Aug 02


Update: We have launched a new website and forums dedicated to people with cubital tunnel syndrome: www.cubital-tunnel.com

No programmers were harmed during development of this article.

(Not true… my cubital hurts like mad today!)

A programming career is supposed to offer advantages such as longevity and limited physical risk. Unlike an athlete or blue-collar worker whose livelihood depends on physical ability and can be cut short by injury or aging, most programmers should expect to work right up until retirement, as long as they can raise donut to mouth. But a nasty secret in the software industry is how repetitive stress injuries including carpal tunnel and cubital tunnel syndrome can make programming a literal pain and threaten your career.

What is Cubital Tunnel Syndrome?

Cubital tunnel syndrome (CTS) is a repetitive stress injury (RSI) that can result in moderate to severe pain and/or numbness in the elbow and ring & little fingers. Untreated, CTS can result in extreme pain, surgery or an unusable hand.

Symptoms: An Unfunny Funny Bone

Chances are you’ve experienced cubital tunnel symptoms many times throughout your life. If you have ever hit your elbow’s “funny bone,” you know what it’s like to have cubital tunnel syndrome: pins & needles & pain.

The initial symptoms of CTS are an occasional tingling sensation along the ring and little fingers and discomfort along the inside forearm near the elbow. As the syndrome progresses, the elbow may become very sore and irritated by any kind of contact. Later, the hand muscles can become numb and weak, resulting in a slow atrophy of the arm. Untreated, CTS can result in ulnar neuropathy, where the last two fingers curl into a claw grip and become unusable, similar to what you may see with cerebral palsy patients.

Quick Anatomy: Your Elbow Bone is Connected to Your…

The hand has several nerves that provide movement and sensation. The two main nerves of the hand are the ulnar and median nerves. The ulnar nerve actually starts at the side of the neck, where nerves are connected to the spine and exit through small openings between the vertebrae. The ulnar nerve travels through the shoulder, down the arm and around the elbow, terminating in the hand.

The ulnar nerve supplies feeling to the little finger and half the ring finger. It works the muscle that closes the thumb into the palm and controls several other small muscles in the hand.

The problem occurs where the ulnar nerve passes around the elbow. The nerve rests in a groove called the cubital tunnel tucked behind the medial epicondyle, the bony point on the inside edge of the elbow (see diagram below). The cubital tunnel consists of muscle, ligament and bone. You can feel it if you straighten out your arm, turn your palm up, and gently rub the groove on the inside corner of your elbow. If you tap that groove and hit the ulnar nerve, you will experience small “electric shocks” up your arm into your hand.

Ulnar nerve as it passes through the cubital tunnel

(Images from University of Florida Department of Neurosurgery)

Causes: Computers and Sleeping (Oh Great!)

When you bend your elbow, your ulnar nerve stretches several millimeters. While your elbow is bent, if you rotate your hand from the natural handshake position to palm down, such as when you use a computer keyboard or mouse, the ulnar nerve stretches more. Moving your fingers up and down like when typing can further stretch and relax the nerve. Sometimes the nerve will shift or even snap over the bony medial epicondyle, a very painful event.

When you have to bend your elbows, rotate your hands, and move your fingers repeatedly in the workplace, as required for most computer programmers and modern office workers, the ulnar nerve can become inflamed and irritated over time. Constant irritation may result in scarring of the ligament over the cubital tunnel, trapping the nerve and causing additional problems. The result is cubital tunnel syndrome.

Constant direct pressure on the elbow may also lead to CTS. The nerve can be irritated from leaning on your elbow while you sit at a desk, drive a car or operate machinery. The ulnar nerve can also be damaged from a direct blow to the cubital tunnel.

The most common causes of cubital tunnel syndrome are:

  • Using a computer
  • Sleeping on bent elbows
  • Repetitive factory work
  • Long-distance driving
  • Playing a guitar or other musical instrument

Diagnosis: The Torture Test

I am not a doctor, so if you experience the symptoms described in this article, please see a real doctor! It’s best to consult with a hand surgeon, especially someone who has performed multiple successful cubital tunnel surgeries.

Your doctor will ask you about symptoms, which arms and fingers are affected, and whether your hand is weak. The doctor should also ask about your work and home activities, sleep positions, and any prior elbow injuries.

Your doctor will then conduct a physical exam. He/she will tap your ulnar nerve to check for tingling and shocks in your ring and little fingers, see how sensitive your fingers are to light touch and pin pricks, and measure your hand strength and dexterity. The cubital tunnel is one of several spots where the ulnar nerve can be pinched, so your doctor may need to probe and prod you a bit. This may hurt, but it’s important to pinpoint the source of your trouble.



If your doctor believes you may have CTS, he/she may order special tests to get more information about the health of your ulnar nerve. One common test is the nerve conduction velocity (NCV) test. An NCV measures the speed of impulses traveling along the nerve. Slow speed means the nerve is constricted or damaged.

An NCV test is sometimes combined with an electromyogram (EMG). An EMG tests the forearm muscles controlled by the ulnar nerve to ensure the muscles are working properly. If not, it’s often because the ulnar nerve is not working well.

I like to call this 1-2 punch of tests “The Torture Test.” If you have CTS, an NCV+EMG will be 15-minutes of shock-and-pain hell. But it’s a small price to pay to see if you have nerve damage and require surgery.

Treatment: Stop Programming!

You can reduce or eliminate early symptoms of CTS simply by stopping whatever you’re doing to cause the problem. So stop programming, sleeping on your elbow, playing the guitar, whatever. Of course, if you are a professional programmer, that’s easier said than done.

If you cannot stop the offending activities, try to reduce them. Take frequent breaks. Use technology and tools (see Prevention below) to accomplish more work with fewer keystrokes and mouse clicks. NSAIDs (non-steroidal anti-inflammatory devices) such as Advil and prescription Voltaren can ease pain and reduce inflammation of the ulnar nerve, but long-term use can result in stomach problems and ulcers.

