Thank you for your query at DoctorSpring.com
I have read your details with diligence.
Please reply me following questions so that i can help you-
-What are your present symptoms?
-What are the aggravating or reliving factors for these symptoms?
-Is there any other associated diseases like diabetes,high blood pressure,etc.?
Patient replied :
Presently my symptoms include occasional forearm tightness and occasional stabbing pain in the palm of my hand on the pinky side. My blood pressure was 125/82 at my last appointment, and the last time I had blood testing done, March 2014, my cholesterol and blood sugar levels were normal. Typically some manual tasks can aggravate the injury, such as lawn mowing and bike riding. Typically walking does not bother me, but sometimes it will cause aggravation. Additionally, when I do housework, such as dishes or regular house cleaning, after approximately 30-45 minutes, once my muscles warm up, my symptoms will subside and I won't have any issues until they cool down again. The other complicating factor is that when things such as lawn mowing aggravate the injury, it's typically a delayed response anywhere from 2-12 hours after the activity. I rarely experience the numbness and tingling typically associated with ulnar nerve compression, but I do get the stabbing pain when the injury is aggravated.
Thank you for your follow-up.
I will definitely rule out cubital tunnel syndrome here, as your NCS and EMG have been normal.
The first test that is ordered is EMG, and even the slightest of pressure at the nerve or pinched nerve can be picked up on EMG as well as NCS. Since they have been negative, cubital tunnel syndrome can be ruled out. I am not sure why your orthopedist thinks it is cubital tunnel syndrome. Probably because the symptoms are suggestive of that typically. The sudden numbness along with pain occurs in cubital tunnel. However, surgery is the last retort and definitely not needed at this point.
You can ask your chiropractor to demonstrate some exercises to relieve pressure on the nerve. Minor compression can cause such pain, and can be missed on NCS/EMG. Also, you are doing the right things to avoid pressure, so you need to keep doing that. There are few elbow pads available which ensures no compression on the ulnar nerve, you can ask your chiropractor for the same.
Also, cubital tunnel is not accompanied in both hands at the same time. Since even the right hand is getting involved now, the etiology seems different. You can try a short course of Gabapentin, along with vitamin b 12 supplements like ( Neurobion Forte ) for further relief. I won't recommend TCAs, unless absolutely required because of possible side effects. Also, you can get an x-ray done of your elbow, and post it as a follow-up.
Hope this was helpful,
Feel free to discuss further.
Patient replied :
I have a follow up in regards to my previous inquiry, I have a burning sensation on the medial aspect of my elbow and well as tenderness in this area that radiates along the path of the pronator teres muscle, my chiropractor feels it's likely either tendonitis or muscle inflammation of some kind. I have done a little reading and see that it's possible I may have medial epicondylitis, and I was wondering if that could possibly be causing the nerve pain symptoms? I tend to get the burning sensation when doing tasks that require gripping, such as driving, or when I'm using the computer to type. Occasionally when I'm doing certain tasks, such as pushing the shopping cart or turning the steering wheel I will get a sharp pain right in the area of my medial epicondyle, this first happened before I ever experienced my sharp stabbing pain in my hand near my pinky. I feel like perhaps my chiropractor could be correct in regards to my tendonitis, but I'm having trouble finding out if that could be what's causing my ulnar nerve symptoms? Typically the burning sensation doesn't begin immediately upon performing a task, I might be driving for 15 minutes before it begins to hurt, but then once it begins it stays for a while, often even after I stop whatever I'm doing that seems to be causing the aggravation. Ice helps make the pain subside, as does rest and ibuprofen. Can this be causing my ulnar nerve symptoms (ie numbness and tingling, and sharp pain in hand)? If so, how long does it typically take for medial epicondylitis to heal? I also was not sure how this could have occurred, I have a desk job using a computer everyday, I took up playing guitar about 4 months before I first experienced pain symptoms, and I had just begun riding my bike regularly after taking a break from riding during the winter time. Could any/all of these hobbies and work contributed to my possible tendonitis/muscle injury?
Yes, the kind of activities you mentioned, should not lead to medial epicondylitis, or tendonitis.
However, it does sound like that from the symptoms, and you should get an x-ray done to rule out the same.
This consult is over a month old, hence will be closed by the system, however, you can initiate a new query with an x-ray of the affected elbow.