Carpel Tunnel Ulnar Nerve Entrapment

[bio43]

My left hand has the following symptoms: ring finger and middle fingers on the palm side are numb and feel like they are asleep;the muscle that spreads the pinky finger outward has been slowly atrophing and feels like it is asleep especially when I am walking. The outer side of my left hand on the tips of the aforementioned fingers feels numb; the muscle that extends my thumb outward has been slowl atrophying. There is no pain. Sometimes my elbow is sensitive and sometimes my back muscles near my left scapula fasiculate when I am prone. Does this sound like Ulnar nerve entrapment.

  My right hand has been diagnosed as carpel tunnel syndrome. I feel a tightness around my wrist and I am getting the feeling that the muscle that extentends my pinky finger out is falling asleep when I am walking. I also feel a compression feeling around my wrist. Does the diagnosis sound correct?

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.

   The symptoms you describe are not specific for a single condition, but there are several likely possibilites.  The atrophy, weakness and numbness in your hands indicates a lesion of the nerves somewhere between the spinal cord and the hand itself.  The nerves can be injured in the roots as they exit the spinal cord (radiulopathy) often due to disc disease.  They can also be damaged in the brachial plexus from the proximal neck to the clavicle.  Finally, the nerves can be disabled as single nerve branches, such as the median, ulnar and radial, etc.)  Common injuries of the terminal nerves include carpal tunnel syndrome (median nerve entrapment at the wrist), damage of the ulnar nerve at the elbow and entrapment of the radial nerve at the spiral groove of the humerous.  Less commonly the ulnar nerve can be entraped at the wrist.  

   I would recommend an EMG (including paraspinal muscles) with nerve conduction studies (including proximal sites such Erbs point) to determine where you trouble is coming from.  Depending on the results, you will likely need an MRI of your cervical spine for further evaluation for possible radiculopathy.  It is odd to have carpal tunnel syndrome without pain (not impossible) especially since your symptoms include more advanced findings such as weakness and atrophy.  Most people with carpal tunnel complain of severe wrist pain, mostly at night.

I hope this has been helpful.

[vega1318]

It sounds correct, but assuming you also had an EMG confirmation of ulnar n. entrapment in the carpal tunnel.  YOu should probably consider treatment:  perhaps, surgery or steroid injections.   Former is probably more appropriate now that you've had such progression.

[Bobadeli]

Hi,

starting with your left hand which could sound like an entrapment of the Ulnar nerve at the Guyon canal (in the wrist) except for the

1- numbness of the middle finger which is from the median nerve (a completely dfferent path/root of the brachial plexus)

2- Atrophy of the thumb extensor muscle, which is from the radial nerve(a partially different path of the Plexus)

3- having no pain and even no parathesia (pins and needles)as they indicate irritation of the nerve while numbness and atrophy more with heridiary problems



So you are beyond the ulnar nerve only from your history, and as you have numbness, that will eliminate some serious diseases of the spinal cord.

What should be ruled out

1- Thoracic outlet syndrom by a routine chest xray

2-Any compression of the lower part of the brachial pleaus(the gathering of the nerves in the neck)by a proper c-xray and MRI

3-At the same time look for a syrinx in the spine

4- Its less likely to be a root problem (the nerve coming out of the spine) in the lower part of the neck

About the rt hand, what you mentioned is not enough to point at CTS. We need to know more as does it wake you up from asleep, do u have to shake the hand to relieve the pain, what other situation could bring up the pain ..ext

But putting the entire detailes together it could be a one disease with liability of involving several nerves (those at a compression site)

In brief, you should be seen by a neurologist who is specialized in peripheral nerves diseas to put all these peaces together for localizing to the best or highest anatomical site



  Bob

[RSR]

I am a 58 year old man that has been having a lot of problems they can't seem to diagnose.  I have never been sick or hurt before.  I work construction/heavy equipment operator.  About 2-3 months ago I started having a lot of pain in both of my shoulders (front of shouders) both hands and forearms.  The right one is so bad I can hardly use my hand.  My thumb and fingers tingle and are in pain.  I have resorted to pain pills to sleep at night, and never taken pills in my life before this.  It is worse when I lay down.  Now the pain is in the back of my legs, sort of the tendant/muscle behind/above the knee.  I have had an MRI of the c-spine and it was normal and today an EMG.  The neurologist that did the emg said it shows sign of carpel tunnel because I have pinched nerves in my wrists.  But what does this have to do with my shoulders and muscles hurting soooooo bad.  Constantly.  I can hardly work anymore, but I have to.

Thanks, RSR