If your symptoms are worse at night or when you first wake, use a lightweight arm splint or athletic elbow pad while you sleep to limit movement and ease irritation. The idea is to keep your elbow immobilized, slightly bent up (45 degrees) and in a handshake position while you sleep. You can also wear the elbow pad and/or wrist braces during the day.

Your doctor may prescribe you to work with a physical therapist. The therapist can apply heat or massages to ease pain, give you tips on how to rest your elbow and use the computer, and teach you exercises to stretch and strengthen your forearm muscles.

Surgery as a Last Resort

If conservative therapy doesn’t work or your symptoms become severe, your doctor may recommend surgery to relieve pressure on your ulnar nerve. There are a few different procedures depending on the patient and situation. One common procedure is ulnar transposition, which simply moves the ulnar nerve out of the cubital tunnel to the topside of the elbow. Another is ulnar decompression, which involves cutting one of the cubital tunnel ligaments to open the tunnel and reduce pressure on the nerve. Another procedure involves shaving down the bony medial epicondyle on the elbow so the ulnar nerve can shift freely in and out of the cubital tunnel.

Most CTS surgeries require a 3-4 inch incision over the cubital tunnel on the elbow, and are performed under local anesthetic as an outpatient procedure. The surgery is painful but the drugs on surgery day should help you forget.

Recovery pain and duration depends on how bad the symptoms were and which procedure was used. If you only had the medial epicondyle removed, you’ll have just a soft bandage wrapped over your elbow and therapy can progress quickly. For ulnar transposition surgery, your elbow will be splinted and immobilized for three weeks. When the splint is removed, you will perform assisted movements with a therapist for another three weeks. Active therapy starts six weeks after surgery and includes light isometric strengthening exercises. Three months after surgery you should be back in top shape, hopefully pain-free and ready to code again.

Prevention: Technology, Ergonomics and a Handshake

Because my job requires me to use a computer keyboard and mouse, I can honestly say my job is a real pain!

The first step to prevent CTS is to ensure your work environment is ergonomically correct. The key aspect for preventing CTS is to ensure your elbows are not bent too much and your hands remain in the handshake position. Next, consider wearing wrist braces while programming and an elbow splint while sleeping.

Most importantly, there are many tools and technologies that can help you to accomplish more work with fewer arm and finger movements. I will discuss each of these tools in future articles. Suggested tools include:

My Experience with Cubital Tunnel Syndrome

I have been writing software for 25 years. I have to admit that for the first decade of my coding career, ergonomics was a foreign concept to me and much the of the computer industry. My first exposure to it was when I joined Procter & Gamble in 1991 and was fitted with an ergonomic workstation and height-adjustable chair.

I first felt pain in 2001, twenty years after I started using computers. The pain started in my wrists and was likely a minor form of carpal tunnel syndrome, but by 2002 the pain migrated to my elbows and became more pronounced. By 2004 the pain was intense enough for me to seek medical attention from the Cincinnati Hand Surgery Specialists. An NCV test earlier this year showed some slight nerve degradation in my right arm but thankfully no permanent damage. I’ve had over three years of significant pain, but things have gotten better recently due to my treatment.

My treatment has included a night splint and change of sleeping positions, wrist braces while using the computer, Advil and Voltaren for pain, and strong reliance on all of the technology tools listed above. The most important tools for me are voice recognition, touch screen monitor and software macros.

Behind every storm cloud is a rainbow, and the upside of CTS for me is an ultra-sensitivity to bad software user interfaces. The fact is that bad UIs require more keystrokes and mouse clicks than good UIs. When every keystroke and mouse click is a literal pain, I can quickly spot UI problems. It also drives me to develop a new software system that is highly efficient, configurable, and friendly to users with disabilities. More on that to come.

Update: We have disabled additional comments on this article and moved the conversation over to our new forums at www.cubital-tunnel.com/cms/forums. Please come visit our forums and join in the conversation on cubital tunnel syndrome!

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Article published on August 2, 2007




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70 Responses to “Programmer’s Nightmare: Cubital Tunnel Syndrome”

  1.   Programmer's Nightmare: Cubital Tunnel Syndrome by depression.vahalo.com Says:

    [...] like to have cubital tunnel syndrome: pins & needles & pain. … article continues at admin brought to you by Depression and Clinical [...]

  2. Scott Andrews Says:

    Thanks very much for the article. I needed it! Been scrounging the net for something understandable on this Ulnar Syndrome. I seem to be on the leading edge of it and want to get control ASAP. My only problem to date is some numbing in the left hand pinkie and ring finger (outer half only). No pain no tingling, but it does feel a little weird. I’m recently retired and using the computer as much or more than I used to as an x-finance guy… and all too often resting my elbow arm on the desk. Not a good practice! Anyway, I look forward to other articles. Would be especially interested in stretches and exercises for the arm, hand and fingers! Thanks again, Scott Andrews

  3. Manda Says:

    I thought your article was outstanding and the most informative I’ve read yet. I am 27 started early on computers and have already had surgery on my ulnar nerve. I had all the torture tests, and the surgery didn’t really help! But what you’ve written here has helped a LOT!

    Thanks so much for taking the time to write this!
    Amanda Bartlett

  4. Shawn Brenning Says:

    good article. I have had surgery twice on my right arm. one subcutaneous ulnar transposition and one submuscular ulnar transposition. neither one helped. now getting the same problem in my left arm from favoring my right arm. here is a product I’m thinking of trying.

    http://www.gyration.com/en-US/ProductDetail.html?modelnum=GP6005M&accshow=3

    Have any experience with the air mice?

    sb

  5. Timm Says:

    Hi Shawn, thanks for your comments. Sorry to hear your surgeries did not fix your problem.

