Ulnar Nerve, EMG Results, and Surgery

[Ryan J]

Hello Everyone,

I am new to the TMS forum, and to TMS theory. I've already finished a couple books so far and I'm trying to have deep acceptance of TMS but I'm snagged on a couple issues.

Over a year ago I started having an odd tingling/numbness sensation in my right pinky while playing the piano. Like many people on this site, I freaked out and went to a doctor which started the long process of "figuring out what's wrong." Long story short, a hand doctor sent me to get an EMG test which detected I had nerve abnormalities and subluxation on both of my elbows with the ulnar nerve. Remember, this problem started out on my right pinky but then also started showing up in my left pinky which was consistent with the EMG results. (I'd also like to point out these symptoms starting happening when I had the busiest schedule I've ever had which was a bit stressful.)

Over time my pinky problem did not get any better or any worse but it was still uncomfortable to play piano and lift weights so I decided to get ulnar transposition surgery on my right elbow. The surgery fixed the problem....for about three months. I thought the problem was solved but then I had a very stressful week about three months after surgery and my right pinky problem was back. It wasn't any better or worse, it was completely back to how it felt before the surgery. Very strange I thought.

I was then starting to have weird numbness sensation in my thumb and pointer finger, so I thought maybe my median nerve was also being irritated. I got a second EMG test done which showed healthy median nerves (nerve that causes carpal tunnel syndrome). That second EMG also showed my right ulnar nerve is healthy (makes sense since they "fixed it" during surgery) and it still showed my left ulnar nerve as still abnormal. What is confusing, is that I still get symptoms on my right side even though the EMG says it's healthy.

My question for someone to answer is, do you think the problem is structural at all, even with the EMG results? I do think it is odd that I sill get right pinky numbness even though the EMG said my right elbow has healed. The EMG results are the last bit of evidence that is holding me back with fully accepting TMS, especially since the test showed my left ulnar nerve at the elbow is abnormal.

Thanks for reading,

Ryan

 

[Cactusflower]

Do YOU think it is structural? If you do, and the EMG says there is no structural abnormality then why are you convinced it must be after you have read TMS books.
This type of duality is part of the crux of people who experience TMS - a divided mind. What happens when the mind has these divided thoughts? It gets stressed out, it gets frightened with “what ifs” and it then causes physical tension. Tension in body and mind. You probably don’t recognize these tensions they begin to feel ‘normal’ over time. Putting into practice what you have read helps ease fears, and learn to relax mind and body. Sometimes it just takes awhile to truly accept that what feels so physical can be generated by the mind.

 

[Ryan J]

Most of the time I believe it's not structural but at times my mind plays tricks on me and makes it seem like it is. What helps me believe it's TMS is that it doesn't make sense that the EMG is normal on my right side, which has the most symptoms, and EMG is abnormal on left side, which doesn't have as much symptoms. It should be the opposite, but it's not. It's also very strange that the symptoms only show up when I play piano and lift weights at the gym, the two things I like doing the most, so maybe that's my mind's way as using that as a trigger.

 

[Atreyu]

Ryan, I’ve had a similar experience and am intrigued by your story. Several years ago, I developed some left elbow pain after weightlifting that lasted a few months. A few years later, after doing planks and other exercises recommended by a personal trainer, I started to get left forearm and finger pain in the ulnar distribution. I went to a sports medicine physician for conservative therapy, then a PT for more intensive therapy, then an OT for dexamethasone iontophoresis to decrease inflammation. EMG showed slowed ulnar nerve transmission around the elbow, consistent with cubital tunnel syndrome. Finally, I had anterior transposition with a subfascial sling done in August of 2020. Symptoms never really resolved, and acutely worsened with moderate lifting (biceps curls) in March of 2021 but then improved. Mostly, I’ve had a baseline “dysesthesia,” a weird, funny bone-like feeling that’s occurred at low levels much of the time. Over the past few weeks, symptoms have changed to more of a tingling, and even brief occasional numbness, worse with the “waiter” position (arm flexed at elbow, hand extended at wrist). I’ve taken Neurontin since June, now at 400 mg three times daily, with minimal benefit. Ultrasound showed the nerve enlarged before and after the sling, which may indicate inflammation, and compressed within the sling, which seems to suggest a tethering effect. I’m due to have another EMG at the end of February.

