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Help...Ulnar Nerve Entrapment


#1

Has anyone had any experience with Ulnar Nerve Entrapment? I have been experiencing tingling in my pinkie and ring fingers in my left hand for about three months now. Originally I thought it was because of a back injury I sustained nine months ago, but apparently this is not the case. I had an EMG done yesterday and it showed my Ulnar Nerve in my left elbow is only about 50% functional. So far, I have not lost any grip strength, but a muscle in my hand has atrophied slightly. The doc suggested I try cortisone shots first. If they do not work I may have to have a surgery called anterior submuscular transposition, which basically moves the position of the nerve in your elbow. I am not opposed to the cortisone shots, but I want to avoid surgery at all costs. Do you guys think ART would be helpful in this case? I am not sure if the entrapped nerve is a result of a specific injury or an overuse injury at work(I sit at a computer all day). What do you think about the cortisone shots? Any other suggestions? As you can imagine I am devastated by this injury because I love to train. I am really at a loss right now, so if you have any advice I would appreciate it. Thanks.

Paul


#2

It could have been cause by a fall, keeping pressure on the nerve (keeping arms bent for long periods of time, like you at work). I work on a comouter for long periods also. Try taking breaks every hour for 10 minutes. The continued stress on the nerve from work is what most likly caused this to happen to you.

If this is in deed what you have keeping your arm straight is the best treatment short of surgery. Keeping it straight puts less pressure on the nerve itself. Anything that keeps you with a bent elbow should be avoided. e.g. talking on the phone, typing on the keyboard at work with the elbow joints bent, sleeping with the elbows bent. Some of the methods to alleviate this is keep your desk area spread out so you're arms are not bent more than 30 degrees. DON'T cross your arms. Keep your arms straight during sleep and use something that will keep it straight without too much pressure e.g. an elbow splint, towel. If you're participating in sports that have contact involved wear a pad to protect it. If these methods do not alleviate the pain, numbness or tingling a cortisone shot and surgery are your next choices.


#3

art asap!!!!!!!!!


#4

Yes, it is directly related to your work. I had the exact same thing. It is caused by resting your elbows either on the computer desk or on the arms of your chair. It is also caused by keeping your elbows bent for long periods of time. I went through therapy for my hands, lots of stress ball stuff. My doc said to keep my elbows straight whenever I can and he actually suggested I take vitamin B-6. B-6 will help to rebuild the mylin coating around your exposed nerve. (That is why your hands are numb.)


#5

Hi again Mizzou! I had this EXACT problem but in my right arm, for about 8 agonizing months. I read and tried everything. My EMG test showed loss of nerve function in my pinky, ring finger, and hand. My forearm muscles were in permanent spasm. My doctor recommended surgery to move the nerve. But surgery and steroid injections have a very poor prognosis for these problems. And I kept thinking, if the nerve position makes it vulnerable, if typing all day long is bad, etc. -- then why doesn't my left arm hurt AT ALL? My nerve in the left is in the same position, and my left hand types all day long too.

After about 8 months, my pain just magically disappeared, practically overnight. And my nerve function returned to normal just as fast. With no surgery. But it wasn't magic; I was doing a lot of things to help my situation, and it just took time to work.

I have now done a lot of research on this kind of pain. I believe it is originally caused by chronic irritation of nerves and tissues because of poor postural mechanics, and then it is perpetuated by stress, anxiety, and/or subconcious tension. It is not computer use that CAUSES the problem, but computer use WITH poor postural mechanics and high amounts of tension.

Here is everything I did to fix my problem. I believe ALL these steps helped:

1) Improved computer ergonomics. (I work on a computer all day, 8-14 hours.) I elevated my monitor, bought a fully-adjustable keyboard/mouse arm with gel cushioning (from Lee Valley tools), and moved the mouse to the left side. I also got a task chair positioned nicely.

2) Improved postural mechanics and motor control through chiropractic adjustments and Egoscue exercises ("Pain-Free at Your PC"). Also through light but consistent aerobic exercise.

3) Got a brace made by an occupational therapist to wear during sleep, to prevent me from flexing my poor arm all night. Saw big improvement soon after I was able to wear it all night (at first, I would wake up and the brace would be nowhere to be found!).