    I have not used the specific mouse you mention, but I have used other wireless optical air mice. In my experience, this type of mouse is not precise enough for extensive programming work and becomes frustrating to use after a short time. These mice are better suited for minor mouse control while standing and doing presentations in front of a group. But your mileage may vary.

    For cubital tunnel syndrome, I highly recommend the 3M Ergonomic Mouse. It allows you to keep your arm fixed in a handshake position and move the mouse with either slight wrist or full arm movements. It’s very precise and holds up well to extended use. I’ve used it for 3 years, and it’s the only mouse I can use without extreme pain. I will write a review shortly.

    http://solutions.3m.com/wps/portal/3M/en_US/ergonomics/home/products/ergonomicmouse/

    http://www.amazon.com/3M-EM500GPL-Ergonomic-Mouse-EM500GPLLARGE/dp/B00008KWWF

  6. Byron Says:

    I’ve been going through the same thing for the last 2 years. The doctor I went to didn’t give me any options except Carpal Tunnel surgery (I have that too, but not as bad). The only thing that has helped me was joining a Tai Chi class, but I am far far far from recovering.

    I think I will see another doctor now that I know more about my problem.

    Has anyone tried the Zero Tension Mouse?
    It looks similar to the 3M mouse, but it has a scroll wheel instead of the 3rd scroll button.

    I record music and a lot of the GUIs for recording software don’t recognize that button on the 3M, while a scroll wheel is the easiest way to zoom in and out while arranging tracks.

    What about the Evoluent Vertical Mouse?

  7. Shawn Brenning Says:

    Byron,

    I have the Zero Tension Mouse. It seemed to make a difference a first, but after a few weeks the pain returned and seemed to get worse. This was before my second ulnar transposition. Many people swear by it the mouse. My condition has progressed so much that I am thinking the only remedy will be to quit using computers entirely. I’m looking into disability next spring if things don’t improve. I have two of them and would be happy to sell it to you one for $45 plus s/h. That is half the new price. You probably need the large size, which is what I have. If it works for you, I would sell the second one too. I bought it for home use.

    Thanks,

    Shawn Brenning

  8. Scott Says:

    Have you tried stretches? There are a number of them, and one of the best sources I’ve found is a $29.95 online booklet called Self Care for RSI/Ulnar nerve!

    They seem to be helping my situation… and I will do whatever I can to avoid surgery. My problem came in the left hand so it’s not a mouse manipulation problem… more a leaning on the elbow issue!

    The booklet also has a number of good diagrams and explanations of just how things work (nerve and muscle wise) and what and what not you can do!

    Here’s the link… http://www.selfcare4rsi.com/ulnar-tunnel-syndrome.html

    Good luck! Scott Andrews

  9. Tina Says:

    I read your acticle and thought that i should respond to the part about the nerve conductive test > I recently had this test however i did not find it exactly painful just a number of shocks that jolted my arm but i would not say painful. I stressed very much about having this test as i was told by friends this was painful. However i must also say i have experinced in the past 7 months much pain with my elbow injury so by comparision the nerve test was nothing. i have already had nerve transposition in my elbow and i am being told its in the wrong place and i now have nerve entrapment. therefore futher surgery is needed. My reason for the nerve transpostion was due to a severe fracture to my elbow. i have plates repairing my fractures and they moved the nerve due to my bones touching the nerve. I was trying to find some article about how they move the nerve and where do they relocte the nerve. I am now awaiting for the surgery again and i am not looking forward to it as i have experienced many complications from my first operation . this operation will be my third one. ps. please excuse grammer i am in pain typing makes it worse

  10. Byron Says:

    I remember there being 2 tests performed when I had my nerve conduction test done. The first that wasn’t so bad was the one with an electrode shooting a charge down my arm to another one. It did hurt more when they got to my upper arm though.

    The second one was the wonderful needle test. They stick needles in your arm to test for something. They start at the top and work their way down into different places in your hand. It doesn’t hurt too much until they get to the hands. But the guy who did mine saved that for last, thankfully. It was weird how the needles did not hurt at all when stuck into my upper arm.

  11. Scott Says:

    I had my Ulnar nerve released 6 months ago and still have numbness, Thank fully the surgery removed the tingling feeling….

  12. Greg Says:

    I’m a Laborer, and have worked building kitchen cabinets for over two years now. I had been relocated to a different department within the company that required me to hand-sand approximately 500-600 eight and ten foot pieces of trim molding, ten hours a day, every day. Sure it was one of the toughest jobs there, but wasn’t beneath me by any means. Even though no one around me could bring themselves to do it, I took it on as a challenge, and took pride in my work. after all, I was the one doing it.
    One year into the job, I noticed some numbness in my left hand. No, I didn’t think it was a stroke. I did go immediately to the hospital from work though. Feeling not worthy of even being there, subsequently I was seen by a Doctor that said there wasn’t much he could do for me, and told me to go to Occupational Therapy right then, and I did. The secretary said my employer denied treatment for me due to the lack of an accident report? Whatever. So I took care of it myself. I had an EMG done. Very interesting test by the way. He said if I do not get the surgery to release the nerve, It could get much worse, and stay that way. I had already noticed some muscle deterioration pronouncing the bones a little more on the top and on the pinky edge of my hand, and noticeable weakness overall. Even some fatigue up high at the shoulder muscle. I had the transposition surgery done two weeks ago. I’m still quite sore, but it’s slowly getting better. As far as the numbness goes, It’s twice as bad. Not a real assuring side effect to say the least, but the surgeon said that is a normal thing. He also said that it was up to my body’s ability to repair the year’s of damage done before I could even hypothesize how long my hand would be numb, or weather the damaging effects would be for life.
    So… Here I sit trying to keep my spirits up, hoping for the best. I just want everyone out there who’s had this surgery, to know that staying positive is the best medicine, and to “believe” in your body’s ability to heal it’s self over time.

    Get well everyone, God bless.

