Hi,

Since late 2013 I have had problems with what I thought was associated with ulnar nerve entrapment. I would get tingling in my right pinky and ring fingers that would wake me up at night. In addition, I would get pain from these fingers up to my elbow throughout the day. Pain occurs when I bend my elbow, lean my elbow on my desk, do push ups, etc.

With research, I found that my symptoms matched ulnar nerve entrapment or cubital tunnel syndrome. So, I went to some specialists to confirm this.

An ultrasound found that "the ulnar nerve within the ulnar groove appears thickened compared with the contralateral side." This ultrasound found features of ulnar nerve neuropathy, and suggested an ultrasound guided peri-neural injection be performed. However, my GP suggested I get a nerve conduction test before receiving this.

So, after waiting 4 months for an appointment, I got a nerve conduction test today that found both ulnar nerves to be normal. In fact, the right ulnar nerve performed better than the left. The neurologist gave no solutions, suggesting that I just don't bend or lean on my elbow. But, for the past year that's exactly what I have been doing!

I am very unsatisfied with this result. I still get pain, but now I have no direction in solving its cause.

Where can I go from here?
Are there any other tests I can have performed?
Are there any ways of alleviating the pain?

I am at a dead end.

Your symptoms could also be a version of Thoracic Outlet Syndrome (TOS) or RSI related.
Explore our TOS forum & sticky threads there to find out more info-
http://neurotalk.psychcentral.com/forum24.html

Any repetitive or sports injuries, previous whiplash, poor posture /head forward, etc..?
Do you have any neck or upper back pain, or tightness in the neck/shoulder muscles?

I have similar issues, although very little pain. I'll wake up in the middle of the night with both my pinky and ring fingers completely numb. Without fail when this happens, my elbow is bent, and I'm usually on my back. It also happens when sitting at my desk when my left arm is bent. All I have to do is unbend my elbow to get my feeling back.

If I lean on my elbow, I can feel odd sensations in those fingers too.

My neuro said I have TOS, but two other docs, an int med doc and a spinal specialist said I don't. (I saw them for second opinions on my neuropathy and mentioned the TOS diagnosis.) They said it's some kind of nerve issue in your elbow. I have a tendency to believe them.

Because I don't have any pain, though, I'm not terribly concerned about it.

Hi Sharna!

Welcome to NeuroTalk!

I am so glad you are asking more questions about this!
although the wait for the nerve testing was lengthy, and likely a source of frustration, the time involved helped to get a different perspective.

I think this is great!
Why do I think this is great?
I had symptoms of a compressed ulnar nerve. I had nerve studies done, which had confirmed compression. I then saw an orthopedic surgeon and he did his exams as well. The conclusion was I'd needed a subcutaneous ulnar nerve transposition surgery ASAP.
I had the surgery, done by a very highly reputable surgeon.

My arm and hand function was worse for a few years (severe nerve pain and weakness), while the problem was not corrected. Three different doctors were concerned I had gotten RSD from the surgery! Later on, the neurologist had stated in his notes his post-surgical opinion that the cause was not ulnar nerve compression. (He never said this to me, yet when I had ordered his notes, this was in his notes.)

I am still working at rehabbing that same arm/hand -- from nerve issues related to surgery. (It's been a few years since that surgery.) I still have the original symptoms, as well. I had sustained a shoulder injury during surgery; that shoulder has never been the same.

Investigate all potential causes!
Be ultra careful about cause and proposed "fixes."

I wish I had known if there was any doubt on the part of the neurologist.
He did not state any doubt at the time. He was acting quite confident I'd needed this surgery. He'd told me I had needed to see the surgeon immediately. His notes show he was relying upon the surgeon to make the call. The nerve studies were not enough to make the call; however, that's something I was never told. I'd discovered the truth after the surgery was done and I had ordered the doctors' notes.

Hope this helps!

To Our Healing,
DejaVu

I had a tendency to lean on my elbows a lot whilst studying, and flex them whilst sleeping. Since then, though, I have put padding on my desk to support my elbows, and have been sleeping with an elbow brace to limit the degree of flexion. I would say that I do have poor posture, yes.