4) Read "Healing Back Pain" by John Sarno and decided that pain didn't have to make me afraid to do anything. There is a CNS component to pain, tightly linked to emotions and the subconscious. Soon after I read this book, my pain disappeared.

Understand that you HAVE to fix your postural mechanics if you want to be pain-free. You HAVE to. A few years after my arm-pain incident, I backslid in my postural issues, and then suffered from back pain. When you sit all day, you inactivate many of your muscles, and over time, your tissues become irritated, your posture degrades, and your motor control becomes impaired. The only way to counteract this is with MOVEMENT. Yet, when in pain, we become afraid to move.

I am confident the right movements will eventually fix you. But you have to realize, it takes a long time for the damage to accumulate and cause pain, and it also takes a long time for the healing to accumulate and the pain to go away. My posture improved a long time before the pain did. And the second component is not to fear and avoid the pain. People who show fear and avoidance behavior (e.g. "I can't _____ because it hurts") are the ones who tend to have chronic pain, no matter what treatment or surgery they have.

I have more information and recommendations if you're interested.


#6

Bump...


#7

Andersons- Thank you so much for all the advice. Until two days ago, I thought the tingling in my fingers was being caused by my upperback injury, come to find out I have a trapped Ulnar Nerve in my elbow. The doc was not sure what caused the entrapment, could be work or a specific injury (I can?t seem to remember one though). My thought is it has to be related to work. I started a job seven months ago that requires me to be at a computer 8-10 hours/day. All of the sudden about three months ago the tingling in my fingers came out of nowhere. Since then, the combination of the upperback injury and tingling has almost made me lose my mind. There are a few things I have tried to change to improve my workstation in the past six weeks:

1) Sit up straight up with shoulders back
2) Raised monitor to eye level with a phone book
3) Bought a standing clip board so I don?t have to look down as much
4) Just yesterday I read that a flexed elbow can aggravate the Ulnar Nerve, so I will concentrate on keeping my arm straight as much as possible

If you think ?Pain Free at Your PC? is worth the money then I will purchase it along with ?Healing Back Pain?. Who knows, maybe I will learn something knew about my upper-back injury as well. A few questions for you:

1) Are there any exercises you did besides cardio? Did you train legs at all? I have some atrophy in my hand so is there any hand strengthening excercises?
2) What is the name of the brace you wore at night? Would it be beneficial to wear during the day? I wrapped an ACE bandage around my elbow last night in attempt to keep my elbow from bending as much
3) Do you know anything about cortisone shots? My doc was really pushing it. Maybe that with the improved mechanics at work would be a good one-two combo?
4) Did you take any supps or meds to aid your recovery? As you read, I recently started taking Wobenzyme, but have not noticed anything yet. The doc gave me a seizure med called ?Topamax? for the tingling, but I am not sure I want to take it. What about Vit B-6? I saw another poster recommend this.

Thank you again. It helps a lot to know that there is/was someone out there with this condition and that there is hope for a surgery-free recovery.


#8

MizzouDawg, in addition to all of andersons FABULOUS advice, I would recommend supplementing with r-ALA at 600-800mg per day in divided doses of 100mg each.

r-ALA improves nerve blood flow, reduces oxidative stress (of the nerves), improve distal nerve conduction, and it will help reduce the pain of nerve damage. It is often used to treat diabetic neuropathy. What is most exciting is that it has been proven to help with nerve regeneration. Not many supps (or drugs) I'm aware of do.


#9

Mizzoudawg

"As you can imagine I am devastated by this injury because I love to train."

An Ulnarnerve problem hardly affect training at all. I got stabbed many years ago and got my Ulnarnerve cut just above the elbow. Only problem is weakness so I have to use straps when going heavy (deadlift only) and slight pain in the palm when I benchpress, I had to use padded gloves the first five years after the "accident". If it becomes cronic, hope not of course, there's no reason it should slow you down, it didn't stop me from training. You just have to addapt.


#10

I wanted to bump this up one more time. Thanks for all the great advice.

Tampa-Terry- I was thinking of adding r-ALA anyway and this just gives me another reason to do so! It sounds like you are a huge proponent of this supplement.

Moose- You may be right about training with this condition. My intuition tells me that lifting weights with an entraped nerve may not be good in the long run however. For the time being, I cannot lift because of a chronic upper-back injury. Once this injury is healed, I may return to light lifting to see how the tingling reacts.