  13. Byron Says:

    Absolutely agree with you! I opted not to get the surgery because it seemed that my cubital tunnel and carpal tunnel symptoms were related to severe tension in my shoulders and back muscles. I also found that my hips had a lot of tension.

    I had all the tests done and was told to get surgery or take ibuprofen until I couldn’t stand it anymore and then get surgery.
    I opted not to get surgery so I started doing yoga and tai chi (tai chi helped a lot more) and I am extremely happy to say that I stopped taking my ibuprofen 2 months ago after over 2 years and I have less pain than I have in a long long time.

    I still have problems occasionally but as long as I stretch daily I seem to be getting better all the time. The strangest thing I noticed about the problem in my wrists and shoulders is that it really seemed related to tension in my hips from sitting with poor posture most of my life.

    Just a note to anyone considering surgery: Doctors are not exactly sure what causes this problem all the time. It is not always caused by tension centered in your elbow. Sure the tension is there but it can sometimes be a symptom of a deeper problem that can be slowly (very very slowly) corrected by changing how you do things in your everyday life. I feel more hopeful than ever that I will be able to recover without surgery.

    I now stretch my arms, shoulders, wrists, hips, back, knees, and hamstrings daily and feel better than I can ever remember.

  14. Timm Says:

    Hi Greg, Sorry to hear you are still experiencing numbness after cubital tunnel surgery. Hopefully your numbness and pain will disapppear as you heal. Please stop back in a few months and give us an update how you are doing. Good luck.

  15. Amy Kasten Says:

    I just got diagnosed today and the symptoms are spot on. I was a masseuse and it started in my right arm, so I thought a change of career was in order. Now I work for the post office and it’s 8 hours of driving a 2-ton every day. The numbness in the morning is the worst, and the splint by IMAK looks comfortable. Anyone tried it? My partner is a computer animator and I will pass this site on to him, thanks to everyone for the great info.

  16. Las muñecas del muñeco « Dejar de imaginar Says:

    [...] casi tan hinchadas como mi muñeca izquierda. Me da que sufre una tendinitisoo quizá… el síndrome del tunel cubital o [...]

  17. Tammi Says:

    Well, I was diagnosed with cubital tunnel syndrome in 2005 and have waited for symptoms to subside but they have not. I am going to undergo surgery and am VERY hopeful as the pain I have is not just numbness in the pinky and ring fingers but massive burning sensations in my elbows. (Yes, I have it in both arms) I first got surgery for carpal tunnel in my right hand but found that the pain and numbness was still there after the initial carpal tunnel release surgery was done. I hear a lot of people say that surgery doesn’t work and PRAY that it works for me as the pain alone keeps me up all night.

  18. Timm Says:

    Tammi, good luck with your surgery. Please check back in a few months and give us an update how you are doing and whether your surgery was successful. Take care.

  19. Byron Says:

    don’t forget to pay attention to all the little things you use your arms and hands for throughout the day every day. You definitely don’t want to injure yourself again after the surgery.

    I’ve heard some good things about the ulnar nerve surgery but it seems that it would be odd to have your ulnar nerve moved so it goes over the top of your elbow instead of the bottom.

    Please let us know how the surgery works out for you

  20. Jan Says:

    I am having cubital tunnel surgery next week. I had carpal tunnel surgery on both of my hands. The hands have improved a great deal so I’m hoping for the same after this surgery. I am a postal worker who does repeatative motion all day. After reading all the people who say the surgery didn’t help, I’m now nervous!

  21. Timm Says:

    Hi Jan,

    From what I’ve read on the Web, many people are helped by cubital tunnel surgery. Success rates seem to be in 50-70% range, with many people reporting at least some improvement. But complete recovery (no pain or tingling ever again) is less common, especially if you return to the activity that brought you pain in the first place.

    Be sure to discuss your expectations with your surgeon. Also ask him/her how many cubital tunnel surgeries they have performed, and what is their estimated success rate.

    Good luck, and please stop back in a few months and let us know how you are doing.

  22. Brenda Says:

    I have just been diagnosed with ulnar neuropathy after suffering with it silently for a couple of years. I have to go in for the EMG in about 2 weeks. I have a question for all of you who have gone through this. Does the Doc test both the left and the right arm or just the arm with pain? The reason I ask is that I was told they have to compare the results to something. They can either use you or some textbook average to determine the severity of the inflammation.

    Any information you can give me on how to interpret the results when I get them would be helpful. Also, I was told the first line of treatment is cortisone. I’m looking for an alternative. Anyone tried accupuncture with success?

    Thanks

  23. Timm Says:

    Hi Brenda,

    Sorry to hear about your diagnosis, though it’s good that you are finally receiving treatment.

    I’ve had the EMG tests twice, and both times they tested only my bad (right) arm. From what I’ve heard, nerve damage symptoms are pretty easy to spot with the EMG, so I’m not sure why they would need to test both of your arms.

    I’m not a doctor, but I’ve been told by a couple different specialists that cortisone treatments are NOT appropriate for cubital tunnel / ulnar neuropathy. Cortisone injections are typically used to treat inflammation and pain in ligaments and joints, but do nothing to help nerve problems, which is what causes cubital tunnel. I have not tried acupuncture.

    Be sure that your doctor is a hand surgeon specialist before receiving any treatment. Cubital tunnel is not a problem that you can delegate to your general practitioner or family doctor. Ensure that your doctor has treated many patients with cubital tunnel and performed many successful surgeries.

    Good luck, and please stop back later and let us know how you are doing.