Recently, I have been having upper back pain associated with poorly cracking my spine in a twisting motion. This results in making it hard to breathe. I get sharp pain from between my shoulders, across my thorax, and into my lungs. This prevents me from being able to breathe normally (only shallow breaths permitted).

Do you think that this could be related to TOS?

Sorry to hear about your situation! It sounds remarkably frustrating. Did you ever find out what the cause to your initial symptoms was, seeing as it was not ulnar nerve compression?

Thank you for putting this into another perspective for me! I guess it is better to still be looking for a cause of a problem, than to get surgery that is futile.

If you haven't had any cervical spine x ray or MRI that might be the next step, to rule in/out any spinal issues, or any bone anomalies..
And/Or advanced PT evaluation or expert chiropractic evaluation..

Personally I had better care & faster results with a very good multi modality (soft tissue work and a mix of therapies used) chiropractor than with most of the PTs I had been to..

Post #1 on this sticky thread is a pretty much crash course on TOS and related conditions as well as treatments..
http://neurotalk.psychcentral.com/thread84.html

you can also try some things on this page for easy at home self care to see it it helps -
http://neurotalk.psychcentral.com/album.php?albumid=422

Welcome Sharna,

I think there is quite a bit of hope in here and some options for more information and improvement. I second the chiropractic consult. You never know what they might find. I have a trick rib that subluxes with some regularity and causes a lot of pain and inability to take a breath. My chiro does a quick, painless adjustment and I am good for another few months or year.

Also on nerve entrapement....I too am a nerve entrapment surgery patient. I have also had nerve ultrasound that found swelling of the nerve and I had a carefully done US guided injection of steroid to "bathe" the nerve as treatment (this was after surgery when things were swollen in general and mechanics of my ankle were tugging on the nerve and it was miserable) NCS WILL NOT indicate nerve swelling. Conduction may look perfectly fine in a nerve that has enough swelling to get stuck trying to slide through its tunnel and is aggravated. Your normal NCS does not rule out the utility of treating the nerve by a skilled PMR who can do that injection. If you do not have improvement with PT and altered activity it is worth revisiting the ultrasound and seeing if you need to do anything. It just may break the cycle and allow healing, mine did!

Sharna260,
I was going to suggest looking at your cervical spine, but Jo*Mar beat me to it. I had sharp pains in my fingers and outer ear, but no neck pain. My MRI showed a couple of bulging discs, bone spurs, etc. and ended with the statement "normal degenerative changs." A couple of docters looked at the MRI and said nothing was wrong, but the neurologist I was seeing sent me to physical therapy and it was amazingly effective for my finger and ear pain. I now have a cervical traction machine I can use at home when I need to and I learned stretching and strengthing exercizes to do on my own.

I never had the other finger symptoms you describe, so I can't comment on that. I would much rather do physical therapy than have surgery. I hope you're able to find something that works for you. Best of luck, Cheryl

You might request a few physical therapy appointments and have them teach you nerve gliding exercises. Or, you can try the DIY version by finding instructional videos or diagrams online...

The height of your desk, chair, mouse and keyboard should be evaluated as well. An Occupational Therapist can be brought in to check your work station if you have a desk job, but again you can probably find this info online. If you do use a mouse, you might consider trying out a touch pad instead--it's more an issue for carpal tunnel patients, but they can cause lots of damage, so...

BTW, you can have false negatives on nerve tests. My nerve responses are faster than normal, so it took years before they dropped to below normal range. http://rheumatology.oxfordjournals.o.../42/4/602.full

Thank you for your help, everybody!

I'm going to go see my GP and see if I can get any imaging done.

Ironically, since seeing the neurologist I have had some spinal pain where the neck meets the shoulders. Apparently the medial trunk of the brachial plexus, where the ulnar nerve branches from, originates near C7 and T1, which is around the area of this pain. Perhaps there is a pinch in the nerve up there that is worth investigating!

Again, thank you for your insight!