Does anyone else think ART may help?


#11

Interesting - my hands go numb whenever I'm laying down with bent arms - and sometimes at my computer at work. I though I was cutting off a vein or something and was a circulation issue.


#12

MizzouDawg, your best bet would be to go to the Active Release web site and find a few practitioners near you. Give them a call and see what they say.

Be willing to extend your search for a talented practitioner, though. I have a number (about 6) in the state, and I'm headed to Atlanta (an 8 hour drive) because the guy there knows what he's doing. The guy in Atlanta gets a lot of business from Florida, unfortunately.

Before making the decision to drive all the way to Atlanta, I did have a number of conversations with the docs up there.

Good luck to you, and yes, I think r-ALA is one of the more important and more valuable supps in my regimen.


#13

I was seeing a PT for similar pain and numbness in my arm. When I read this thread, I called my doc and asked him if he had considered it. He said it wasn't because I didn't have numbness...to which I replied that I told him that I did when I saw him. Short story shorter, I have an EMG next week to see how bad it is.


#14

Mizzoudawg

You're right; it's not good to train with an entrapped nerve. Of course you should get it fixed. What I meant was that IF it gets permanent it shouldn't be much of a problem.
Annoying, yes.
Stop you from training, NO.


#15

Tampa-Terry, thanks for the info about r-ALA. I didn't know any of that. GREAT stuff!

Mizzou, I'll keep taking stabs at your questions. But first of all, "ulnar nerve entrapment" is nothing to worry about! I've had it. Been there, done that. The term sounds fancy and scary, but it just means that something is compressing your ulnar nerve and preventing it from sliding freely. It's horribly painful, but you can fix it! The WORST thing you can do right now is to be afraid to lift, afraid to work out, afraid to do anything to "damage" your arm. What is the cure for something that's immobilized? MOVEMENT! ANYTHING that your body can do -- even if it hurts -- is perfectly fine to do and is not going to hurt anything.

The absolute worst thing you can do is to restrict your activities. Do NOT allow yourself to think "I can't do ____ because I have ulnar nerve entrapment." You're immobilizing yourself. Immobilization will never free any nerve.

With all due respect to doctors, most, probably 99% have no clue about these painful conditions. It is really sad, because there is a lot of great information out there in the research literature, but the doctors know nothing about it. Even the physical therapists I have seen know little about it.

Back to ulnar nerve entrapment. Aside from some catastropic injury that would show up on an X-ray, what "entraps" nerves? Muscles. A healthy muscle's fibers slide freely, and so does the nerve. Simply increasing the resting muscle tension can "trap" and press on the nerve. Overly tight muscles also change the space in a joint, causing compression there.

This is one reason why surgery does not really fix the problem of nerve entrapment: the CNS determines what muscles do. You can move that one nerve, but if you don't have good descending inhibition from the CNS, you'll have a different painful problem soon enough because you haven't fixed the SOURCE of the problem.

Nerve entrapment IS horribly painful, but it's not dangerous. Here is a "neural flossing" movement that can help that ulnar nerve slide freely:

Stretch your arm out straight to your side, palm facing up. Bend elbow AND wrist to 90 degrees. Slowly lean your head to the side, away from your arm. You will probably feel your ulnar nerve stretch, on the inside of your elbow. This may trigger or reproduce your pain. Don't worry, that's OK. Remember that pain is just a sensation, an interpretation of the way nerves are firing. Slowly and rhythmically move your head back and forth, gently stretching or "flossing" the nerve, 25 reps. Don't overdo the stretch, just a little at a time.

Even spinal nerves severely compressed by herniated disks show the ability to heal and regenerate and slide freely again. The nerve apprears to be able to "dissolve" the tissues around it so that it can move freely again. The "flossing" facilitates this healing process.

Now to your questions:

I firmly believe you can do just about ANY exercise. YES, train your legs! Why not? You can train upper body too. The only important caveat about training is this: Don't do anything that perpetuates the postural problems you have. Priority #1 is to fix ALL of your postural mechanics. If you have pelvic tilt, for example, it will affect your arm. Gotta fix it.

The brace was custom-fit by an occupational therapist. Nothing fancy; it's just a plastic that softens in hot water. While it's soft, she squeezed it around my arm to fit, then stuck some Velcro on it. By the way, the equilibrium point for the elbow is not straight; it's a slight bend, like 150 degrees or something.

