Puzzling Ulnar Nerve Test Results

Brain and nerves
1

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 forums I can post on?

Are there any other tests I can have performed?

Are there any ways of alleviating the pain?

I am at a dead end.

2

Hi Sharna,

You sound as though your'e having a tough time too.  I have what they call neuropathic pain which encircles my back and thus makes wearing a bra impossible as the area is super sensitive to the lightest touch.  I have been to various specialists, had an MRI, ultrasound, and a whole body bone scan and apart from expected degeneration in certain areas nothing showed up that could truly identify the cause of the pain.  I have now been given morphine patches but haven't used them as I am now going to see a chiropractor on Thursday to see if that will help.  I really feel your frustration as before Christmas I was fit,happy and healthy, going to the gym and now everything's changed.  But I will not let it beat me I still work really hard in the garden and I am also keeping busy in the house (I had just retired when this happened) so most of my plans have been put on the back burner.  I do so hope that you get some sort of help, I've tried orthopedic massage, physiotherapy, acupuncture and some other alternative therapy where a lady flicked what looked like an egg whisk back and forth and I parted with a lot of money (still makes me laugh now)!  Hope I have been of some help xx

 

3

Hello,

Some of what you are discribing sounds similar to what I've been experiencing. I often get strong pins and needles in my hand(s) at night. During the day I often get quite strong pains, mainly in my little fingers and ring fingers. It started on my left hand a year ago but moved to my right. I also get a similar pain in big toes but no pins and needles. This may not be related but it did start at the same time.The pains in my fingers are quite strong. I haven't noticed any triggers such as leaning on my elbow. They can start without me doing anything ... watching TV ... driving ... etc. The pains seem to effect one area at a time. So the left hand or the right hand but not both at the same time.

My nerve conduction test were normal as well. I've had several other tests but nothing so far.

I'd be interested to see how you get on and I'll be happy to tell you more about what I've had checked.

Regards .. Jon

4

Hello,

This sounds like the beginning of the same road I started down 8 years ago. I was diagnosed with cubital tunnel (ulnar nerve entrapment) and all of my symptoms matched this diagnosis perfectly.  I will condense my ridiculous path of seeing 30 doctors in two different countries - it turned out to be Thoracic-Outlet-Syndrome, compression of the ulnar nerve in the chest cavity.

While it is a long-shot that you have the same thing, I thought it worth mentioning.

I had the same symptoms you mention, including negative nerve conduction study findings.  A very reputable surgeon even operated on my elbow because of my ulnar symptoms, ith no results. 

Personally, ALL of my test results over the years were negative, including MRI's and X-Rays, until I was given the tests for TOS.  They are simple tests you can try a few times at home, and see if they give you a slight rush of ulnar activity/numbness.

Like I said, this is a long-shot when you consider how many causes nerve pain can have, but worth ruling out before you have drastic measures like surgery.

I'd start with finding a good neurologist and orthopedist who are interested in working with you to find your source. You might find your answer right away, and it could be as simple as a cortisone shot smile  But if not - just know that nerve pain can sometimes be difficult to pinpoint, you just need patience, a lot of research on your own, and hopefully a doctor who is willing to ride it out with you. Many doctors might give you a test, then give you an "I'm sorry I can't help you" if it was a negative result. Don't get discouraged.

A great forum is NeuroTalk.

Good luck!

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5

Hi Jennifer,

Thank you so much for your response. Sorry to hear about the grueling process you went through in finding your diagnosis! Do you mind if I ask you a couple of questions?

I looked briefly at TOS online, and it states that some of the symptoms include "pain, tingling, prickling, numbness and weakness of the neck, chest, and arms." Were you affected in the neck or chest at all, or was it mainly your arms? 

I've recently had a problem where if I inappropriately twist my back to crack my spine, it will make it difficult to breathe. So, a sharp pain will occur across my rib cage/lungs, making it possible to only breathe shallowly for a certain period of time. I'm now wondering whether this could be a pinched nerve, which could have some relation to my ulnar nerve problems?

After unsuccessful surgery for cubital tunnel syndrome, how was the search for proper diagnosis then directed? For example, what tests were conducted to conclude it was TOS?

Thank you!

P.s. A couple of links that you provided were removed upon moderation. Is there any way you can send them to me via a private message?

 

6

Hi Jon, 

I'm sorry to hear you are going through this. I hopre you are able to find some closure soon! What other tests did you have performed?

7

Hi Joyce, 

Your experiences do not sound very pleasant at all! I hope your chiropractor visit will be beneficial! 

8

Hello,

Can you tellme ... were your pains just in your hands?

And were your pins and needles at night .. pains in the day?

Any info is really appreciated ..

Thanks

Jon

9

Hi,

No problem. I hope my personal experience I'm writing here doesn't lead you down a wrong road, but here's how it's been for me....

Were you affected in the neck or chest at all, or was it mainly your arms? 

I have never had much problem at all in my upper body, nothing that I ever thought was related or even something I'd mention to a doctor. My posture could be better, but this never seemed like something to talk to a doctor about.  My pain is only in my fingers, sometimes palms, and when it's really bad my forearms can tingle.  It's only been after being treated for TOS that I can recognize trigger points and problems in my back and chest that I had no idea were there.

