(Ulnar) Nervous Breakdown

UlnarI recently visited my awesome hand doctor for a follow-up to the carpal tunnel surgery I had back in June. As I’ve mentioned in blog posts before, my decision to have carpal tunnel release surgery was based on the fact that I couldn’t sleep through the night due to numbness in my hands waking me up every hour on the hour. People with diabetes are at about a 20% increased risk for carpal tunnel than your average person, and of course at higher risk for nerve issues in general. The surgery I had made more room in the tightly wound bundle of my carpal tunnel nerves, and I have been overall pleased with the results – the numbness is occurring less frequently and less intensely at night, and I’ve gained enough strength in my right hand to get back to kickboxing 2-3 times a week. Overall, this surgery has worked really well.

For my thumb, index and middle fingers that is.  My ring finger and pinkie seem less cooperative. I’ve still noticed some numbness in those fingers, usually early in the morning and especially when I sleep on my sides with my arms tucked up near my chin. I asked the doctor about this at my follow up visit last week.

“I’m still getting some numbness in some fingers” I said

“Really?” he asked, looking surprised. “Well which fingers?” he said.

“Uhhh, pinkie and ring finger I think…does it matter?” I asked him.

“Yeah it matters, that’s a different problem, give me your hand.”

The doctor took my middle finger in his hand and held it up, so that my arm dangled in a U-shape between us, bent slightly at the elbow. He tapped lightly on the inside of my elbow.

“Any tingling?” he asked

“Yes, pinkie and ring finger” I told him, amazed at the simplicity of the diagnosis. 

“Yep, that’s what I thought. Your ulnar nerve, which runs all the way from your shoulder down to those two fingers is irritated for some reason. When you bend your arm when you sleep, it gives that nerve 50% less room and is causing the numbness. This is different from carpal tunnel though, ok?”

“Uhm. Ok.” I said, a little nervous about the next thing he was going to say.

“Ok, this treatment is going to sounds really goofy, but it works, so hear me out. Here’s an ACE bandage. Tonight, I want you to ball up a sweater or get a really small pillow, and ACE bandage it to your arm, so that you can’t bend at the elbow.”

“Seriously?” I said dubiously.

“Yep, seriously,” doc responded. “Trust me, it works.”

“Ok. Umm, Dr. is this, uh, you know, uh related to my diabetes?” I bit the inside of my cheek, blinking back the tears as my mind filled with terrified thoughts of amputations and a fingerless future.

My doctor leaned in closer and looked into my eyes, “Of course it’s related, it’s a nerve issue and nerves are related to diabetes. But you are going to be just fine, this is nothing to go home and worry about.”

The doctor’s words soothed my mind and heart. After everything I’ve been through with this doctor, I knew he was right. I knew this was nothing to worry about and that this wasn’t a sign I was going to end up with no feet in a wheelchair. It’s hard not to jump to the terrifying Land of Complications when certain buzz words come up. I’m 16 years in to living with this disease and have so far dodged all complication bullets.

“Thanks,” I said, feeling myself relax. I went home that night and slept with a sweater bandaged to my arm. And guess what? It totally worked. No amputation required.

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The doc should have also told you that the most likely cause of the ulnar nerve irritation in the first place is the pressure right on top of the nerve as it crosses the palm in the fleshy area just below the swell of the thumb CAUSED BY YOUR CYCLING. I had this develop 25 years ago when I was cycling a road bike around 200 miles a week (3-5 x 20 miles commutes and 75 – 125 miles on weekend club rides). Spinning, which I saw you do, is the best cycling style, but actually puts more pressure on the palms for balance as you’re not stomping the pedals. When riding the tops of the brakes on a road bike , with the brakes between your thumb and first finger, you put more pressure on the ulnar. It really never goes away, although the upright mountain bike I now ride puts less pressure on the ulnar (more on the low back and butt). My computer mousing/keyboard brought it back bad, even after being off the bike for a while. Sound like your doc’s treatment makes sense and should work. Also using a higher gear on the bike (which will take some pressure off your hands and move it to your quads) also helps. A club rider showed me a way of relieving the pressure is to ride with your brake lever bewteen your first and middle finger – no real braking power, but it’s a change-up position. And obviously keep changing hand positions often.
I feel your pain (quite literally – both the ulnar and CTS)and hope the combination of surgery for the CTS and ace bandage for the ulnar nerve give you relief.

Had this surgery in 1998 – huge success! Been good ever since 🙂

Rich – as soon as I did my own research on this, cycling came up as one of the number one irritants – you’re totally right! I need to watch it while on the bike, I am going to fiddle with m brake grip and keep changing hand positions often. Thanks for all the info, I appreciate it, and I know you have gone through this too – just another ‘betes issue to think about! At least the goofy sweater trick totally works!

Tiff did you have ulnar surgery or carpal tunnel?

Carpal Tunnel. I was pregnant with my first child and had developed Gestational Diabetes. I was in month 4 when I noticed my 3 lateral fingers getting numb. A client of mine (I’m a vet) & I started talking and I told her. She came back the next day … turns out her husband was a neurosurgeon and she was telling him about my hand. She said he told her this was way too early to be getting this (I guess many women get it in the 8 or 9th month) and I needed to seek medical attention asap. She was right! They did the testing pronto and within 2 weeks I had the surgery. 10 weeks later I was back to normal.

I now hear it’s common for diabetics … makes sense, my dad is one and has had both wrists have a release.

thanks a lot. I was diagnosed with ulnar nerve compression and I was totally worried about it. Now I feel better 🙂 Thank you

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