Ulnar neuropathy

[Adamantane]

A year or so ago I developed what has finally been pinned down as a bilateral ulnar neuropathy, which means that I have some numbness and tingling in my fourth and fifth fingers (ring and little) and beyond, and from time to time expanded numbness as well as some arm and shoulder pain. The cause according to the nerve conduction studies is compression of the nerve that runs through the elbows, and the standard treatment is surgery. (Carpal tunnel is the same thing but in the wrist.)

For some reason, except during periodic episodes of arm and shoulder pain, there’s been no discernible effect on my riding, which I find pretty amazing.

The cause is a bit unclear. The neurosurgeon seems to discount one hypothesis of the neurologist who did the studies that it related to some heavy lifting disposing of trash following a very sudden weight loss.

I’m very glad that they eliminated a decades-long cervical compression of C6/C7 as the cause, which until recently was the suspicion, having been aggravated by a fall while riding. Having somebody cut on my arms is annoying; having someone cut on my neck is very frightening.

Anyone else have experience with this?

[RMJacobs]

I don’t know if it’s precisely the same problem, but I have ulnar nerve entrapment. I was given two options–physical therapy or surgery. Of course I went with physical therapy, and the results were just amazing. I had the feeling back in my pinky and ring finger after one session (after not feeling them properly for years). If I keep up with the exercises. I keep the problem at bay. When I get lazy, it comes back. The nice thing about this approach is that I can even do the exercises at my desk at work if it starts bothering me excessively during the day.

Rebecca

[Adamantane]

[QUOTE=RMJacobs;6829043]
I don’t know if it’s precisely the same problem, but I have ulnar nerve entrapment. I was given two options–physical therapy or surgery. Of course I went with physical therapy, and the results were just amazing. I had the feeling back in my pinky and ring finger after one session (after not feeling them properly for years). If I keep up with the exercises. I keep the problem at bay. When I get lazy, it comes back. The nice thing about this approach is that I can even do the exercises at my desk at work if it starts bothering me excessively during the day.

Rebecca[/QUOTE]

Yes, it’s the same thing, thanks! PT wasn’t mentioned. I’ll need to check that out! (Even if I choose to go with surgery ultimately, it would seem to me likely that if things are calm, the surgery is likely to go better than if there is something actively flaring up.)

[jen-s]

I did PT and chiro for mine. It was caused by a fall on asphalt when I landed on my elbow and crunched the bottom of my olecranon and ulnar nerve. It took a couple of years, ok, maybe 3-4 really, but eventually I noticed it was “normal” and had been for as long as I could remember. I also had no problem riding.

[Adamantane]

Still mulling over options. Need to discuss non-invasive interventions such as laser therapy with my chiropractor and massage therapist, possibly if for no other reason than to make a successful surgical outcome more likely.

[sandsarita]

Also look to make sure you aren’t doing things to irritate your ulnar nerve such as leaning on your elbows at your desk. For me, one of the big things was riding my bike in the aero position put a lot of stress on the nerve and stretched it. The other big one was the position I slept in at night, elbows bent all the way putting the nerve on maximum stretch. My PT developed a little brace that I use at night when the nerve is inflamed that keeps my elbow in a neutral position, and after using it for a while (time varies depending on how inflamed/far out I’ve let it go), the symptoms go away. That being said, I don’t have nerve damage yet, and I am trying to keep it that way. I’ve already had too many arm surgeries from broken bones and I don’t need any other surgeries. Good luck!!

[lv4running]

OP, your options for fixing this are really based on the actual nerve conduction numbers. If you conduction was down in the 30’s you simply need surgrey before the nerve shuts down. Glides, steroid pulls, etc are all when the nerve is still in the 45-60ms range.

Carpal tunnel isn’t quite the same, and ulnar nerve transposition has a MUCH better outcome. Which surgery are you considering? Submuscular or not?

[DancingFoalFarms]

Mine was entrapment after my thumb and wrist were shattered in an auto accident. I went the PT route first, then injections, and finally when I could no longer write or hold reins, I had surgery. Two years on and the surgery worked beautifully for me. Fairly fast recovery, lots of PT after – including cold laser and ultrasonic therapies. However, I have a fully functioning hand again – and although it sometimes aches – I have no numbness or discernible weakness

[Adamantane]

[QUOTE=lv4running;6843534]
OP, your options for fixing this are really based on the actual nerve conduction numbers. If you conduction was down in the 30’s you simply need surgrey before the nerve shuts down. Glides, steroid pulls, etc are all when the nerve is still in the 45-60ms range.

