Ulnar nerve compression - any advice/solutions?

[Tampabass]

I'm following up ...
Just went for another appt with my orthopedic doc, following the neurological testing.

His diagnosis now is Ulnar Nerve Palsy, and he is advising surgery to remove the blockage in the nerve (which is resulting in tingling/numbness in my left-hand pinky and ring fingers).

The surgery is technically called "Transposition of the Ulnar Nerve" or, alternately, "Neurolysis."

Doc tells me that doing nothing will eventually result in a worsening of the condition. I guess I'm pretty confident about him - very experienced, and was formerly an orthopedic doc for an NFL team.

Not sure what I'm going to do, as I really don't like the idea of cutting - worried about the law of unintended consequences, etc.

I guess I'll look for a second opinion before making any decisions.



Any input would be appreciated.

[3wavylines]

I've been dealing with ulnar nerve compression in my right arm for several years now. I'm an electric player, not URB. I switched over from guitar. My day job is working at a computer all day.

I'm not sure if the compression is happening at my elbow, in the area of my neck/shoulder, or both. At my shoulder, it could be Thoracic Outlet Syndrome.

My symptoms have improved over the years. So far, I don't believe I have any loss of strength in my hand. I saw a neurologist a while back that said I had some loss of sensation in my palm, but nothing else permanent. My symptoms are mostly tingling, pain and numbness in my ring finger and pinky, pain at my elbow, and sometimes pain in my armpit.

I've found some things that help and some things that make it worse.

Things that help:

- Wearing a splint on my elbow at night to keep my elbow straight. I use this one http://www.amazon.com/Imak-10113-Pil...6069847&sr=1-1
- Don't bend my elbow at a sharp angle. Try not to bend it too much sharper than 90 deg.
- Don't let my shoulder drop. For some reason that makes it worse, and it may be because my nerve is getting compressed between my neck and shoulder.

Things that make it worse:

- Pinching something between my thumb and forefinger. If I play with a pick, I start to get pain after a few minutes. I can play fingerstyle for quite a while without much pain at all.
- Poor posture. Hunching over or leaning my head and neck forward for any length of time seems to make it worse.
- Sleeping with my elbow bent or my arm over my head. I used to wake up sometimes with my pinky and ring finger completely numb.
- Using a computer mouse with my right hand. I've switched my mouse to my left hand.
- Bending my wrist to the side, like when hitting the enter key on the keyboard. I try to move my whole forearm over, rather than just bending my wrist sideways.

Things that might help a little:

- Icing my elbow if it has started to hurt.

Like I said, I haven't had any weakness in my hand that I am aware of. If I were to start to lose strength in my hand, or my hand showed any muscle wasting, then I think my primary care doctor would send me back to the hand surgeon, and surgery would be a possibility.

My symptoms sound a bit different than yours, but I hope there's some useful information in there. The adjustments I've made over the years have lessened my symptoms, but they've never completely gone away.

I wish you luck with this. This has been a long, slow process for me, but my symptoms have been pretty mild, and so the doctors haven't recommended much more than taking it easy, taking breaks, and not keeping my elbow bent for too long.

[3wavylines]

Also, the neurologist I saw was Dr. Michael Charness. He was able to describe very well what was happening with my arm, and gave me some helpful suggestions. Perhaps he might be able to refer you to somebody in your area.

Here's a clinic for musicians he runs in Boston:

http://www.brighamandwomens.org/neur.../PerfArts.aspx

[philip sirois]

My only advice: Seek many opinions before embarking on neurosurgery. don't forget that these guys make their living cutting people so they are often biased in that direction. The NFL thing might seem like a overwhelming stamp of approval, but also don't forget that the job of the NFL surgeon is to get these guys playing football, not to make sure they're operating fully when they're 50 years old. I have experienced the salesmanship of these surgeons and they can be persuasive, and from experience (at maybe the top Ortho hospital in world) hospitals do little follow up on the long term success these things. Just make sure you've examined all the options first.

[jweiss]

Originally Posted by 3wavylines

- Wearing a splint on my elbow at night to keep my elbow straight. I use this one http://www.amazon.com/Imak-10113-Pil...6069847&sr=1-1

Big +1 for this. It sounds like you have a structural issue in the nerve so this may not be the quick fix it was for me, but this is easy to try and completely solved my ulnar nerve related numbness.

As a test just wrap a towel around the elbow and tape it closed as a temporary splint before you go to bed. Try it for a couple of nights in a row.

[Don Higdon]

Rather than one humungous post on this thread, I'll break it into parts.

Originally Posted by philip sirois

My only advice: Seek many opinions before embarking on neurosurgery. don't forget that these guys make their living cutting people so they are often biased in that direction. The NFL thing might seem like a overwhelming stamp of approval, but also don't forget that the job of the NFL surgeon is to get these guys playing football, not to make sure they're operating fully when they're 50 years old. I have experienced the salesmanship of these surgeons and they can be persuasive, and from experience (at maybe the top Ortho hospital in world) hospitals do little follow up on the long term success these things. Just make sure you've examined all the options first.

