Ulnar nerve entrapment

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pamf
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Ulnar nerve entrapment

Post by pamf » Fri Oct 10, 2008 9:37 pm

I have just been given a preliminary diagnosis of ulnar nerve entrapment. I need to wait 7 months to get a nerve conduction test to prove it, but I display the related symptoms of numbness specifically in my ring and pinky fingers, but sometimes extending to whole hand/arm.

I am not yet certain what has caused it but, certainly, a possible culprit is kayaking. So I was wondering if anyone else has suffered from this condition in relation to paddling? If so, were you able to determine a particular cause, eg paddling technique, paddle type etc? Or was there some other underlying condition that paddling aggravated? And do you have any advice on how to get over it?

I did a search on the forum already, but could only find references to carpal tunnel and tendinitis type conditions. The ulnar problem can also be known as cubital tunnel syndrome.

Many thanks.

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janet brown
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Post by janet brown » Fri Oct 10, 2008 10:42 pm

Hi Pam
Ulnar nerve picks up sensation from the little finger and adjoining side of ring finger, so sensory distribution sounds about right.

Suggest you go and see a good musculoskeletal physio and get it checked out: hopefully should be sooner than 7 months (can't promise this however!).
They should be able to check your symptoms out and check whether coming from neck or elbow, or if you have a problem with the nerve being compressed by overused muscles. All very complicated and takes a bit of working out.

Janet

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Ulnar nerve entrapment

Post by pamf » Sat Oct 11, 2008 7:23 pm

Hi Janet - Thanks for your advice. We do have a good physio locally, so I will probably seek her advice in the meantime. I used to get sore elbows when I first started paddling, so maybe there's a connection. Seven months seems a long time to wait without doing anything, but that's the waiting list time for the only nerve conduction test machine in the west of Scotland. Might as well try to make some headway meantime.

Cheers,
Pam

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GriffyB
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Post by GriffyB » Sun Oct 12, 2008 10:00 am

Hi Pam,

I reckon this explains my numbness a fortnight a go. Normally paddle 12 miles max, we spent a day out and covered 40 miles (lots of tidal assistance but still an increase from 4 to 10 hours or so paddling).

Woke up several times that night with a numb right hand and lower arm, then when driving to work the next day had my right hand start to lose feeling several times- starting at the little finger and moving over. Was a little worrying but solved by lowering it and allowing the blood supply to gravitate back. Put it down to excessive grip over a longer period of time paddling that I'm normally used to. Only lasted 24 hours with the numbness phasing in and out.

Hope yours isn't long term. Griff.

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Post by pamf » Mon Oct 13, 2008 12:18 pm

Hi Griff - Sounds like a similar type of thing. I've read that, with this condition, you should lower your arms in bed at night, ie keep them straight rather than having them bent with hands up around face etc, which is easier said than done. But this helps free the nerve(s) up - maybe that's why it helped you to lower your arms. I've been paying a lot of attention to paddle grip as I'm aware that too much is a bad thing for a number of reasons. But any less and I'm sure I'll drop the paddle! Not sure how to address that better.

Hope yours doesn't come back.

Pam

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Post by Jim » Mon Oct 13, 2008 2:15 pm

I have had occasional numbness after shoulder/neck injuries but more thumb and forefinger. Clearly in my case the relevant nerve was being trapped at the shoulder and my osteopath was able to effect some some releif using an ultrasonic technique. I beleive a lot of physiotherapists use similar equipment?

My point is that however long the wait for a test is on the NHS, if you can find a private physio or osteopath with the equipment you can probably get a reasonable diagnosis and treatment immediately if you are prepared to pay for it. How accurate the diagnosis will be without a proper test I cannot say but as long as the treatment is not likely to have adverse effects it may be worth looking into this sort of thing. Be aware that ostepaths will try and make you dependant on them for several months which can get expensive.

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Post by ChrisBainbridge » Mon Oct 13, 2008 2:41 pm

Hi
Cubital tunnel Syndrome.

great little diagnosis. The ulnar nerve runs around the back of the elbow (your funny bone) and is therefore stretched everytime you bend your elbow. Normally the nerve glides and stretches BUT in the situation of nerve entrapment then the gliding doesn't occur and the nerve stretches. In addition the simple compression causes problems. So you have two problems. Simple compression produces pins and needles, numbness and eventually weakness of the hand. These problms are all made worse by bending the elbow and stretching the nerve.