Carpal tunnel isn’t quite the same, and ulnar nerve transposition has a MUCH better outcome. Which surgery are you considering? Submuscular or not?[/QUOTE]

I wasn’t provided the numbers but will find out, thanks. That would be good to know. The simple decompression surgery was recommended as outcomes appear to be statistically identical to the more complicated and elaborate transposition.

[Adamantane]

The neurosurgeon said that I would be able to resume normal activities almost immediately. I’m not sure whether riding is what he would consider a normal activity. Curious how long it requires to ride comfortably. For some reason even during the worst of the bouts of arm and secondary shoulder pain, riding never seemed to be much affected or contribute to the pain.

Had surgery for a torn meniscus some years ago and discovered to my surprise that the pain was worse post-op and continued to be worse relative to pre-surgically for months. Apparently there was nothing unusual about my surgery, although the orthopod did say that he had to carve out more than he originally thought, and no complications to my recovery. Eventually there were only twinges and pain if I dangled my leg, then finally, two years later it was as if there never had been anything wrong. The surgeon assures me that the time course for an uncomplicated recovery is not even remotely comparable to that.

Since it is bilateral, I asked if they would do both sides at the same time. Apparently not. Typically they start with the more affected side first, I am told, which is my right. (I’m primarily right-handed.)

[DancingFoalFarms]

I’ll be honest: it was at least 6 months before I could ride. It’s not the actual holding the reins / joint articulation that was at issue for me, but that I’m a dressage rider and currently have 3 young horses of my own that I’m training – one that I was saddle breaking at the time. Therefore, the intense and unexpected traction / torsion that a BIG young horse can exert on the hand / wrist was more than my surgeons were willing to sign off on for awhile. Luckily, a good friend let me borrow her horse for a post op ride, so that my docs could get a sense of how the site was healing and functioning. I found that I could manage to ride using a double bridle, while carrying a whip in the affected hand, with only minor weakness. That weakness is now negligible, and my grip force is almost identical on both hands. However, at the end of the day, after lots of riding, barn work, and then typing, I do occasionally ache.

As a side note, I developed compartment syndrome post op, which initially complicated things, but after lots of PT, etc regained sensation in the hand.

[Adamantane]

[QUOTE=DancingFoalFarms;6844508]
I’ll be honest: it was at least 6 months before I could ride. It’s not the actual holding the reins / joint articulation that was at issue for me, but that I’m a dressage rider and currently have 3 young horses of my own that I’m training – one that I was saddle breaking at the time. Therefore, the intense and unexpected traction / torsion that a BIG young horse can exert on the hand / wrist was more than my surgeons were willing to sign off on for awhile. Luckily, a good friend let me borrow her horse for a post op ride, so that my docs could get a sense of how the site was healing and functioning. I found that I could manage to ride using a double bridle, while carrying a whip in the affected hand, with only minor weakness. That weakness is now negligible, and my grip force is almost identical on both hands. However, at the end of the day, after lots of riding, barn work, and then typing, I do occasionally ache. [/QUOTE]

Fortunately I’m not in that situation, but maybe a few weeks of longe lessons wouldn’t be out of order. Hard to know what will hurt and what won;t until I’m actually dealing with it.

[Adamantane]

So what about anesthesia? I’ve decided upon the surgeries, presumably three weeks apart. I loathe general anesthesia, having seen the irreversible life-destroying mental wrecks that has left others in, including my elderly late mother. My neurosurgeon prefers a general for a 30 minute procedure. What have others used as alternatives? I’ve fought this battle with anesthesiologists in the past. They hate having to do anything more complicated than sticking a needle into an arm, but I saw what happened to others who underwent generals.

[jen-s]

Sadly, since you’re having nerve work done, you won’t be a candidate for a nerve block. I think you’re likely stuck with traditional anesthesia. But, I’d absolutely argue to talk to anesthesia long and hard before surgery.

[PalominoMorgan]

I have similar issue but when I was dx it was called Thoracic Outlet Syndrome. I had nerve conduction study done. The dr who did my test said that surgery was usually not very successful for TOS. In my case the issue is coming from an issue somewhere in my cervical spine. (That is already a mess so I wasn’t surprised to hear that.)

I was shocked to be dx with TOS bc I had been told 10 years earlier I had carpal tunnel and that was confirmed with conduction studies. I have a connective tissue disorder so my body is always doing wacky things.