  24. Shawn Brenning Says:

    Brenda,

    I have been dealing with this problem for almost 10 years. I had two EMGs on my right arm; one in 2004 and the other in 2006 before my FIRST cubital tunnel surgery, a subcutaneous transposition, in March 2006. They did not use my left arm for a benchmark. They used whatever standard measurements are generally accepted. I had a submuscular transposition on the same arm in April, 2007. That was a major surgery and required therapy to regain full movement and build up strength. Neither operation has helped. Now my left arm is trashed from trying to give my right arm rest. I’m going for two EMGs tomorrow; left AND right arms. They have the 2004 and 2006 readings to compare against, which tell how much worse my right arm has progressed. They are now talking disability as I have tried everything you can imagine; Lyrica, Celebrex, Neurotrin, lidocaine patches, Flector patches, physical therapy, etc… I’m taking Hydrocodone daily to control pain. I say all this not to garner sympathy and have a pity party. I am blessed beyond measure that I can still work and provide for my family and that I have an excellent insurance plan and disability coverage should I need it. I tell you all this just to let you know that you may be in this for the long haul. The ONLY thing that helps me is NOT touching a KB and mouse. I can work on my land mowing, shoveling, digging, lifting etc… with no problem. After a few days of not using the computer, my pain is almost gone except for when I apply pressure to the nerves directly.

    I have not tried acupuncture, but I am going to my chiropractor weekly to see if he can work on the pressure points for the elbow, arm and pinky and ring fingers. He works the muscles and the pressure points beneath the muscles under the chest and back. It hurts like heck, but it might provide a little relief.

    I have tried the air mouse and speech recognition s/w, but both are tow slow and clunky to allow me to do my job effectively.

    Hope this information helps you and you have some success in your treatments.

    Grace and Peace,

    Shawn

  25. Shawn Brenning Says:

    Brenda,

    Almost forgot until I reread Timm’s post. I have also had the steroid shots. While they did provide some short-term relief, they are not a cure. They are also EXTREMELY painful as you can imagine injecting in, or around, a damaged nerve would be. I agree with Timm that I would not do it again for this injury.

    Shawn

  26. Byron Says:

    Shawn,

    That really stinks! Have you ever heard of Brain Fingers? It’s a computer controller (mouse-like) that hooks to your head and it mostly reads the electromagnetic impulses from your face to control the mouse.
    Apparently it works decently and has given some severely disabled people (paralyzed from the neck down) access to computers again.

    When I had my EMG done they tested both arms. Of course I did have pain in both arms…
    I’m still really curious to see how that ulnar transposition surgery works for people. I find that my ulnar nerve regularly catches in my elbow and while I can stretch it out little by little, it may be easier to simply get the operation.

  27. Jan Says:

    They will most likely only test the arm that has pain. I didn’t think the EMG was that bad. I hurts a little but only for a second. I think the suspense of the next shock is worse than the actual shock. I have heard people say the EMG was very painful maybe thats why I expected it to be worse. Don’t worry about it. It will only take about 5 minutes. I am having my cubital tunnel surgery tomorrow. I will let you know how the recovery is.

  28. Timm Says:

    Jan, good luck on your surgery!

    I’ve had the tests twice. First time I had both an NCV and EMG, but I couldn’t tell you which was which. It was 20 minutes of shock and pain. But the results showed only slight nerve damage. Two years later I had another NCV test by a different technician. That lasted only 5 minutes and was only a little painful. As you mentioned, the worst part was the anticipation of the shock. That test showed more severe (but thankfully not permanent) damage. So who knows? Maybe the first technician conducted a more thorough test, or didn’t know what he was doing, or perhaps he was a closet sadist. ;-)

    I hope your surgery is successful! Please stop back and share your experience and recovery. Take care.

  29. Shawn Says:

    Byron,

    Have not heard about Brain fingers. I’m afraid to spend anymore of my company’s money on these gadgets. I have also tried the vertical mouse with no success. I hope the surgery works for those recent posters who are about to have it. I would also like to hear how they go.

    sb

  30. Byron Says:

    I tried that Zero Tension Mouse and it sucked.
    I got a medium when I should have gotten a small I guess, but I used the chart on their website to determine that I needed a medium.

    The mouse wheel is on top of this gigantic mouse and it causes a lot of pain to try and turn it with my thumb.

    I have a 3M Ergonomic Mouse and it just feels so good to use. I have virtually no pain with it now. The only problem…..there is no mouse wheel!! just a middle button that I have to set to something….

    Is that Vertical Mouse any good. How does the quality feel? Sturdy?
    I noticed it has a mouse wheel; does it feel solid?

  31. Byron Says:

    When I had my EMC and NCV tests it wasn’t so bad either.
    The NCV was much worse especially when they stick the needles in your hands…. ugghh…..*shudder*
    That kind of sucked. especially when they couldn’t tell me anything helpful other than “Sure enough, you have compression on the ulnar and carpal tunnel nerves in both your arms.”

    Wow what a relief since I already knew that. The odd thing is that almost all of the numbness is in my left shoulder (mostly just pain in my hands/wrists/arms).

  32. Timm Says:

    Hi Byron,

    I’ve been using the 3M Ergonomic mouse for years and it is the main reason why I can still use computers. It’s impossible for me to use a regular computer mouse more than a few seconds without excruciating pain.

    Here’s another trick: I have a programmable keyboard that I use with my left hand to click the mouse buttons. That way my right hand has to simply move the 3M mouse around, which gives me the freedom of many different hand positions.

    Note that you can click the middle mouse button on the 3M mouse (located vertically along the “handle” of the mouse) and that will scroll most applications similar to a mouse wheel.

    Thanks for commenting!

  33. shawn Says:

    Byron,

    Sorry, I was referring to the zero tension mouse when I said vertical I may try the 3m mouse if works that well for Timm. I’m on my way for EMGs on both arms (3rd for right, 1st for left)

    Shawn

  34. Jill Says:

    My left arm/hand had been numb for 3 months before I finally went to the dr. The last 2 months of that was constant numbness from the elbow through the pinky and ring finger like you all have said. My GP said possibly carpal tunnel, but sent to a specialist so that it could be properly diagnosed. Saw the hand surgeon and he instantly told me it was cubital tunnel syndrome. Had me sleep with the towel wrapped around my elbow for 2 months and I just returned yesterday for a visit. Since it is relieving it, but only temporarily and it’s still numb, just not constant and I don’t feel like sleeping with a towel on my arm for the rest of my life, we’ve set up surgery. Set it up for April 1st so we’ll see how it goes. I’m not sure how long I’ll be off work, but I work for the postal service and sorting mail will be a problem.

