ulnar predicament

Hey everyone,
I'm resorting to posting a message here, as i'm running out of options...

I've been harassing my GP for a year now, to try and improve my condition, but in spite of all my attempts it's worsening.

I have a number of symptoms that are changing and sometimes a bit contradicting. It all started a year ago with a mild pain in the elbow, near the cubital tunnel. after a few month i decided to see my GP about it. He had x-rays done on the elbow which showed no abnormality, so he sent me to a physiotherapist. I saw the physio and after a few weeks I was better, the pain was gone. On the assumption that muscles had weakened in the area, he had given me strengthening exercises for the elbow.

I started working out normally again (not too intensely though). Shortly after, the pain came back (we're 6 months ago now), stronger, and this time accompanied by pins and needles in the hand (mostly pinky and length-wise half of ring finger). I went back to the physio, and he made me do the same thing, adding exercises for the neck. From there it was downward spiral, the symptoms worsened and the pins and needles spread to the entire hand, along with actual pain (palm and wrist). elbow pain also spread on the other side of the elbow and the shoulder blade (very acute pain there).

After about a month, I decided to stop physio, as it seemed to me the ulnar nerve was badly irritated and working out the muscles around were probably worsening the condition. My GP had me do an MRI of the neck and a EMG/NCT. The former showed no bulged disk and the latter no obvious damage to the nerve. Still the pain has kept on worsening... I went for massage therapy, which relieves the symptoms but do not seem to improve the condition over time. I tried yoga in order to stretch, it eventually became too painful. I've stopped any activity other than working at the computer (can't afford to, although i've optimized ergonomics) that could worsen the condition.

Now the pain in the elbow per se rarely flares but the pain/pins and needles in the hand are almost permanent (the hand looks purple-ish with white dots, indicating impaired blood circulation) and the pain in the shoulder blade is intense. neck stretches relieves but also seem to make the pain flare up afterwards. Whenever i move my shoulder, i can hear cracking and rubbing in the shoulder area. i now believe that this is where the problem really is (hence the seemingly cumulated symptoms of carpal and cubital tunnel syndromes). The latest consensus is that extreme tension in my upper back constrict the nerves and creates the observed symptoms. Which would mean nothing's wrong with my arm per se, but rather that it's higher up (yet not at the spine either).

My last hope is that i'm scheduled to see a physiatrist (apparently the MD counterparts of physiotherapists), and that he might prescribe some kind of cervical collar that would help with the symptoms. I put a lot of ice on the affected areas, and was taking a lot of anti-inflammatories for a while but it only provided temporary relief...

Any chance ANYONE has ANY advice for me?! :(

PS1: i'm also a bass player
PS2: if you recommend alternative medecine, please provide evidence of proven efficiency, as i've found none so far! (don't mean to be rude but i want to save time, money and avoid false hope...!)

Sounds like it could be thoracic outlet syndrome, which puts pressure on your nerves and blood vessels. It can do this at a few places, in the neck between the scalenes, in the pecs (pec minor) near the collarbone. If they are really on flare as they seem to be, even minor stretching work can worsen the situation. Have you seen your doc about the hand colour? Occasionally there can heart issues can show up with colour changes in the hands. What is your posture like when you play bass? When you play, do your symptoms change in any way?

Pec minor can be difficult to stretch, though there are some out there. It responds well to massage (trigger point), though can be painful. Massage vacuum cups can work really quickly at releasing a tight pec, though you may end up with round circles in the area for a few days.

Can you check in with your physio or massage person to have them assess your pecs and scalenes to see if this could be the trouble?

Hi Anthony

Although you're a bad case, I see these symptoms regularly in people who have problems in their ribs and shoulder girdles. I would suggest that you get these areas moving asap to reduce the tension and adhesions.

First of all, try a foam roller. Put put it horizontally under your upper back, on the floor. Bend your knees, lift your bottom off the floor and roll up and down your thorax. You may hear some clicking, which is fine; after a while you should also feel the area start to relax. Then you'll need a *good* physio to work on the muscles around your shoulder girdle, and to mobilse your thoracic spine, ribs and shoulder joint. In my experience, your shoulder is likely to be protracted (tilted forward) and this puts a lot more strain on the muscles and nerves in the area. For the muscles, they'll need to focus on your rhomboids, levator scapulae, scalenes and - particularly - your subscapularis. As your symptoms are also going so far down your arm, I'd suggest massage to your inner upper arm and forearm as well - essentially along the path of the ulnar nerve. I'd also get you gently stretching your forearm, elbow and thorax. There are some really good exercises for this in a book called Keep Your Joints Young by Sarah Key.

The key to this is to persevere. This issue has been going on for you for much longer than when you first started to notice it - these things don't just creep up on you overnight. How's your posture when you play bass?

Oh, and I'd avoid a collar. Immobilisation will make things worse.

Good luck!

Nell