My route went -

Hand Specialists/Surgeons - Nerve Entrapment tests (tapping/bending/moving arm parts)

Neurologists - Nerve Conduction Studies, Reflex tests

Orthopaedist - Structure exams, MRIs of upper body

GP - Blood Tests, Thyroid test, Spinal Tap

Pain Clinic - Medications

Neurosurgeon - Reflex & Entrapemnts tests

Psychologists & Psychiatrists - as I was told many times it was Psychosomatic due to my negative nerve conduction studies

Treatments I've tried personally -

Sleeping Splints (this can help if it's cubital tunnel)

Cubital Tunnel surgery

Cortisone in wrist

Manual Therapy

Physical Therapy

Craniosacral Therapy

Strength Training

Accupuncture

Medications: Anti-epileptics, Novamin-sulfon, Tri-cyclic Antidepressants, Topical creams, Lidocaine Patches

Vitamin B Shots

Electrotensgerat (muscle relaxation)

Muscle Cupping

Kinesio Taping

Pilates

Low-Glycemic Anti-inflammatory Diet, eating Paleo

MBSR

PMR

Jon and Sharna - I'll PM you both some links that explain things better.  You probably have a major difference in where to look for your symptoms.  If they are only in your hands, then you need to look more at structural problems. If you are also having numbness in your toes, you might need to look at neurological and metabolic problems. 

 

10

I had an MRI on the back of neck and lower scull. This didn't show anything other than standard wear and tear. Because my toes also seem to be effected the theory is that the problem would be around my upper spine. I've had loads of blood tests and I'm having an xray this week. I'll be honest I'm not sure what all the tests were for. One of them was for diabetes.

It's been 14 months so far. I have had one stretch about 6 weeks ago when the pains practically stopped ... but unfortuanely they've returned and now seems to also effect my palms. That's a new one!

 

11

Oh yes .. I was checked for MS .. and nothing there either.

12

Hi Jennifer ..

If my toe and hand problems are caused by the same thing  ... and I think it's likely as the pains are very similar ... then it seems to point at neurological ... No-one has suggested metabolic problems. That's interesting. Can you tell me more about this?

Also ... which treatments do you find work for you?

13

There is one thing that happened a few months ago that was very weird. Until then I'd had pains in boths hands, mainly little fingers and ring fingers and big toes. One day I was trying to repair a light fitting and I gave myself a 240v shock in my right hand. I didn't sustain any injuries from the shock and in fact from that moment the pains completely stopped in my right hand for the next couple of months. They have now returned. I told my doctor thinking this might be relevant to my diagnosis but he didn't have much to say about this. Unfortunately .... I'm not trying it again as it really hurt and of course you can do real damage to yourself. I've tried tens machines since then but they had no lasting effect.

14

Follow up:

I have since had a cervical spine MRI and chest x-ray. 

The MRI was performed to look for signs of C8 radiculopathy. Results were normal, and showed no spinal stenosis or focal nerve root compression.

The x-ray was performed to make sure there were no tumours (e.g. pancoast tumours) causing nerve compression. Results were normal in terms of neurology, though thoracolumbar rotatory scoliosis was incompletely visualised.

It appears my GP doesn't know what to do from here, so I have a referral to see a neurologist. 

What would the neurologist offer me that hasn't already been done? I seem to be at another dead end!

15

Hi..

I am really sorry that you have hit more dead ends.

I've decided to keep a diary on pain levels, diet, sleep patterns, excercise, etc to see if I can find any patterns. It's worth a try I suppose.

16

Hello, I too am having these same symptoms... I have had two spinal fusions and I have cervical spondylosis as well as bone spurs. However they insist it is not from my neck. I have ahd ALL of the tests including TOS. My PT said months ago he elt this was the cause. I apparently have the "Extra Rib" that is reffered to i TOS. But the neurologial testing showed normal.  This has been going on since 2013 and I think that since the therrapist has been working on my neck anyway... it has gotten bette in that respect. However the pain continues in my shoulder, arm, wrist, clavicle and traps. I wake up with tingling fingers EVEN if I sleep on the opposite shoulder! It stinks.

17

I am sorry to hear of your problems. I still have no direction. Weirdly .. I recently have to have an emergency operation in relation to another matter and I had a 6 week respite from the nerve pain.

I'm not sure if it was do do with diet, being on an IV, change of enviroment, distraction of other pain..who knows??

The reaon for the op was due to a digestion problem and i couldn't eat for 8 days. I completly stopped all of my nerve pain meds. This was not ideal as you are supposed to gradually decrease them. I was admitted to hostital for 2 weeks and was on a drip for the majority on my time there. I did have morphene during my time in the hospital and Oramorph for a few weeks after. 

My nerve pains are only coming back now .. but nowhere near as bad and I'm no on any meds.

It is very odd. I am still in post op pain and so it could be that my body is focussing on those pains and not the nerve pains. I have read the body does this to some extent.

If that is what is happening then maybe excercise resulting in muscle pain/growth my distract from the nerve pains. Once I'm over my op ... if the nerve pains return I will be trying that.

Before the operation ... Another thing that a doctor told me is to try sleeping with my arms as straight as possible. Something to do with the elbows. I tried this and I also think it may make a slight diference. I seemed to get less pins and needles  and when I get less pins and needles in my hands I generally get less finger pain. (It doesn't help the toes!)

I'd be interested to know if anyone has a view on the strange decrease in nerve pains as soon as i went into hospital and also the straight arm at night thing ....

18

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.

19

I've never applied this stright elbows at night thing with any structure and of course once asleep who knows what you do. 

When I was in hospital I was on my back and pretty straight and the pains stopped. 

There msut be some devices out there taht could be used at night that would have a more constant positive affect.

Also ... if this can help the hand pains .. and many people also get the toe pains ... does that mean if you apply the same principle to the knees you may also benefit?

Anyone got any info on this?

It would be good to see if a few people with similar hand pain problems on the forum could benefit from a test run with some sort of elbow braces at night.

20

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!