[2ndyrgal]

Have it

It is annoying and sometimes painful. Occasionally feels like I grabbed a hot wire.

My surgeon (who just did both my shoulders) says it’s likely from years of repetitive motions w/weight, ie I cleaned stalls and rubbed racehorses for years.

Unless the pain becomes unbearable, I will likely do nothing about it. It hasn’t ever affected my riding and is usually the worst when I wake up in the morning.

DMSO and Cortisone helps (not recommending this) as does a course of Prednisone I’ve been prescribed for something else altogether.

Mostly I just live with it. But I completely understand why baseball players abuse steroids. If they weren’t illegal and didn’t have such nasty side effects, I’d be all over it. Make you feel 9 feet tall, bulletproof and 16 again.

You’d think the medical community could come up with something that was safe and effective for pain.

And getting older

[Adamantane]

Thought I’d updated this after the surgeries but apparently not. Better late than never.

The first was done at the end of March and the second ~2 weeks later on my dominant side after I knew what to expect. Didn’t need general anesthesia. Recovery was quick, so I took lessons a few days after each while covering the site (exposed, surgistrips) to keep it clean. It entailed so little pain that I kept overdoing unawares. No problem with shifting the 5-speed. The only hitch was that the incision on my right side was right over the boniest part of my elbow and bled to one extent or another for at least a couple weeks. The bed sheets looked like the scene of a murder since I saw no point in washing them until they wouldn’t get blood-soaked again each night. It was a king so I just switched sides after the first week. (Pre-wash meat tenderizer removed every trace of blood from the cotton sheets.)

My left arm is 95% normal (as in pre-problem 1/1/2011 baseline) again and continues to improve as predicted by the neurosurgeon (nerves regenerate about one inch per month). Affected muscles in my arm and hand have regenerated and as far as I can tell strength is now normal, as of course is range of motion. No left shoulder pain since the surgery.

The right had been worse from the outset and is significantly improved though I get twinges and still have noticeable 4-5 finger numbness. When my hands get cold near or below freezing – I ride without gloves when possible – my fingers no longer turn white on either hand but instead remain pink.

I signed up for PT a few months ago because my right arm still had twinges and there was soreness around the shoulder joint, apparently because the interactive complex of muscles and tendons related to my rotator cuff due in part to misdiagnosis as a cervical issue, spent a long time compensating in asymmetrical ways. Right now range of motion, strength and flexibility are pretty good except for a tendon associated with my biceps. That keeps getting yanked on mostly from random lead-rope surprises. PT told me if I quit riding and periodically traumatizing it, I’d be 95% in 6-7 weeks, but if I didn’t it would be more like 6 months. It’s doing better and bounces back more quickly every time I strain it a bit, but there are 4-5 months left to go on that. Some things aren’t negotiable.

Thanks to everyone who posted for your advice and support early last spring. If this had been rightly diagnosed much sooner, long ago this whole episode would have been history.

[jen-s]

Glad to hear things are better!!

[equisusan]

[QUOTE=2ndyrgal;6905630]
But I completely understand why baseball players abuse steroids. If they weren’t illegal and didn’t have such nasty side effects, I’d be all over it. Make you feel 9 feet tall, bulletproof and 16 again. [/QUOTE]

I think we are talking about two different types of steroids here. Anabolic steroids are what sports folks are taking to cheat and increase muscle mass. Corticosteroids are like Prednisone and what we inject in our horses’ hocks along with HA. Great anti inflammatory but not good for long term use.

I’m just in the diagnosis process. I had a repeat MRI of my neck this week and I get the EMG next Thursday. I just hope its something they can operate on and fix as the effect on my hands has certainly incapacitated me. I’m ready to get this done and be onto recovery before show season.

Glad to hear you had a good outcome.

[Adamantane]

[QUOTE=equisusan;7432243]

I’m just in the diagnosis process. I had a repeat MRI of my neck this week and I get the EMG next Thursday. I just hope its something they can operate on and fix as the effect on my hands has certainly incapacitated me. I’m ready to get this done and be onto recovery before show season.[/QUOTE]

Every best wish for a good result. My cervical MRI had shown some “very old” damage that I trace to an event when I was 17, but that proved to be the red herring that delayed intervention.

Nerve conduction studies on both arms conclusively eliminated any cervical contribution despite what even I could see looked to be concerning, so I can’t blame the original doc – the human body is remarkably resilient – but offered up a smoking gun for bilateral ulnar compression.