  35. shawn b Says:

    Jill,

    Did you get an EMG? How did the hand surgeon know instantly it was cubitul? I had a misdiagnosis of cubitul tunnel 4 yrs ago by a guy who did his EMGs wrong. Two surgeries later, problem was worse. Had two EMGs last week and had the proper diagnosis of carpal TS in both hands. Carpal does not always cause pain in wrist. Mine hurt from pinkie to upper arm.I also had an MRI to rule out a C8 bulge or rupture, which can cause pain down the arm like cubitul TS.hope your diagnosis is right. It might be worth it to get a 2nd opinion. I wish I had.

    BTW, tried the 3M Ergo mouse with no success. I’m sleeping and computing with ortho wrist braces on both hands which IS helping. I look like a cyborg, but I don’t care at this point.

    Grace and peace,

    sb

  36. Jan Says:

    Jill….I just had the surgery two weeks ago. My surgeon moved my Ulnar nerve from the outside of my elbow to the inside of my arm.
    I was put in a splint which was really a two sided cast wrapped in ace bandages. It went from the top of my arm down to the fingers. I had no use of that arm at all. You will need help when you get home for at least a few days. The best way to sleep will to rest the arm on 2 pillows at your side. It really depends on the Surgeon whether he puts a cast on or not. Some people tell me they were just bandaged. I had my cast removed a few days ago. I can’t straighten my arm yet but I’m sure in due time that will work itself out. My incision was about 6 inches long closed with about 20 staples. It was also made on the inside of my arm which seems strange to me. I only needed my hydrocodone (pain pills) for about 3 days after surgery. I didn’t like the way they made me feel. I will be out of work for a totol of 4 weeks I think. After that he said 3 months of light duty work. I also work for the Postal Service as a mail processor so luckily they do offer light dury. I’m wondering if you claimed a workers compensation case considering it most likely is work related.
    I was refused the first time but am putting in for a reconsideration with better doctor documentation now that we have a confirmed diagnosis and the fact that I did needed surgery. Good luck to you. Let us know how it goes for you.

  37. Byron Says:

    Jan,

    Please let us know down the line how the surgery worked out for you.
    I can currently live with the pain and am not usually taking pain killers anymore (maybe 1-2 times every other week now), but there are still those days that I just can’t do anything.
    i’m going into computer programming too so ahhhh crap….

  38. terri Says:

    I just had cubital tunel and tendonitis surgery on the same elbow last Friday. I’m still in the splint and sling and can’t wait to get this off. i’m wondering if any of you who have had the surgery have experienced the feeling of large needles going into the under side of the elbow along with the ever present burning sensation. I’m assuming this is the nerve ‘waking up’. It is not bad when it happens a few times but when it goes on for hours it sends me back to the hydrocodone just to be able to sleep. I have virtually no pain from the tendonitis surgery which is on the top of the elbow. All of my pain is on the under side of the elbow.
    Thanks for the great info about an alternative mouse! i’m feeling the familiar tingling from my right elbow now so before i do this again, i’m going to try the mouse!
    BTW typing one handed is a treat!

  39. Jan Says:

    Terri
    I had the cubital tunnel surgery two weeks ago. I didn’t have either one of the symptoms you are having. Only had pain for a few days.
    I did have a problem about 7 days after the surgery when the pain got really intense and brought me back to my hydrocodone for one night.
    I couldn’t move my middle finger upward without severe pain. It was fine the next day and the Dr. said it must have been from swelling.
    My splint has been off for 4 days. I can now bend my arm but straightening is a problem. Let us know how you make out.

  40. Shawn Says:

    Terri,

    The pain may be subcutaneous nerves that were cut. I had needl-like pain all around my elbow for several months after my second surgery, which was a submuscular ulnar transposition. Nerves heal slowly from what I have been told.

    Shawn

  41. terri Says:

    I’m not liking the frequency of people talking about 2nd surgeries. That is not on my radar at all!! Shawn, you’re scaring me =)

  42. Shawn Says:

    Terri,

    my second surgery was to correct the first one which was the wrong type and performed incorreclty. Unfortunately, it has not helped either because, as noted in previous posts of mine, I had an incomplete diagnosis in 2004 and 2006 of only having ulnar nueropathy when in fact I also had carpal tunnel in both hands, which was causing much more pain and more problems than the ulnar nerve. Hopefully, I’m on the right path now. meeting with two hand surgeons next week to discuss my options.

    sb

  43. Tammi Says:

    Has anybody that has already had the surgery had GOOD results? (Ulnar Nerve Transposition)? I am supposed to go for this surgery next week and after reading all of the down’s to the surgery, I don’t know if I am willing to get it done and have no relief. My problem is the extreme pain, let alone the numbness in pinky and ring finger. I have extreme pain in my elbows and cannot even sleep on my sides anymore as the nerve feels pinched when I do so. I toss and turn all night. Sometimes I wrap my elbows but obviously cannot keep them wrapped all day. I cannot lift things like I could before this all came about. My fear is that I have nerve entrapment in my shoulders as the pain I have seems to stem from there. But, what type of doctor can diagnose that? The hand specialist I go to only does arms and hands, not into the back and neck area. I have seen a chiropractor but he cannot even tell me if I have nerve entrapment in my shoulder/neck area. I hate feeling confused about this whole Cubital Tunnel Syndrome thing. Any feedback would be WONDERFUL!!!

