Puzzling Ulnar Nerve Test Results

Hi Jon,

Sorry to hear about all of that, I hope you recover soon!

When you flex your elbow joint, this can stretch the ulnar nerve, putting pressure on it and compressing it. This compression is what makes your hand go numb, because the nerve isn't able to function properly. This is also why leaning on your elbows a lot adds to the pain.

When you keep your arms straight, this helps to prevent the nerve from stretching, getting compressed and hopefully making your hand go numb! Unfortunately, it's not foolproof and doesn't work 100% of the time.

I don't know about how to apply it to knees, sorry.

Try to find an elbow brace with a splint, or just a firm elbow brace that still allows a little bit of flexion (but doesn't let your elbow flex more than, say, 90 degrees). See what works for you. For me, just having a more rigid elbow brace that allows a certain degree of flexion is okay!

Here is what cubital tunnel sleeping splints look like, so you have an idea what angle you're shooting for if you try to splint.  Unfortunately these custom UCLA splints cost $400 each.  They look pretty disappointing don't they?  There is a much cheaper way - some people safety pin their pajama sleeves to their pajama pants. They say it helps!

As far as the hospital pain reduction, the opiates seem like the reason I might think.  Opiates are not the go-to med for nerve pain for a variety of reasons, but they do help a lot of people with it.  It's just unfortunately not a good long-term solution.

But you could also look at the symptoms for TOS as well, just in case.  I thought since you have symptoms in your feet this would rule it out.  But I recently found out some people have symptoms in their feet as well, really surprising.

Here's another thought - T4 Syndrome. I'm not sure how likely that is for you, but check the symptoms just in case they match you. 

https://www.shoulderdoc.co.uk/article/1630

It sounds like you could have compression of the ulnar at the elbow, so it could just be cubital tunnel. As far as I understand it, the negative nerve conduction study results do not mean that you don't have cubital tunnel. Don't base ruling it out on the NCS. 

If it is c.t., you'd have ulnar transposition surgery and very likely improve. It's a surgery that has fairly good results in patients improving.

But you can also get symptoms made worse at the elbow when the initial source is elsewhere.  Like my nerve compression is at my 1st rib and also my pec minor, so my nerves are agravated/firing.  Subsequently, leaning on my elbow (the one I did not have the transposition surgery on), causes more nerve pain. I can lean all day on the elbow I had the surgery on, no problem.  It's not that I have compression there, it's that the lightest touch sets of an already overly sensitive nerve.  If I didn't have the severe compression further up, leaning on the elbow would probably not cause any symptoms.

You could also have compression of nerves exiting the spine. T4 is an example that causes numbness & tingling in the hands.

I wish I knew the answer for you and I'm sorry it's been going undiagnosed for so long.  I hope you find the neurologist who can really help.

Hi .. 

I love the safety pin idea!!! Genius!!!

I also think wrist to ankle pieces of elastic could be good. 

I wonder if there is anything out there showing that the arms straight at night is actually proven to help some people? It doesn't seem to be very well advertised if it is? If it does work ... perhaps there is an equivelant for feet!!

What's the test to show Thoracic-Outlet-Syndrome? I'm sure TOS hasn't been mentioned by my doctor before. I hadn't heard of it until it came up last year on this post.

You could be right about the Morphene. Although i am still in a lot of post op pain and so it could also be my body focussing on the worst pain. .... Maybe?

If the pains come back properly..... I'll try it again and see if it works again... I've still got a couple of bottles of Oramorph.

Thanks for your reply by the way .... 

Hi ..

Thanks for all of the information you've sent me. It's very kind. I'l let you know what I find out.

Regards ... Jon

I don't want to send you down a wrong track since TOS is not very common and gives many negative test results (even when you have it). 

But there are a few easy tests you can try at home.  If you repeat each of these tests a few times, and they reproduce your symptoms (nerve pain/tingling/numbness in the hands), it is worth talking to a doctor about. 

