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Ulnar nerve problem
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Ulnar nerve problem - April 2, 2005 1:00:00 PM
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MPTSTUDENT
Posts: 88
Joined: April 29, 2004
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Hi, I dont know if this is against the forums rules or not but I wanted suggetions on a problem I am having. I have had problems with my ulnar nerve off and on for about a year now at the elbow. Symptoms would come and go and I would do the nerve glides and the david butler mobs when symptoms were active. For the past week or two it has been really bad. I wake up everynight with numbness in my little and ring fingers, and discomfort at the elbow. Also happens when sitting at a desk if my arm is bent or if it is straight and my elbow is resting on the desk. Yesterday I felt fasiculations on the ulnar border in my hand. I am also really sensative up to 3-4 inches proximal to my elbow in the course of the ulnar nerve. If I bump it on something or if I tap it lightly with my other hand I can feel the pulses run down to my fingers. Like I said I have been icing at the elbow and doing the mobs but havent had any success. I am assuming that the problem is at the cubital tunnel but am not sure why this would make it so sensitive to tapping proximal to the elbow. Any thoughts or suggestions? Thanks.
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Re: Ulnar nerve problem - April 2, 2005 1:34:00 PM
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PTupdate.com
Posts: 1474
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Could be a multitude of different things. Perhaps just basic inflammation and tissue changes at the area of the pain itself. You may have a shallow grovve, and threfore irritate the nerve as you move the limb. You might want to consider a double crush syndrome, with neural compression occurring farther up the chain...either in the thoracic outlet or the cervical spine itself. Until you resolve those areas, your distal problem will always be volatile.
Any previous injury when younger? Were you a thrower?
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Ulnar nerve problem - April 2, 2005 1:51:00 PM
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MPTSTUDENT
Posts: 88
Joined: April 29, 2004
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I have had several problems in my right (dominant) shoulder in the past but this is happening in my left arm. Never really had in c-spine injuries to note. I have full painfree cervical rom as well. No vascular symptoms of TOS either although I dont know a lot about it. Anything you suggested looking for? Any suggestions for tests or further treatments? I have no ortho classes this semester, but I am gonna try to catch one of the ortho profs with some free time.
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Re: Ulnar nerve problem - April 2, 2005 2:20:00 PM
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jma
Posts: 2405
Joined: August 24, 2000
From: NY
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Since you are in school, you can take advantage of your library or medical library by looking at a good little reference, Special Tests for Orthopedic Examination 2nd ed, by Jeff Konin, ISBN: 1-55642-591-0.
However, it would be best to have someone look at it more carefully. You will learn about those in orthopedics for sure.
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Re: Ulnar nerve problem - April 2, 2005 2:26:00 PM
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MPTSTUDENT
Posts: 88
Joined: April 29, 2004
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Does the fact that the tingling sensation in my fingers can be reproduced by tapping proximal to the elbow suggest that there is a more proximal problem?
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Re: Ulnar nerve problem - April 2, 2005 4:14:00 PM
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dross
Posts: 54
Joined: March 16, 2005
From: NJ
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Hi. I had cubital tunnel syndrome (cts). My symptoms were exactly the same as yours. The tingling with tapping proximal to the elbow is consistent with CTS. It doesnt mean you have a doulble crush, but it also doesnt mean you dont. I found it was best not to get "off the record" evaluations by teachers when I was in school. This is something that should be evaluated and treated by a doctor/pt who is seeing you as a patient and not as a friend/student. It can lead to permanent damage if not handled correctly.
I suggest seeing an upper extremity ortho surgeon or a physiatrist who does musculo-skeletal medicine. You will need EMG/NCVs and probably steriod injections with bracing. If that doesnt help the nest step is an ulnar nerve transposition. Thats what I did, with good results too.
But it sounds like CTS, dont sit on this too long, get it taken care of now. You need your hands for your job.
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Re: Ulnar nerve problem - April 2, 2005 9:02:00 PM
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Alex Brenner PT MPT OCS
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Joined: February 29, 2004
From: Kentucky
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Yes, sounds like cubital tunnel syndrome to me. Dr. Frank Underwood is the guy you want to speak to at your school. The person that trained me to do EMGs was trained by Dr. Underwood and I believe his Phd may be in neuroscience. He has been doing EMGs for a very long time too and I am sure has seen his fair share of CTS.
I would consider wearing night splints that keep your elbow straight. When I was in school I remember having some ulnar nerve irritation also but I was certain it was because I was in class for 8 hours a day resting my elbows on the desk during lectures. When I started paying attention to this the pain and irritation lessened.
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Alex Brenner, PT, MPT, OCS
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Re: Ulnar nerve problem - April 3, 2005 8:01:00 AM
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MPTSTUDENT
Posts: 88
Joined: April 29, 2004
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Thanks army. It is interesting to hear that you know of Dr. Underwood. He is one of the profs that I planned on asking about it. I also wanted to get the advice of the knowledgable folks on here. I wrapped a towel around my arm last night as a night splint and it seems to have helped some. I did not wake up with numbness in my fingers but I still had the discomfort at my elbow. Also, the splint was so uncomfortable it made sleeping dificult.
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Re: Ulnar nerve problem - April 5, 2005 3:22:00 AM
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Shill
Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
Status: online
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Hey MPT,
To get you through your classes with less symptoms, get yourself an elbow pad. Hockey style, rollerblading style, something with a plastic cup to disperse pressure away from the ulnar groove. Not a cure, and you might look a little funny, but how bad do you want to NOT hurt?
Incidently, the elbow pad might be less restrictive than a splint, yet still keep you out of extreme flexion enough to prevent worsening.
Good Luck,
Steve
_____________________________
Steve Hill PT
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