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Ulnar Nerve Entrapment

dmnz

23-Jan-2012
6:00:25 PM

Anyone gone through this?

What was your recovery/treatment? Surgery?

patto

23-Jan-2012
7:24:19 PM

I've had issues with my ulnar nerve being pinch in the cubital tunnel. These days I cannot sleep with my arm bent because of it. Climbing and muscle strength work improved my condition such that it doesn't interfere with daily tasks.

dmnz

23-Jan-2012
9:30:21 PM

How long have you had the issue? How bad was/is it for you? Ever considered surgery. Seems to be the only long term cure. Looks like leaving it could lead to longer term musculoskeletal issues and muscle wasting.

Initially I thought it may have been overuse and golfer's elbow but pretty sure it's some sort of ulnar nerve issue now. The bent elbow position is bad for it and leaning on it too.

It obviously affects climbing, esp things like locking off not so much daily tasks except pain.

But it's not really getting better. Going to get another opinion or two and maybe look at a more permanent fix.

It is a problem for flying (paragliders) as bent elbow is required all the time, sometimes with more force applied. Got more pain from that the other day on short glides than climbing, though the latter has been light and short.

elaine stevenson

2-Feb-2012
3:00:39 AM

Hi There,

Ulnar nerve entrapment, assuming that's what you've got, is quite a common problem and arises at a number of points along the nerve's pathway. Would strongly suggest you seek out a good manual therapist and get them to assess and treat.

Personally I'd suggest seeing an osteopath or perhaps a myotherapist with a **particular** interest in manual (hands-on) therapy for upper limb problems and peripheral joints. Ideally I'd be seeking out someone with an appreciation of the sorts of things you do - ie climbing etc. Both would have the assessment skills to be able to work out what was going on for you. They also have a range of different soft tissue and joint manipulation/mobilisation techniques which would assist in decompressing the nerve in question. A physiotherapist may also be helpful too, but again, ask around and find someone with a particular interest in elbow/arm issues. Equally, there are some excellent remedial therapists out there who get very good results too.

That said, make sure you get a recommendation before you see someone. Not all therapists are alike and often it's a matter of the skills and interests of the person you see - and the additional training they've done **after** they finished their physio/osteo/chiro/myo etc training, rather than the base qualifications that they hold. If you're stuck, email me some details of whereabouts you are - ie which city/state - and I'll make some enquiries among my colleagues.

There are surgical procedures which can assist in decompressing the nerve - assuming that's the problem, however, like all surgery, there'll be a degree of collateral damage (ie incisions into skin and subcutaneous layers, etc), you'll also have some down-time - for healing, and any surgery carries some level risk (admittedly small these days) for complications such as infection, scarring, adhesions etc and therefore the general recommendation is to avoid it unless absolutely necessary - ie where conservative approaches aren't available and/or fail to produce the desired result.

Hope that helps and good luck with getting it sorted.

Cheers!

Elaine.

hero

2-Feb-2012
9:19:14 AM

I thought this was going to be a Trip Report.

patto

2-Feb-2012
9:26:21 AM

On 23/01/2012 dmnz wrote:
>How long have you had the issue? How bad was/is it for you? Ever considered
>surgery. Seems to be the only long term cure. Looks like leaving it
>could lead to longer term musculoskeletal issues and muscle wasting.
>
> Initially I thought it may have been overuse and golfer's elbow but pretty
>sure it's some sort of ulnar nerve issue now. The bent elbow position
>is bad for it and leaning on it too.
>
>It obviously affects climbing, esp things like locking off not so much
>daily tasks except pain.
>
>But it's not really getting better. Going to get another opinion or two
>and maybe look at a more permanent fix.
>
>It is a big problem for flying (gliders) as bent elbow is required all
>the time. Got more pain from that the other day on short glides than climbing.

Sorry for not replying earlier.

The issue originally arose as a working RSI issue. The GP and physio I saw regarding it was worse than useless. The GP had no idea and didn't care, he simply told me to take voltarin. The physio care but also didn't have an idea and gave me a hand splint to wear. It made it significantly worse.

I self diagnosed. But I'm confident that it is the correct diagnosis. As you say there isn't much to do apart from surgery. Something that I really don't have want to do unless it is debilitating. At the moment my condition hasn't changed in the last 5 years. So I'm currently not chasing a cure. I just make sure I don't do anything that exacerbates the condition. Including sleeping with my arm bent hugging a woman :-(

I find using a computer in a arm bent fashion more of a problem than climbing. By the sound of it I would avoid going gliding. You might love it but is it worth your health?

jdb

2-Feb-2012
9:30:04 AM

Hey Dmnz,

I've had self diagnosed ulner nerve entrapment. I had pain above the elbow near my triceps. I found deep tissue massage from a competant therapist and the stretches Julian Saunders prescribes for tennis/golf elbow (just google Dodgy elbows and you should find the link)

Good luck

dmnz

2-Feb-2012
1:12:50 PM

On 2/02/2012 patto wrote:

>Sorry for not replying earlier.
>
>The issue originally arose as a working RSI issue. The GP and physio
>I saw regarding it was worse than useless. The GP had no idea and didn't
>care, he simply told me to take voltarin. The physio care but also didn't
>have an idea and gave me a hand splint to wear. It made it significantly
>worse.
>

The physio I saw has just passed it off and actually took a while to get to this diagnosis, ie milking the cow, and I will not return. In fact he just finally told me it was a nerve problem, without giving me a real name/diagnosis. Hence I am looking for a second opinion.
Without further testing, not sure where exactly the compression is taking place. But it's not really going away. Often it doesn't come during the climbing itself but after (Think a few hours or a day and then it's a bit sharper)

>I self diagnosed. But I'm confident that it is the correct diagnosis.
> As you say there isn't much to do apart from surgery. Something that
>I really don't have want to do unless it is debilitating. At the moment
>my condition hasn't changed in the last 5 years. So I'm currently not
>chasing a cure. I just make sure I don't do anything that exacerbates
>the condition. Including sleeping with my arm bent hugging a woman :-(
>

Good excuse to not to have to spoon! "But my doctor said I can't"

On a serious note, I find it feels better when I retract the scapula so maybe it's not (just) compression at the elbow? So yes I'm looking for a specialist in this area in the Sydney region.