Amen.
The truly egregious malfeasance I’ve been subjected to by doctors came at the hands of sports physicians. For instance, one of my legs is ¾” shorter than the other. I went to 3 orthopedists. Two were big NFL, NBA, NHL guys, pictures of big names all over the office. They both were at the hospital that I think Phil is talking about (HSS ?)
With my condition, there were 3 possible diagnoses - left short, right short, or no difference. I was given 3 different opinions, meaning 2 were wrong. Both NFL doctors were wrong, and in one case, arrogant. I can’t tell you how much pain I experienced by my eagerness to accept their opinions just because of their pro sports references.
Another “sports podiatrist” misdiagnosed a foot problem and had me scheduled for surgery when another DPM let me watch a sonogram that proved the condition did not exist.
To reiterate Phil's point, there are too many cripples in the ranks of retired football players.

[Tampabass]

Guys - Thanks for the feedback. I'm NOT jumping on the surgery option. Taking my time on this ...

[Hawaii Islander]

Originally Posted by Tampabass

No, there was no obvious activity (that I know of) that caused the issue.
I do spend much time at the computer keyboard for my day job - don't know if that has anything to do with it or not.

Some people have a habit of resting their wrist on the edge of the desk or keyboard tray. This can put pressure on the ulnar nerve. Changing the way you position your wrist (or using soft gel cushion for support) when using the computer may help.

I had a compression fracture of my left ulnar bone at the elbow. The caused compression of the ulnar nerve, which resulted in the same type of symptoms you described. After the cast was removed, physical therapy (mostly range of motion and squeezing rubber ball exercises) for several weeks helped alleviate the symptoms.

[Tampabass]

Originally Posted by Hawaii Islander

Some people have a habit of resting their wrist on the edge of the desk or keyboard tray. This can put pressure on the ulnar nerve. Changing the way you position your wrist (or using soft gel cushion for support) when using the computer may help.

I had a compression fracture of my left ulnar bone at the elbow. The caused compression of the ulnar nerve, which resulted in the same type of symptoms you described. After the cast was removed, physical therapy (mostly range of motion and squeezing rubber ball exercises) for several weeks helped alleviate the symptoms.

Hawaii Islander - I think that may be a leading cause of my issue. I sit at a desk, using a laptop all day long, and I use the laptop's mouse, rather than external mouse. Keyboard is not elevated, so my left and right elbows are always resting on/pressing against the desk.

I've taken to using a pad under my left elbow, to reduce this pressure. I'm thinking that maybe I should elevate the keyboard and/or use an external mouse.

[Jake deVilliers]

Definitely use an external mouse on a keyboard tray below desk height.

For me, if I use the mouse set up right handed I feel pain in my forearm within minutes whereas using the buttons as for a leftie is pretty comfortable.

Good luck!

[Gimongous]

Ok, I'll weigh in on this topic. I make my living as an Internal Medicine physician and see people with musculoskeletal and neuropathic problems affecting the upper extremity regularly, as this group of problems is very common. The cause can be occupational, avocational, injury, degenerative, or sometimes spontaneous with no apparent cause. From reading through the posts on this thread, there is some confusion and mixing-up of several of the more common diagnoses as far as usual symptoms, evaluation, and treatment.

There is much potential for complexity regarding problems with the neck, shoulder, arm, wrist, hand, and fingers. There are many potential diagnoses, many overlapping symptoms, many potential diagnostic tests, and many methods of treatment, all variable depending on each person's individual findings. There are many well-meaning people who give advice on internet sites , and many hopeful people suffering from some physical symptom who take the advice of others without having a medical evaluation done .

Take heed of the advice you see so much here on TBDB:
get yourself a teacher
take your bass to an established luthier

ie: Go see a doctor. Follow a prescribed plan of evaluation and treatment. Follow up to see if you need further evaluation or different treatment.

I think it is reasonable to try home remedies or advice from others (non-physicians) if the symptoms you experience are mild or infrequent. If you have persistent or severe numbness, pain, or weakness, you need to see a doctor. if you need to, see a second or third doctor to arrive at a correct diagnosis and treatment plan. When surgery is recommended, it is usually advisable to get a second opinion, particularly from a non-surgical physician who has been part of your evaluation or initial treatment (I perform this function for many of my patients).

It is now after-hours, time to go play bass.

KM

[emilio g]

What helped me heal my ulnar nerve problem:

1. Drinking more water

2. Getting my bass set up to be very easy to play (regular strings, medium tension, but low to very low action)

3. Sleeping for about a month wearing a long sleeve shirt with a towel wrapped around my left arm to keep it straight, and getting a pillow with better neck support.

4. Videotaping/recording myself practicing to look and listen for tension. (this is good to do even if you have had no nerve problems)

5. Incorporating light hand stretches into my day.

6. Learning to type and use a computer in a more ergonomic way.



For what its worth, I'm young, and my nerve issue was not very bad so I healed quickly, but I learned that most of (but definitely not all of) my problem was from bad habits that had nothing to do with my bass playing. The biggest factor was probably sleeping in weird positions. Learning to sleep on only my back with my hands at my sides helped a lot!

[Tampabass]

Thanks for all the advice and feedback.
I still have the issues - numbness/tingling in left pinkie and ring fingers - although they seem to have lessened. I've been more conscious of where I place my elbows when I'm working at my desk. As of now, I'm not doing surgery. I'm going to get a second opinion very soon.

I should add that I haven't played upright since June 1 - had a sub play a couple of scheduled gigs. I'm going to play electric for my next couple of gigs, later this month. I'm aware that my left hand undergoes more tension/stress when I play upright than when I play electric. I don't think that's necessarily inherent to upright playing, though - probably the result of some "unconventional" approaches to left-hand work, as I started on electric at age 13, and didn't begin seriously playing upright until my late '20s - about 20 years ago. I've only taken a few upright lessons along the way.