I don't know about daytime wear. If you feel your forearm muscles are rock-hard (i.e., in spasm), the brace might help them to relax. Night was important, because I was flexing my arm hard all night. My arm would be fully flexed with my fist clenched tight, while I was sleeping! Apparently, this is common in people with these problems. It's really similar to teeth-grinding or jaw-clenching, and all are signs of stress and anxiety.

No, I wouldn't recommend the cortisone shots. The medical profession loves these, but I think the negatives outweigh the positives. The only thing they seem to be good for is short-term pain relief. I'd rather be patient and recover in a healthful way. Good mechanics at work won't eliminate the pain immediately, but will matter in the long run.

If you are not currently taking a high-dose B supplement, it wouldn't hurt to try. I knew B6 wasn't my problem, because for years I have taken Whitaker's Forward multi with high potencies of all the B vitamins (you should take all the B vitamins together).

I would doubt that Wobenzyme will help you with this problem. I'd rather see you take fish oil, a lot of fish oil, like 10+ grams EPA+DHA per day. This is a great, systemic anti-inflammatory, specifically beneficial to joints (your elbow is probably irritated from the chronic muscle tension), and essential for healthy nerves.

I am so happy to be able to help. And Yes, it IS great to know that others have healed.

I highly recommend John Sarno's book. I believe it is EXACTLY what you need. From what you've written, I wouldn't be surprised if the mind-muscle connection is, at this point, responsible for 95%, if not 100% of your pain. By the time I read the book, that was the case for me. Within days after reading the book, my pain was virtually gone. I had already fixed my office ergonomics and my postural mechanics, and eliminating the residual CNS-induced muscle tension was the last piece of the puzzle.

Good luck and don't hesitate to ask more questions!


#16

Andersons- Thanks for all the wonderful information. Hearing what you say is really helping to ease my mind about this condition. I started reading John Sarno's book and it is very interesting. I definitely think there something to what he is saying. Along with ulnar nerve problem I had to quit working out for several months because of a muscle strain in my upper-back. Seven months later I am still having pain in that area. There really should be no reason for this injury to have not healed by now. I think my anxiety alone about getting back to lifting weights has probably given me TMS. I literally go to bed thinking about back pain and wake up thinking about it even though it is not severe pain.

After three months of not lifting is when I started feeling the tingling. Do you think this could be from increased muscle tension from not lifting? The gym has always been my stress and tension reliever, so maybe by being inactive I have increased muscle tension, thus compressing my Ulnar Nerve?

I have one question regarding the exercise you mentioned that allows you to ?floss? the Ulnar Nerve. I hold my arm straight out to the side and then bend at the elbow at a 90 degree angle then bend my wrist to the outside with my palm facing up, kind of like a waitress would hold a tray?

Thanks again for all your help. I will keep you updated on how I am doing.


#17

Yikes, MizzouDog! I can practically guarantee that if you stop worrying about your pain, it will improve tremendously. Look at Moose's post above again -- his ulnar nerve was actually CUT! and yet he is largely OK. Chronic muscle tension and spasm causes a great deal of pain. Sarno's book will help you tremendously.

Yes. Research has shown that people who fear pain and restrict their activities suffer from more chronic pain. (I will summarize some of this research in another post.) Fear, anxiety, and restricting movement all increase muscle tension. Exercise helps relieve muscle tension. I found that anything that caused my back, neck, and forearm muscles to relax would relieve my ulnar nerve symptoms.

Hold your arm straight out to the side, palm facing the ceiling. Bend at the elbow to a 90-degree angle, then flex at the wrist so that your fingers point toward your head (not to the outside). Then lean your head away from your flexed hand.

Yes, please keep me posted. I'm amazed at how similar your situation is to what mine was. I'm really encouraged by how you're approaching your problem!


#18

Here are some quotes from a good book that summarizes some of the research about back pain. (I post it here because it generalizes to chronic, musculo-skeletal pain, and also because back pain and ulnar nerve pain are almost certainly related.)


#19

This post is 2 years old!
However I wanted to bump it as a thanks for the info.

I am suffering from Ulnar Nerve Entrapment, also known as cubital tunnel syndrome and I needed to read this post. The doc wants to cut my elbows (both hands) but I am not giving in yet.

Thank you.