The little and ring fingers are affected and it is often only half of the ring finger. Progressively the problem goes on to produce weakness in the hand and atrophy of the small muscles in the hand.

Diagnosis is confirmed by nerv conduction studies.

Treatment: The first treatment to try yourself is to splint your arm straight at night time and see if that will help. At the very least it should improve the problems at night time.

If this is unsuccessful then surgery is helpful. There are a number of surgical treatments of increasing complications. The evidence for one technique over another is not there and so I would always suggest simple decompression as a first step. Unfortunately the success rate with cubital tunnel is slightly less than for carpal tunnel and about 5% of patients will need a second operation.

Causation: Cubital tunnel is in general an idiopathic condition which is commoner in middle age, etc. There is no evidence of a general relationship to work or activities. Occasional overuse may initiate a form of Cubital tunnel where the nerve runs through the large wrist stabiliser into the forearm but I have only seen a couple of such cases turn into a permanent problem in many years.

You might like to point out to your MP, etc that in my clinic in Derby nerve conduction studies are done at the outpatient clinic appointment and surgery takes place within 16 weeks of beig seen.

Alternatively you could look at paying for your nerve conduction studies privately and taking them to show the surgeon.

Alternatively get on a bus to England.

Best Wishes

Chris

(I have written a chapter on this for a major text book and lecture regularly on it. This is the abridged version!!!)
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Post by NickB » Tue Oct 14, 2008 1:22 pm

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Post by Jonathan. » Tue Oct 14, 2008 8:52 pm

ChrisBainbridge wrote: The ulnar nerve runs around the back of the elbow (your funny bone) and is therefore stretched everytime you bend your elbow........

(I have written a chapter on this for a major text book and lecture regularly on it. This is the abridged version!!!)

That has the sound of high quality advice, expertise you might have to go a long way to find.

As a paddler with similar symptoms, I'm obliged to you for taking the trouble to explain the issue so clearly. I suspect your user-friendly abridgement may have taken longer to write than the unexpurgated version, and that's particularly welcome.

Perhaps you'd explain something else, Chris. What's the likelihood of cubital tunnel syndrome getting worse or developing into something else, and over what time-scale?

The tip of the little finger on my right hand is numb, and the next finger has pins and needles. That's something I can live with - particularly as the back and chest-stretching excercises prescribed by the physio seem to have mitigated my problem. But I wouldn't want to lose more sensation or have muscles wasting. I'm 57, by the way, and have had my symptoms for a couple of years.

Cheers

Jonathan

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Post by Mark99 » Wed Oct 15, 2008 2:50 pm

Jim wrote: Be aware that ostepaths will try and make you dependant on them for several months which can get expensive.
Hi Jim, I deeply regret that your experience of osteopaths has lead you to feel this. I'm sure that as in all walks of life some osteopaths are better than others but all are regulated by law to act in the best interests of their patients. Just as doctors are regulated by the GMC, osteopaths are by the General Osteopathic Council (www.osteopathy.org.uk) which demands high professional standards and to whom you can turn if there is a problem.
Pam, this problem may be serious and require surgery,but I can absolutely promise you that in many cases the solution is straightforward and will not take months. I know because I treat several a week at least. Yours may not be one of that group, but don't despair yet! It may be a forearm problem, caused by gripping too hard, too long, or with the wrong fingers. But it can also be caused by hunched tight shoulders, or even lifting your boat.

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Post by ChrisBainbridge » Wed Oct 15, 2008 6:15 pm

Hi Jonathan

If you truly have cubital tunnel, we believe it is in general a progressive problem which can eventually lead to significant weakness in the hand. In general I would suggest having a set of nerve conduction studies and then perhaps redoing them 6 months later. Whilst they are relatively crude they do give an indication of the severity of the damage and whether it is progressing. I tend to be a bit more pushy about surgery with cubital tunnel as the results of late surgery are somewhat poorer than for carpal tunnel syndrome.

Mark, I am sorry but cubital tunnel is not caused by gripping too hard, too long or with the wrong fingers unless you are talking about 12 hour shifts of gripping in people that are new to the job with inexperienced muscles, etc. I agree that hunched shoulders, cervical spondylosis, thoracic outlet syndrome, etc may all cause similar problems and need to be excluded from the diagnosis. I also agree that bad posture, cervical spondylosis may all respond to any of a variety of interventions including osteopathy, chiropractic, physiotherapy, etc. Unfortunately the long term outcome data and the short term data comparing these techniques with advice to keep moving is lacking in most instances. having said that I have an occasional acute left Sacro iliac problem for which I visit my favourite Chiropractor with immediate relief.

