on x-ray my triquetrum is diplaced more dorsally. I have weakness in the interosseous muscles inbetween ring and pinky. There is a slight drooping of the dorsom of my hand exclusive to the ulnar side. I'm thinking that I could have had a wrist problem all along. Will a torn interosseous ligament or other wrist ligaments cause grip weakness?
Doctor's Answer
by CCF-Neuro-M.D.-PW, Dec 09, 2005 12:00AM
The symptoms you describe are consistent with an ulnar neuropathy, but striking the side of the hand would only be expected to cause a milder sensory disturbance as the nerves that supply the muscles are higher up.
THe ulnar nerve is a notoriously difficult nerve to localize a lesion to with EMG/NCS. Different centers either bend the eolbow or keep it straight when taking measurements to determine nerve velocity - this makes interpretation sometimes conroversial
Without knowing the extent of the injury I cannot comment on the prognosis. If nerve damage from compression is severe enough there may not be total recovery. The EMG can appear normal after the acute incident has resolved.
Torn ligaments can cause apparent muscle weakness but should not cause the sensory symptoms.
THe ulnar nerve is a notoriously difficult nerve to localize a lesion to with EMG/NCS. Different centers either bend the eolbow or keep it straight when taking measurements to determine nerve velocity - this makes interpretation sometimes conroversial
Without knowing the extent of the injury I cannot comment on the prognosis. If nerve damage from compression is severe enough there may not be total recovery. The EMG can appear normal after the acute incident has resolved.
Torn ligaments can cause apparent muscle weakness but should not cause the sensory symptoms.
