treatment for compressed ulnar nerve

[salsaqueen99]

Over the last three weeks I have been suffering from a very irritated ulnar nerve where the pain radiates down my arm on the inside of the arm (anterior side I think).

A few years ago, I hurt my shoulder dancing which we think caused some instability. MRI scans haven't confirmed this but just showed abnormality in the scap of the glenohumeral joint. Prior to the instability, I tore the rotator cuff which we believe was infrasprinatus as it is constantly inflamed and has been cranky for a long time.

Recently I had a muscle spasm in supraspin where I experienced some tingling down my arm on the fourth and little finger which my physio believes was referred pain.

Then about two weeks later I had to take minutes for a meeting and my shoulder went. It almost felt like it was about to spasm but it settled after I stopped writing. After training three days later, I was unable to write. My physio believes that I have compressed/inflammed the ulnar nerve and as such I can't sit in front of the computer for long periods of time let alone write or type (I'm getting good at typing with my left hand!)

I guess I'm looking for advice in relation to how to manage this, how long it will take to heal (this is the longest time it has taken for something to heal) and if I should be training at all. My physio is currently doing dry needling work and I get acupuncture every wk to treat the rotator cuff bc it too is irritated and can cause referred pain down the arm. I guess the million dollar question is how long w3ill it take to heal and if I should be training at all. I find if I work out,and do light weights and theraband my arm actually feels better because it is warm and working out gets the blood flow going in the muscles. I then normally apply heat straight away as ice does not seem to work. I am not keen to stop training as I'm working on getting my scap stability better and I know that if I don't work out my body gets cranky with me.

Any advice one has to offer is greatly appreciated.

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[f1progeny]

Hi salsa,
Two distal areas where entrapment of the ular nerve can happen are the medial elbow where the nerve wraps underneath the medial epicondyle or through the ulnar aspect of the wrist where the Ulnar nerve goes through Guyons canal.
Prolonged time with the elbow bent, sleeping on it or leaning on the point of the elbow (on the phone) can compress the nerve and cause irritation. Increased sensitivity can arise from hitting this area (off the edge of a table) etc causing inflamation and subsequent irritation. tapping over this site may increase tingling down the arm.
Entrapment through Guyon;'s canal can be similar to carpal tunnel, resulting from repetitive stress/compression of that side of the hand or trauma.

Both would probably require a consistent amount of pressure directly on the nerve, repetitive trauma or possibly some bony deformity to give symptoms to this area. If this sounds like something that may be happening to you working/sleeping then changing technique/using appropriate padding over the area should help decrease the pain and your physio should be able to show you some gentle ulnar nerve mobilisations to help the nerve heal.

However, i think you may need to get your physio to look higher up (if not done so already) in the cervical spine on that side. This may be more likely a cause of your pain in the hand than triggerpoints in the shoulder/forearm, as referral into these 2 fingers is fairly specific and if you spend a lot of time at a computer there's a good chance you've got poor posture, rounded shoulders and are at an increased chance of compressing the joints in your neck. Also generally in referred pain from muscles resistance exercises are more likely to make the pain worse rather than better.

Really you and your physio need to identify where along the course of the nerve is the greatest irritation, what exactly brings on the pain and work on improving mobility/relieving stress. Your physio can monitor your mobility using the Upper Limb Tension Tests and invent some gentle "slider" techniques to help and also mobilise any restricted joints alond the way.

I would continue the same gym work (no harder yet), as long as it's not irritating you and work on your scapular position and posture. Once the problem is identified, progress can be slow and steady over a few weeks. If no progress is made at this stage or if you experience any muscle wasting or loss of sensation/weakness i would go see a specialist.
Good luck with this, let us know how your progressing.

[salsaqueen99]

Hi there,

We actually think that the compression is coming from the cervical spine and I have had dry needling to try to relax some of the muscles so that it doesn't compress as much. It seems to be working but it is rather painful but I guess it's the only option. We know that nerve pain can also be referred pain and that it could be coming from the RCs. I'm just terribly ticklish and can't handle the thought of someone dry needling subscap.

You're also right that I have rounded shoulders and my posture is not great. That is why I am focusing on stretching the pecs, and strengthening the scap stabilisers to try to bring me back into a position as close to as possible to neutral. Scap stabiliser work seems to actually make me feel better, I'm not sure why though. I know that my muscles are cold for most of the day even though it's in the middle of summer here and very warm. Doing exercises seems to help to get the blood flow back into the muscles and my pain doesn't increase either.

