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Neurology (Expert Forum)
ulnar nerve symptoms
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ulnar nerve symptoms
by mike1105, Feb 15, 2006 12:00AM
5 months ago i was doing some rather overzealous stretching to help relieve/correct some chronic myofascial issues in my neck/back/chest. I was placing my fully bent (at the elbow) arm upwards and backwards in an attempt to stretch the muscles on my flank under the arm--- ie pec minor, suscapularis teres etc. In retrospect this was not a good stretch for me since I have for years felt a "tightness" around the right elbow where the ulnar nerve passes. predictably, the next morning i woke with classic ulnar nerve paresthesia, which has improved maybe 30%, but has levelled off and sometimes even gets worse for a few hours, especially later in the day. Only sensory loss (only in outer palm, 4th,5th digits), motor is fine. the "tightness", which feels like a lack of slack (no pain in the elbow) is still there upon bending. Nerve studies showed ulnar sensory loss but intact motor function. I know there is a surgery which moves the nerve under a different muscle to create slack and prevent constant rubbing in the bony canal, and I am wondering if i am a candidate. My question is: 1.what is the likelihood that surgery will help me? Is it possible that there is perm damage to the nerve at the elbow and simply moving it will do nothing? Or, could my lack of progress and exacerbations be due to the constant rubbing and therefore the nerve's inability to heal? 2. when I tap my wrist at the outside (ulnar) side of my wrist, my symptoms exacerbate ( Is this indicative of possible entrapment at the wrist also?) I am a dentist and use my 5th digit as a finger rest--- i need to feel it!!
Doctor's Answer
by CCF-Neuro-M.D.-PW, Feb 21, 2006 12:00AM
1) surgery does not gaurantee releif of symptoms. It depends on where the nerve has been injured and the ulnar nerve is notoriously difficult to localize an injury based on electrodiagnostic studies. Based on your history of a possible stretch injury it is more probable to be the site of injury, although with only sensory involvment clinically or by EMG this is less certain as anywhere form the distal sensory brancy in the forearm and higher may have been affected.
Surgey will not help a fixed nerve injury that has occurred already but may help in terms of ongoing repeated truama or compression. Evidence of this comes in the form of episodic worsening of symptoms after compression or EMG evidence of ongoing active denervation by the presence of fibrillation potentials. This may help in the risk/benefit decision to try a surgery. If you have not had a detailed EMG examination of that limb - at least 5-6 ulnar muscles, this may help in the decision.
Tingling after tapping your wrist is not a specific sign for damage at that site, it still could be from damage anywhere along the course of the nerve.
A consultation with a neuromuscular specialist may help interpret your clinical history and electrodiagnostic studies to come to a comclusion whether further injury to the nerve is possible. In the meantime you should avoid positions of ulnar nerve compression like leaning on your elbows etc
Good luck
Surgey will not help a fixed nerve injury that has occurred already but may help in terms of ongoing repeated truama or compression. Evidence of this comes in the form of episodic worsening of symptoms after compression or EMG evidence of ongoing active denervation by the presence of fibrillation potentials. This may help in the risk/benefit decision to try a surgery. If you have not had a detailed EMG examination of that limb - at least 5-6 ulnar muscles, this may help in the decision.
Tingling after tapping your wrist is not a specific sign for damage at that site, it still could be from damage anywhere along the course of the nerve.
A consultation with a neuromuscular specialist may help interpret your clinical history and electrodiagnostic studies to come to a comclusion whether further injury to the nerve is possible. In the meantime you should avoid positions of ulnar nerve compression like leaning on your elbows etc
Good luck
Hope you get an answer to your surgery question.
The very best relief I have received upper body therapeutic massage by a licensed therapist. This was just recently, and the results are excellent, very little remaining symptoms after just a few massages.