Question
Dear Dr Leatherman

You seem very knowledgeable about problems with the ulnar nerve and I am hoping you could help me?  I would be very grateful if you could.

For about the past year or two I had a pain running down the left arm from the armpit, stopping short of the elbow.  Recently it developed into a pulling sensation which I stupidly took to trying to relieve it by 'flicking' my arm over my head.  I had done this quite a few times with no problems.

About six weeks ago I did this manoeuvre, heard a popping sound (which I had heard before) and out of no-where a tingling/numbing sensation went all the way up my arm and into my left hand -no pain, just tingling.  That has since settled but over the past six weeks I have experienced pain in and around the elbow, pain in the wrist  (small finger side) and occasional tingling in my little and ring fingers.  It can also get painful in and around the grove where the ulnar nerve sits in the elbow.  

About the same time I woke up one night with the little and ring finger on my right hand numb.  Since then I have experienced the same symptoms in my right arm that I am in my left i.e. pain in and around the elbow, pain up the inside of the arm from the elbow to the arm pit and pain on the outside of the right wrist.  Now I am starting to feel a burning sensation across the back of the hand side of my wrists and in some areas of my forearms.

I have no numbness in my fingers, no noticeable loss of grip/pinch strength and only periodic tingling in my left hand ring and small fingers.  However I do have 'waves' of pain in both arms.  The pain seems to magnify as the day goes on.  When I dont have pain I have areas of sensations like someone was running a feather duster across my skin.

I now believe that the original pain in my left arm was caused by some compression in the left hand side of my neck, which I have got under control by stretching and ironically this is now the least of my troubles.  My arms and elbows are functioning correctly in terms of range of movement etc and I have had no real previous injuries in this area.  I have not as yet had any nerve conduction tests.

I am trying conservative treatments i.e splints at night and resting the elbows and not trying to bend them too much but I am most concerned by the pain in my elbows which I believe is cubital tunnel syndrome and I am terrified at the prospect of surgery.

In your experience, can I expect the ulnar nerve will return to normal and if so how long should I give it to heal?   I appreciate people are different but what would be a realistic time to give it before deciding that surgery is needed?  In these circumstances do you consider the damage I have caused is reversible?

Once again I would be very grateful for any advice you could give me.

Best regards

Mr Allan Curran
United Kingdom

Answer
Dear Allan,

First of all surgery should be the last option you consider as once you have broken through the skin, you can never go back. The conservative measures that you have tried thus far do not seem to be working, and I would recommend that you get the neck evaluated for dysfunction. However, I am not sure how you are utilizing the splints...should do this at night and have the elbow flexed to about 45 degrees.  Conversely, the fact that you are having symptoms in both arms is an indication that the problem is originating at the neck, rather than the elbow, and your pain descriptions move across multiple dermatomes (nerve root sensory distribution areas).  For instance the armpit pain you described can come from the axillary nerve or the nerve roots in the base of the neck to the top of the upper back.

You mentioned a popping sound...from where...what joint?  You do not give any history of repetitive motion of the elbow, or a valgus force at the elbow, which is the arm positioned away from the body while the elbow is flexed...like throwing side arm. Not to mention bilateral cubital tunnel syndrome is rare.  So...I think you need to have this evaluated.  You seem to have a really good grasp of the anatomy, condition, and likely care options, but this should be evaluated by a musculoskeletal expert who can orthopedically test you and try to differentiate the offending tissues.

Radicular symptoms of pain and paresthesia into both arms is the hallmark of a central cause, although this could be unrelated bilateral issues.  Things to consider would be disc degeneration, posterior and central disc bulge, cyrinx formation (like a cyst in the spinal cord), and arthritic changes such as osteophyte formation (small bone spurs).   Bottom line here:  functional examination.

I of course would recommend that you seek the care of a good chiropractic physician because we are uniquely qualified to diagnose and manage these conditions.  Chiropractors are specifically trained to be musculoskeletal specialist, and functional physical orthopedic testing is indicated in your case for the neck, shoulder, elbows and wrists.  If you can find a chiropractor who has additional sports injury training, these doctors are often even more acute in their examination skills concerning the joints of the extremities.

Hope this helps Allan.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net