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Proximal Median Nerve Compression ?
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Proximal Median Nerve Compression ?

About a year ago I started getting aching pain in both elbows whilst excessively rock climbing. I took a  month off with no pain to get better. After a month I started getting ulnar nerve symptoms in my right hand whilst mouseing (I work in IT) and a general ache in my left elbow. After another few weeks the pain subsided but then whilst leaning back and stretching I felt something "twang" in my right elbow and immediately had median nerve symptoms (tingling/numbness) in my right hand. Again, over a couple of weeks this subsided.

Then I started getting very painfull aching in both my elbows around the flexor/pronator origin whilst typing at work and pain in my wrists. I've been off work for 6 months now and the pain in my wrists has gone but I still have a permanent dull ache in the flexor/pronator region of my left elbow and a sort of tickling/tingling where the median nerve crosses my right elbow.

There is also a lump on my left elbow about the size of a small half egg when by arm is supinated and wrist extended, also a smaller one on my right. An ultrasound showed it is the pronator teres muscle but the doctor says it is normal even though it is much worse on the left and I am sure never used to be there. The left is the most painful as well.

I had an EMG at the start showing ulnar nerve compression at the elbow (when I had ulnar symptoms). I've suggested it could be pronator syndrome but he says you would have definite hand tingling now and an EMG would have definitely showed it, but what I have read contradicts this.

Grateful for any help, I am desperate
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Avatar_n_tn
Please keep in mind I have not personally examined you nor have I reviewed your studies.  In peripheral nerve cases, the neurological exam is very important in determining where the problem may be, which makes "guessing" what the diagnosis is by an email post extremely difficult if not impossible.
For example, I'm not sure I can accurately comment on the "egg sized" mass near your elbow, because I have not seen it personally nor do I know exactly where it is. However, rock climbers definitely can get new muscle bulks in the forearms due to excessive use of the muscles there that msot people don't normally tend to use on a day to day basis.

As for the pronator syndrome, technically you should have some numbness, tingling, or weakness in the hand area that is innervated by the median nerve (weakness/wasting over the base of the thumb in the palm or tingling in the fingers).  And it should show up on an EMG.  Not sure what you read and where you read it, but there is sparing of more proximal median innervated muscles on exam and EMG like the pronator teres itself, which may be what you're referring to.  However, more distally innervated muscles like the ones in the hand should be affected. Other possibilities to explain your symptoms include an ulnar nerve problem as was found by prior EMG and tendinitis (rather than a primary nerve problem).  The pronator syndrome may still well be a possible diagnosis, but again it's difficult to say without seeing you myself.  If this is a significant problem (which it does sound like it's getting to be as you've missed 6mos of work), then strongly consider a second opinion and perhaps another EMG.  Once the right diagnosis is made, then you can hopefully receive appropriate treatment. Not sure where you are in the UK, but try an academic hospital if you can. Good luck.
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Avatar_m_tn
A related discussion, shoulder pain, hand numbness was started.
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