>I find using a computer in a arm bent fashion more of a problem than climbing.
> By the sound of it I would avoid going gliding. You might love it but
>is it worth your health?

I could also stop climbing too but that's not a suitable solution for me. Seems the only safe thing I can now do is ski...if you don't count the snowboarders sitting across the hill having their lunch or their faster brethren falling over in front of me that I have to dodge

BoulderBaby

2-Feb-2012
10:17:22 PM

Hey Dmnz, are you located in victoria?

Your inbox is full.

citationx

3-Feb-2012
10:00:29 AM

On 2/02/2012 BoulderBaby wrote:
>Hey Dmnz, are you located in victoria?

he mentioned he's sydney based.

dmnz

3-Feb-2012
10:57:40 AM

On 3/02/2012 citationx wrote:
>On 2/02/2012 BoulderBaby wrote:
>>Hey Dmnz, are you located in victoria?
>
>he mentioned he's sydney based.

cleared out the inbox

but yes, what he said
(and thanks for the referral)

dmnz

17-May-2012
10:56:23 AM

I think I've narrowed it down to biomechanical issues due to muscle imbalances and postural maladaptations.

So I have to report back to those in a similar situation or who may be in the future from climbing and other activities if they do not take corrective actions now.

I've had a lot of time to think and research this talking to various people along the way.

But basically it boils down to biomechanics:
Think slouched, hunched climbers with basic biomechanical problems from overdeveloped pulling and pushing muscles in the upper body, namely the pec major (chest) and latissimus dorsi (pulling in the back) while the relative strength of and ability to activate things like their 'stablilisers' (think TA and glutes but also things like scapular retractors namely rhomboids, forearm extensors) lags behind. That is, overuse from climbing without a focus on making sure the opposing muscles stay strong enough to allow LONG TERM development.

Both pec major and latissimus dorsi attach to your humerus (upper arm) in pretty much the same place and internally rotate your arms and hence pull your shoulders forward til you get that rounded shoulder look. Then the overuse and imbalances manifest themselves differently in different people when you overload them with repetitive motion and your body breaks down somewhere. The problem site depends on the individual, the extent and specific nature of the individual's problem...for me it was the elbow, for others it may have been the rotator cuffs, back etc... and it's a long rehab process because all the imbalances were also 'learnt' over a long time.

Summary (for those who don't want to read the above):
1 problem is a biomechanical one:
from overuse/muscle imbalance (pec major and lats while the stabilisers have not developed to the same extent) and poor muscle activation patterns
2 then you overload it with repetitive motion
(for me, becoming fixated on a particular boulder problem/s that had similar moves)
THEN the body breaks down somewhere (in this case the elbow)

SOLUTION/PREVENTION : work the opposing muscles before you get injured so you dont get injured and so you can be a better climber in the long run

do targeted work on the rotator cuff muscles.scapular stabilisers.forearm extensors.glutes etc
HOT TIP...rowing, horizontal, think rowing machines seated rows etc are great so long as you initiate with the right muscles...surprisingly doing pull up holds at the top of the ROM also helps a lot as you HAVE to use your scapular stabilisers if you want to be able to stay up there. This will help by giving you more balance and a stronger base to use your big muscles, and even if it means you dont get injured and you can climb/train without as many breaks then you will get better anyway.

dmnz

17-May-2012
10:54:22 PM

I think a lot of it is also compounded by sitting a lot and being tall doesn't help either when everything is sized just a bit small for you to use properly with proper posture.

lisaw

17-May-2012
11:11:10 PM

This thread came up just prior to me suffering this problem by days. My suggestion (despite my own self diagnosis) is this is a conversation best had between you and your doctor. I have been quite strongly reccommended to have surgery, and may proceed down this track after the delaying tests we have agreed to - mri and nerve conduction studies. Despite no climbing (at least rock climbing) for 4 mo I still have sensory deficits and theres no way Im tall and Id hardly call me your classic agonist only type. a little knowledge and the internet caveat...

dmnz

18-May-2012
3:49:03 PM

Every case is different. I'm just trying to relate my experience to help or at least inform others who may be in a similar situation.

Most of the medical people I've spoken to have dismissed it so I've had to hunt around.

For me I think a lot of it is really related to the shoulder girdle. tonic IR of the humerus and tight pecs on that side. stretches involving ER of the humerus, scapula retraction and pec release have been of the greatest benefit to me. I'm finding new ways to release and relieve the problem and do acknowledge it is a long term problem I need to deal with.

Nerve (peripheral) can actually regenerate if you can remove the initial cause in some cases which is what I'm trying to do now.

Don't worry, no one on Chockstone takes anything written here seriously anyway!

good luck with your own health

Duang Daunk

18-May-2012
4:13:57 PM

On 18/05/2012 dmnz wrote:
>Every case is different. I'm just trying to relate my experience to help
>or at least inform others who may be in a similar situation.
>
>Don't worry, no one on Chockstone takes anything written here seriously
>anyway!
>
I do, and so does my mate shortman.

There are 16 messages in this topic.