I also have a very tight thoracic and I normally release it on a foam roller at night. Do you think it's worthwhile doing this throughout the day and can you suggest some stretches to release the thoracic?

Many thanks for your advice

[f1progeny]

Hii salsa,
sounds like ye're on the right track re:the cx-spine. I'm assuming that your getting the joints of the neck mobilised along with the dry needling? Releasing the muscles should allow for easier mobs to the spine.
The 1st rib on the same side may be elevated causing more restrictions to that side of the neck, this should be checked along with spinal restrictions to mobilization.

From my experience Subscap will generally refer to the wrist, a "watch-strap" area across the joint. Infaspinatus may be a more likely cause of the referral to the fingers- If indeed it is as a result of referral from the R.C. Tight Infra will be shown on internal rotation of the shoulder. Physical Examination of the Shoulder — The Nicholas Institute of Sports Medicine and Athletic Trauma this shows internal rotn @ 90degs abduction (out to the side) If theres a big difference side to side this needs to be addressed.

Improving scap stability Has a few effects, An improved allignment of the thoracic (and lumbar) area will have a beneficial effect on the neck, relieving pressure on the joints and decreasing tension in the musculature of the neck, stretching the pecs helps this. Also improved scap positioning wil allow the R.C and scap stabilising muscles to function at an improved length reducing the stress on them.

Continue with the foam roller, try the exercises on the first page of this PDF http://beauchamphouse.co.uk/download/thorax.pdf, general extension, rotation and side bending using the chair to stabilise your lower spine - check with your physio so they can make sure your doing them right. Make sure to take a break, even for 30-60 seconds every 20-30 mins at the computer, do a little stretch/rotation and get your shoulders and neck back into position, this will help prevent the scap stabilisers from becoming overloaded.

It's hard to say where your pain is coming from without assessing you but improving your posture, addressing muscle tightness and weaknesses etc will always help. Any restriction to the nerve can and should be measured by your physio through a thorough nerual assessment which along with your own feelings about progress/pain/pains and needles will show any progress.

All the best

[salsaqueen99]

Hi f1progeny,

I think that we are on track with the cx spine too. Yes I am getting dry needling done and in the first instance it was very hard to get the muscles relaxed but the second treatment was much better.

We constantly review 1st and second rib and I know that I am very tight but I think it's an important point and I hope that my physio has considered it. I found a trigger point on the side of my right neck where the scalenes are where I can literally reproduce the pain I experience. Pressing on it seems to relieve it a but. I am also doing nerve exercises which are proving to be very helpful.

Thank you also for sending me the exercises to free up my thoracic. I haven't seen the ones on the first page before and will run it past my physio before I try them. During the day I do a lot of work to try to free up the pecs because my shoulders naturally roll forward.

I agree re the RC. I do have a tight infra and it is shown on internal rotation as this is the position which aggravates my old injury and brings on tenderness in the long head of the biceps tendon. I have also had subscap looked at but I am very ticklish and it's not an easy spot let alone pleasant spot to have dry needled. I think that a combination of dry needling and acupuncture it should free up soon.

Regarding improving my posture, can you suggest some ways which might help me throughout the day at work. My sports doc has recommended getting a posture brace and to wear it for a few hours during the day as it will help with my posture. I can't be taped following an allergy to the tape recently. I did however notice significant improvement when I was taped though and it certainly helped reduce the aggravation when I had an inflamed supraspinatus.

I guessing that the likelihood of this recurring may be quite high so I presume I will need to continue to work on the preventative side of things- scap stabilisers, thoracic release etc and to also allow for my injury to heal properly.

Many thanks for all your help
salsa

[salsaqueen99]

Hi f1progeny,

Just wanted to say thanks for sending through the link to the stretches. I've been doing them at work in combination with some RC stretches and it is helping a lot. I'm actually much better than I was a week ago and have had minimal pain for about a week now. After treatment, I seem to be relatively pain free for at least 4 days which I think is a good outcome.

Thanks very much for all your advice. I greatly appreciate it.

[salsaqueen99]

hi there,
I just wanted to give you quick update. The referred pain from infraspin has now ceased which is a great thing. I am still undergoing intensive physio (weekly at the moment) and getting accupuncture. The pain I get from the ulner nerve compression is getting better I'm relatively pain free now. I still have physio weekly though which keeps things under control. I've also been working on my posture and have started pilates on the reformer and this is improving my posture in general. I'd say it has created more awareness of my posture too.

Thanks for your advice to date. I've also realised that the levator scap muscle spasms are most likely being caused due to cervical spine dysfunction. It seems that the dry needling is helping so I am not getting muscle spasms as often.