  44. Jan Says:

    Terri,
    I sure hope you had a nerve conduction study. That shows where the nerve is trapped. I had the surgery a little over two weeks ago.
    Of course I’m still healing but I don’t have anymore numbness in my little and ring fingers. It was waking me up at night too and hasn’t happened since. My surgeon was an orthopedic doctor. I don’t know if you are seeing an ortho or a neurologist. I wouldn’t do anything unless you have had the nerve conduction study. I wouldn’t let ANY Doctor guess at such a thing. I have also had carpal tunnel surgery done on both hands with good results.

  45. terri Says:

    Jan, I think you were addressing Tammi in your last response.
    I too had my surgery by an ortho surgeon. I no longer have the tingling or pain but I am only 10 days out. I get my dressing off tomorrow. I’ll let you know what song I’m singing then!

  46. Tammi Says:

    I did have nerve conduction tests that showed that I have cubital tunnel syndrome. I had the nerve tests done in 2005. The pain has since progressed. I also had x-rays done that show that the bones at my elbows are not the problem. The hand specialist said that the ulnar nerve transposition should stop the pain in the elbows that I have as I cannot even keep my elbows bent for more than a few minutes without excruciating pain. Also, I am weaker now and drop things ALL the time. I did ask my doctor why I have the tension in my shoulder area but he is only a hand specialist (I guess that means only hands and arms). He said that the ulnar nerve transposition should help only the elbow issue, not the neck/shoulder area. So……..what type of doctor do I see to make sure the underlying problem is NOT in my shoulder/neck area? Also, am I making the right choice to have the ulnar nerve transposition surgery??? Any input would be GREATLY appreciated.

  47. terri Says:

    Tammi,
    before you go for the surgery, i would see an orthopedic surgeon.

  48. Jan Says:

    Tammi,
    I agree with Terri. You should see an orthopedic doctor. When you had your nerve conduction study, they probably checked from your hand to just above the ebow. If they didn’t go up and beyond your shoulder that means you do have a problem with the ulnar nerve in your ELBOW which should be fixed. If the nerve is entrapped in your shoulder it doesn’t seem like it would show being entrapped in the elbow. Your shoulder problem could be a whole different matter. I also have bursitis and tendonitis in my shoulders which has nothing to do with my cubital tunnel. Before I had my surgery I had completely different symptoms than I read on this forum. I only had pain if I straightend my arm. I had no pain when my arm was bent. I did get numbness in my fingers if my arm was bent only while sleeping. I had 2 carpal tunnel and the cubital tunnel surgery and have had success with all three. Good luck and let us know what you decide.

  49. Byron Says:

    Tammi,

    You might want to consider something like Yoga or Tai Chi too. The main principles of Yoga and Tai Chi are typically centered around knowing your self. It helps to increase self awareness to determine where the problem is coming from and what parts of your body are affected. I don’t really trust doctors very much so I have opted not to get the surgery (at least thus far) until I know why I developed the problem in the first place. I have made several adjustments to almost every action I perform throughout the day.

    It has been working ok for me. I don’t have very much pain anymore. I still have tension in a few areas now, but it has mostly moved out of my hands now. For me it seems that most of my tension was centered in a shoulder injury on my left shoulder right near the middle of my back.
    That is now the only place I have any numbness or tingling.

    I had MRIs and x-rays and sure enough there is nothing wrong with my bones. So why couldn’t I raise my hands over my head? I can now, yay!

    This is not to say “don’t get the surgery” by any means. Just a word of caution that surgery is not a solution to the problem. Surgery is for relief of the symptoms of the problem. The problem is how you sit when you type or how you lean when you walk (at least for me). How many hours you spend in front of the computer trying to finish up that last bit of work before taking a break. I have heard of a lot of people who get the surgery only to injure themselves again and it is sad that they may have to go through the surgery all over again.

    So far it seems that the surgery is working out real well for a lot of people. Good luck

  50. Tammi Says:

    Hey Jan,
    I have read all of your posts and as I get ready for my cubital tunnel surgery Monday, I am sooooooo scared. I have already rescheduled my surgery twice (This is the third time actually) and I am wondering how you are doing now? Do you have any idea how long the actual surgery took? Did they use staples to close the wound? Do they put a drain in? Did they cast you or use a splint? Sorry for the questions but I have not had a pre-op as my surgeon is two hours away and supposedly is going to call me today but I am not holding my breath. The same surgeon did my Carpal Tunnel surgery and I think he is a great surgeon but I think his office gets mad at me for rescheduling so much. Even with the carpal tunnel surgery, I rescheduled many times. I am just such a baby when it comes to having somebody cut me open. This surgery however is wayyyyyy more serious than just the small incision for the carpal tunnel release that they did on me. I GREATLY APPRECIATE YOUR FEEDBACK!!!
    Take care,
    Tammi

  51. Shawn Says:

    Tammi,

    I had the ulnar transposition. No drain. He used staples. Full arm cast.surgery time was 1.5 hours.

    BTW, was your carpal surgery successful?

    Tx,

    Sb

  52. Jan Says:

    Tammi,
    Surgery was about an hour. He used staples. Full arm cast which was really a two piece cast held on with ace bandages which was nice because you could split it a little at the top to relieve pressure. My incision was on the inside of my arm and is about 5″ long. I am doing well. Still hurts a little to straighten my arm but in due time I’m sure it will be fine. Some muscle soreness still but it has only been 3 weeks since my surgery. Good luck and let us know how it goes.