Meanwhile, I’ve been learning about TMS or neural circuit pain, and I’m also conflicted as to whether this would qualify. I understand that imaging studies may show “normal abnormalities,” but what about nerve function studies? I got stomachaches every so often as a kid but didn’t really have much as an adult, and have never really had the migrating pain that others mention, although I’ve certainly been anxious often enough. I’m trying to journal in the spirit of Nicole Sachs and Betsy Jensen, if for nothing else than to learn more about my inner self and relieve anxiety, but I’m not sure how much benefit I can expect with regard to ulnar neuropathy symptoms. They’re certainly not disabling, but it would be nice if they went away.

I’d appreciate any insights! Thanks in advance.

 

[Ryan J]

Hi Atreyu,

I can definitely understand your situation, especially with the nerve tests. What I can tell you from my experience is that the nerve conduction study showed my right ulnar nerve is normal (4 or 5 months after surgery) but I still get symptoms. My left ulnar nerve is compressed at the elbow but I don't get as much symptoms as my right. I have not gotten an ultrasound for my ulnar nerves but I did have them for my median nerves at the carpal tunnel.

The ultrasound found that I had my left median nerve enlarged at the carpal tunnel, however at the time I was experiencing carpal tunnel nerve pain in my RIGHT hand. The findings were backwards in this case.

I was pretty much obsessed with these findings at the time. One doctor said "well you haven't completely trashed the nerve..." Then another doctor thought the findings really weren't that big of a deal. It sucks having multiple doctors tell you different things because they are all obviously smart and trying to help you.

If I was in your shoes, I'd try and talk to a TMS doctor about all your symptoms so you get another side of the story. You could also read Steve Ozanich's book The Great Pain Deception. The amount of physical tests that showed physical damage to his body is incredible and he was able to heal using TMS approach.

I am halfway through the pain recovery program and structured education program and it has helped significantly. As gym goers we tend to highly focus on our bodies simply because that's what we've been taught. Having perfect proper form and worrying about pain or numbness is everywhere in the fitness industry and it probably does more harm than good.

All that being said you can try a couple things while you wait to see a TMS doc:

1.- You can try resting/using lighter loads with that area of your body in the gym for a certain time period if it needs to heal. For example: instead of planks on the hard ground, try doing 'stir the pot' planks on a yoga ball. Those are just as difficult as normal planks with less pressure on the elbow.

2.- If there isn't a structural problem, just keep reading the TMS books and try the two programs on the forum website. The books are inexpensive and the programs are free. In my opinion, it takes a certain amount of 'brain washing' to accept TMS, especially if you are skeptical person. Reading about other people's success stories also helps a great deal.

3. - You can also try caring less about the problem. I was obsessed about my tingling and numbness. I thought about it all the time. Now I have more of an attitude that is "I may or may not have numbness today. That's okay, I'm going to have a nice day anyways."

Hope this helps,

-Ryan

 

[Atreyu]

Ryan, thanks, I appreciate the advice, and I think you’re right on target about not caring too much. I’ve heard this refrain in several places, and it sounds right to me that the right approach to symptoms can defuse an overactive nervous system, even if there is a structural or functional (non-neural circuit) problem. From what I’ve read and heard, the trick seems to be not to block out the pain or symptom, but to process and accept it, and then move on. It’s a subtle distinction from ignoring it, but an important one that I’m going to work on. I think you’re also on to something about being focused on perfect form and hyper-vigilance about pain or numbness. Maybe we should treat them as badges of honor for self-work (physical and psychological) done?