So TOS can be compression of 3 things: nerves, vein, & artery going down each arm.  Doing these home tests, you can only easily test for the nerve compression part.  (when this video talks about checking the pulse for bloodflow compression, that is better done by a dr or physical therapist)

Symptoms vary (since there are 3 kinds - nerve, vein, artery), but here are possible symptoms:

Numbness or tingling in your fingers or arm

Numbness, tingling, or weakness when arms elevated or above head

Pain, aches, or tight muscles in your neck, shoulder, upper back, or hand

Weakening grip

Arm fatigue after activity

Symptoms increase with arm & hand use

Symptoms decrease with less use

Discoloration of your hand (bluish color)

Arm pain and swelling

Lack of color (pallor) in one or more of your fingers or your entire hand

Weak or no pulse in the affected arm

Cold fingers, hands or arms

Tinnitis

Dizziness

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Hi John,

I'm sorry that you're feeling this way!

I never found answers, because I never fulfilled the referral to a specialist.

I have, however, got better at managing it, which has alleviated some of the symptoms. For example, using a soft splint to limit elbow flexion whilst sleeping, not resting elbows on hard surfaces, or wearing elbow pads if I have to work at a desk.

All the best!

Hi ..

Thanks for the info ..

I'm still getting a lot of big post op pains from my non-related February operation and still ... my nerve pains are very low on the pain scale... 

I wonder when the operation pains go if the nerve pains will rise again ... 

Very strange ... 

I have already had an Ulnar nerve decompression last year( simple surgery) . I have pain at my elbow, tingling in my pinky, pain in my shoulder blade and a little in my armpit. Have had MRIs,xrays , emgs etc. Only thing that showed was 2 very small cervical ribs. My doc says this isn't the problem but can't tell me what is. Have done lots of strengthening exercises of my back and shoulders. Plus 6 months of pec stretching. I can't get a diagnosis. Iv lived in Australia and now Ireland. Some of my scans even went to America.!! Between the 3 countries no one can diagnose me

Hi John,

Your symptoms match mine exactly. I'm curious if you have made any progress in your quest for answers. I also have cubical tunnel as well as horrible pain in my scapula and at the bottom tip of my scapula near the armpit. The cubital nerve transposition surgery I had a few months ago did help alleviate some of the hand and elbow pain. It did nothing for the scapular pain however and when that is bad it makes the whole arm down to the fingertips inflamed. The exact same thing is starting to happen on my other side now. Tests all reveal nothing, not even ulnar nerve entrapment but I had the surgery anyway since I had all the symptoms and my muscles were atrophying rapidly and it had been going on for years already. Apparently that part is t abnormal in an otherwise healthy person but why the scapular pain? It's technically not a symptom of ulnar nerve issues but it's directly correlated in our cases. They are going to try treating me for scapulothoracis bursitis next to see if that is the issue so I will let you know if it's successful. Considering this is now happening on the other side I seriously wonder about that.

Can you let me know if you have found out anything new which might help?

Thanks and all the best!

Please go see a Thoracic Outlet Specialist, both of you. You both match the symptoms of TOS, esp. John having cervical ribs & Sharna having scapula pain.  If the diagnosis is indeed TOS, you are using valuable time you don't have.  The longer it goes untreated, the harder it is to make progress.  If the diagnosis is not TOS, then no harm done!  It must be a TOS specialist, a vascular surgeon who has experience with it.  They will do a vascular sonogram and refer you to a neurologist who is experienced with this.  At the very least, you can join the facebook group "Thoracic Outlet Syndrome (TOS) Support Group" and browse posts to understand it better and see if what people are talking about matches your experience.  For example just put "scapula" or "cervical rib" in the search bar.  In the files section, there is a document "Surgeons/Doctors that you recommend" that has an extensive list of specialists. There are about 10 for the UK.

Excuse me, I meant Halina with the scapula pain, not Sharna.