Chris
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Post by Jonathan. » Thu Oct 16, 2008 11:32 am

Thanks a lot, Chris.

I'll get myself checked out pronto. It's good to think I'll be better informed and shan't be completely clueless.

Best wishes

Jonathan

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Post by Jim » Thu Oct 16, 2008 12:52 pm

Mark99 wrote:
Jim wrote: Be aware that ostepaths will try and make you dependant on them for several months which can get expensive.
Hi Jim, I deeply regret that your experience of osteopaths has lead you to feel this.
That probably came accross wrong.

The osteopath's way tends to be intensive with a lot of repeat visits over a relatively short time (they get less frequent as you go on), whilst most physios seem require much fewer visits and get you to do more of the work for yourself (so results depend more on what you do between sessions).
As far as I can tell both methods can give the same results over the longer term, although reading Chris' notes if the diagnosis is cubital tunnel then it may well require surgery and has nothing to do with the back so this sub-thread is getting off topic.....

Personally I like the fact that I can walk out of the osteopaths surgery much more easily than I walked in, but it comes at a much higher price which people should understand - many people go in thinking that one treatment will cure them.

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Post by janet brown » Thu Oct 16, 2008 8:56 pm

Chris Bainbridge wrote:
having said that I have an occasional acute left Sacro iliac problem for which I visit my favourite Chiropractor with immediate relief.
Aha! I have several physiotherapy specialist colleagues who would argue that there is no such thing as a sacro-iliac joint problem!!

Janet

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Thank you!

Post by pamf » Thu Oct 16, 2008 10:32 pm

Thanks everyone for pitching in on this one. In particular, thanks to Chris for your insights. It certainly has given me pause for thought in relation to getting the conduction tests done now (privately) rather than waiting until my hand potentially weakens. I spend all day working on a PC and kind of need my hands, not least of all for kayaking! I might look into this, although I wonder if costs are prohibitive? I do hate having to bail on the NHS - and it's esp annoying to realise that such tests are more readily available elsewhere in the country. (How long before the current economic crisis is used as the default excuse for such shortcomings?).

Anyway, thanks again. Great info.

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Post by Jonathan. » Fri Oct 17, 2008 9:27 am

Pam,

Maybe your doctor could find you somewhere that doesn't have a waiting list that stretches to eternity? I got a conduction test here in Cambridgeshire within three weeks of seeing the gp.

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Re: Ulnar nerve entrapment

Post by husky » Fri Oct 17, 2008 9:16 pm

pamf wrote:I have just been given a preliminary diagnosis of ulnar nerve entrapment. I need to wait 7 months to get a nerve conduction test to prove it, but I display the related symptoms of numbness specifically in my ring and pinky fingers, but sometimes extending to whole hand/arm.

I am not yet certain what has caused it but, certainly, a possible culprit is kayaking. So I was wondering if anyone else has suffered from this condition in relation to paddling? If so, were you able to determine a particular cause, eg paddling technique, paddle type etc? Or was there some other underlying condition that paddling aggravated? And do you have any advice on how to get over it?

I did a search on the forum already, but could only find references to carpal tunnel and tendinitis type conditions. The ulnar problem can also be known as cubital tunnel syndrome.

Many thanks.
I have had a few bad neck traumas in my time and have a c5 c6 problem with a disc prolapse ect this gives me a nerve problem in one or both of my arms varies due to stress sleep patterns and bumps/knocks
I was told I would need surgery!
I have a maintain /care routine which has It under control
If I can help I will
Steve
LET IT BE

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Post by ChrisBainbridge » Mon Oct 20, 2008 11:49 am

Ask your GP for a referral to a NHS hospital in England and have it done south of the border.


we English will be paying for it either way!!!
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Post by pamf » Mon Oct 20, 2008 3:40 pm

ChrisBainbridge wrote:Ask your GP for a referral to a NHS hospital in England and have it done south of the border.


we English will be paying for it either way!!!
Oooh, with friends like these ....!

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Post by NickB » Tue Oct 21, 2008 11:59 am

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Post by NickB » Tue Oct 21, 2008 12:00 pm

Cheers
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Post by NickB » Tue Oct 21, 2008 12:01 pm

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