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Sharp stabbing pain in arm, hand. Is surgery needed?

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Approximately 4 weeks ago I saw a local orthopedic doctor regarding pain I was having in my left forearm and hand. The pain in my hand could beat be described as sharp stabbing. The orthopedist felt that I likely had cubital tunnel syndrome and ordered and emg and nerve conduction study. The results of the emg and nerve study came back negative and there was no damage. After following up with my orthopedist this week he still feels it's likely cubital tunnel. I informed him the symptoms were less severe and asked if it's likely it will heal on it's own. He stated that it's possible for it to heal on it's own but more than likely the symptoms would continuously go from better to worse to better to worse until eventually it requires surgery. When I research the matter online it sounds like it can often be treated by simply resting it and keep it straight while sleeping and not resting on my elbows and not keeping them flexed for long periods of time, all things I've been doing for a couple of months. My question(s) is, is my orthopedist simply pessimistic, and this can heal on it's own without surgery? Also, if so how long does it usually take to heal, my symptoms fist appeared approximately 3 months ago? What activities should I be avoiding, I haven't been going much besides walking and I occasionally cut my grass, other then that I sit at a desk all day and rest my body/arms in the evenings? Would physical therapy/stretching help? I have been going to my chiropractor and getting deep tissue massages that she recommended for the last couple of weeks and it seems to help some although it typically causes flare ups for a day or two afterward, are these massages a good idea or am I doing more damage? Finally, what can I do to help manage symptoms? I asked my orthopedist about tricyclic anti depressants, which I had read online can help with nerve pain, and he shot the idea down stating that they wouldn't help and will just cause negative long term side effects, mainly seizures. He felt my best course of action was to ride out the symptoms, ie pain, until the nerve was damaged and we could do surgery to fix the problem. Please help! I was feeling like I was finally getting a grasp on my problem until I spoke to him and now I feel helpless like I just have to deal with the pain until I'm damaged enough to do surgery. And to make matters worse my right arm is now displaying some similar symptoms, tightness in the forearm and numbness and tingling in my hand. Now that I have it issues in both arms can it be something else all together or am I just incredibly unlucky? Should I seek a second opinion? My ortho didn't do any testing besides physical exam, emg, and nerve conduction, would MRI and X-ray be advised? Thanks


Category: Orthopedic Surgeon

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Category: Spine Surgeon
Dr. Mukesh Tiwari is online now

Expert:  Dr. Mukesh Tiwari replied 4 Days.

Hello,
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.?
Please reply.


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.


Expert:  Dr. Mukesh Tiwari replied 3 Days.

Hello,
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?


Expert:  Dr. Mukesh Tiwari replied 2 Days.

Hello,
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.
Regards.


Dr. Mukesh Tiwari
Category: Spine Surgeon
Experience: 
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
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