  53. Tammi Says:

    Shawn,

    I believe that the endoscopic release worked. I do not have the cramping in my hand that I used to have, however, the pain I was having at the same time was the forearm to elbow pain in the muscle which I now find was due to the cubital that didn’t show up in the first NCV test that was done. Also, a orthopedic surgeon told me that sometimes cubital tunnel doesn’t show up on Nerve Conduction tests. So, on the ulnar transposition, they actually cut the muscle right? My surgery center says that stiches are used, not staples…I wonder what difference it makes…they also said that they use a splint, not a cast. Well………even though I am scared, I will go under the knife (so to say) this coming MOnday……….I can’t wait for it to just get here and be over so I can start on the road to recovery. As long as all goes well, I will get the left one done after the right one is healed enough!!
    Jan, I am glad to hear that you are feeling better, it gives me something to look forward to. I am sooooooooo tired of being in pain when bending my arms, whether it be to brush my teeth, apply mascara or just wash my hair…..so……pain now and hopefully none later!!
    Thanks to all for your reply’s back, they mean a lot to me!!
    Take care all

  54. terri Says:

    Tammi et al,
    I am 2 weeks out from my surgery. I got my dressing off on Tuesday which was a half cast wrapped in cotton and then an ace wrap. I have two incisions because I had the cubital tunnel release and tennis elbow surgery. My two surgeries took less than 1 1/2 hours. My cubital tunnel incision is about 3 inches long, closed with staples which hurt a bit when they took them out. No drain. I was amazed at how good it felt right when they took the dressing off. I’ve been getting more mobility back every day. There was a lot of bruising and swelling – the swelling is what is keeping me from fully extending and bending my arm. He said not to lift anything heavier than a coffee cup for a month but other than working on the mobility, I’m good to go. The under arm area is very tender so I use a pillow a lot when I’m sitting because resting my arm on anything hard is painful. So far I feel really good about the surgery. I’m hoping with good care and I plan to add yoga and tai chi to my exercises as Byron suggested that it will heal completely. It makes good sense as yoga (I’ve never done tai chi) elongates your muscles and opens up your joints, so I plan to incorporate that and hopefully avoid surgery on my right arm and any subsequent surgeries on my left.
    Good luck to you on Monday, Tammi.

  55. Andrea Says:

    hello again all of you lot on here i watch and read this page with anticipation while i await my surgery on the 8th April. I was just wandering although we all seem to have similiar syptoms does any one else on here have the loss of the baby and ring finger as i cannot use mine at all they just stick out straight at all times and i cannot bend them, they are also both swollen. I am waiting to also have my nerve moved from the bottom to the top of my elbow..

  56. Andrea Says:

    hi!! Tammi if you get the chance let me know how yooooo get n i am going in on tuesday week and like you i have been told i will get a splint though not to sure what that is , i dont know if i will get stitches or staples.I cant use my left arm or hand for much at all and my right arm has been hurting for the last few months so think that will be next though want to get on the recovery from this op before sorting that arm out .

  57. Tammi Says:

    Hello there,
    got surgery the 24th of march. no splint, stitches, i have pain but i am managing. after recovery i will get the left arm done too. what other questions do you have Andrea?? I got to remove my bandaging the next day and now just have bandaids over the stitches. My dr. wants me to start moving my arm as soon as possible so that the scar tissue doesn’t stop the nerve from moving. I am slowly typing with my arm but when it hurts, i stop (which is not typing often) I hope 2 have great results as i have the massive pain in my left arm too.

  58. Tammi Says:

    that last entry was to andrea from me…………tammi sorry

  59. Adam Says:

    I had the endoscopic release a year ago – didnt do it for me.. the doc in KY claimed I was one of three over the years and many of the procedures that it didnt work for.. so looks like it will be transposition for me next. I did have extensive nerve tests (they compared speeds to all other nerves in arms and even went to the back – the neurologist was very comprehensive.. and agreed I had it after another neurologist shocked my arm a couple times and looked at the graph on a machine from 1950 and said nope.. doesnt look like you have it here. the more in depth study – that doctor said he absolutely disagrees with the other doctors and the results were there).
    anyway…. hope it works .. three months before full activities.. yuck.. and then the other arm as well. blech.

  60. Tammi Says:

    Ya, the endoscopic release worked for the carpal tunnel ONLY. I also had cubital at the same time but was not diagnosed for the cubital until after the endoscopic didnt relieve the pain in my elbows and forearms. Today is one week since the ulnar nerve transposition was done on my right arm. My muscle is hurting a lot and i cant move my hand much but i dont have the nagging pain in my elbow that i had b4 the surgery so i am crossing my fingers that it is working. I still have numbness but i am sure that the trauma to the nerve is why. I have had cubital in both arms since 2005. It was definitely time to try anything to stop the excruciating pain even though i was petrified about the surgery. GLAD I WENT THRU WITH IT!! My surgeon is awesome!!!

  61. Mike Says:

    Hey all,
    I had the cubital tunnel nerve transposition and carpal tunnel on my right hand on Feb. 1. Before the surgery, I had numbness on my entire hand when I slept, extreme pain in the middle, ring, and pinky finger. Some days it felt better, some days it felt worse. I had to wait so long to get a surgery because workers comp. took that long to approve it. I do think the surgery worked. Some days now I have a liitle pain and numbness in my fingers, and other days no pain at all. Sometimes after surgery, you have to distinguish which is the surgery pain and which is the pain from carpal tunnel and cubital tunnel nerves. After you heal a little bit, it is easier to tell if the surgery was a success. I now have to decide if I am going to do my left side. I also have pain on my left side on the outside of my elbow and on the back of the elbow. I am not sure if that is the radial nerve or not. I hope not, I have enough nerve problems. I also have pain in my upper arm and shoulder. The nerve condition test was positive for cubital and carpal tunnel syndrome. Does anyone know if on the top side of the elbow and back is the ulnar nerve or is it some other nerve?

  62. Andrea Says:

    hello Tammi finally managed to get back on here , well i go in on this tues and have to admit the nerves are setting in. i have been told i will definately have to have the splint so not sure about anything else so guess i will find out on tues when i awake from the op. You are really lucky to not have to go through all that. Yeah i am going to see about getting my other arm done once this one has healed. Thankscoming back on here and letting me know how you got on x

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