Muscle Atrophy from my Ulnar Nerve

Shortly after my tummy tuck operation I developed a weakness in my right hand. I first noticed it during my normal exercise routine which included a limited number of finger tip pushups. Following surgery, I could no longer do finger tip pushups nor could I even hold myself up in that position. I first attributed this weakness due to my recovery period following surgery. I was wrong.

Pictures showing muscle atrophy and hand/finger deformity due to a pinched or damaged ulnar nerve located in my arm.
	Muscle Atrophy from Ulnar Nerve Damage Loss of fleshy muscle mass between the thumb and forefinger. Spread fingers cannot be closed. Bent little finger. All caused by a pinched or damaged ulnar nerve in the arm. images/muscle-atrophy-in-right-hand-caused-by-damage-to-the-ulnar-nerve-weak-fingers_small.JPG
	Loss of fleshy muscle between the thumb and forefinger is very noticeable with a closed fist. images/muscle atrophy in right hand caused by damage to the ulnar nerve-closed-fist_small.JPG
	Open Hand with Muscle Atrophy Pinched ulnar nerve in my arm caused numbness, muscle atrophy and partial loss of function in right hand. images/loss-of-muscle-meat-in-right-hand-caused-by-damage-to-the-ulnar-nerve_small.JPG
	NO ATROPHY in left hand Compare normal left hand with damaged right hand in the picture above. images/normal-left-hand-no-nerve-damage_small.JPG

I quickly recovered from my surgery and my muscles quickly regained their strength, that is, all of them except my hand and fingers of my right hand.

At a follow-up meeting with my plastic surgeon, I mentioned that I had a problem with my right hand and fingers. I explained about not being able to do the pushups, that I had occasional numbness, that my right hand and fingers were weak and I pointed out the loss of muscle between my thumb and forefinger. He then examined my fingers, hands, arms and my neck area.

I asked him if this could be related to my tummy tuck plastic surgery. He indicated that it was not, but maybe it was nerve or neck related. He provided me with the name of a neurologist and recommended that I make an appointment.

I made an appointment with the neurologist the very next day and I prepared the following "talk" sheet to bring with me.

Right Hand Symptoms
- weakness in fingers (in particular the pinky and the adjacent finger).
- sideways motion of fingers is difficult. Hard to close fingers, as in a salute.
- small finger is bent.
- the fleshy area of the hand between the thumb and the first finger is "sunken" and appears to have lost some of it's "meat" or muscle when compared to the left hand.
- finger tips get cold easily as compared to left hand.
- cannot "push" with small finger at all. Pushing capability with other fingers is diminished.

Hard To
- unlock car door with key
- write name with pen
- use tweezers

Neck & Hand History
- I am right handed and probably for the last 10 years or so my right hand strength has been strong but not as strong as my left hand.
- I work on the computer and use a mouse in my right hand. For the past couple of years I have been wearing a wrist band to alleviate pressure on my wrist.
- I lift 25 lb dumbbells daily in each hand, so I still have some "gripping power" of my fingers
- for about the last 20 years or more I have had occasional difficulty turning head to left (stiff neck/shoulder).
- I can only sleep on my left side. If I lay on my right side for more than 3 minutes my neck/shoulder bothers me.
- 20 years ago when I worked bent over a drafting board, I would frequently get migraine headaches and a stiff neck.
- I "crack my neck" frequently. I have been cracking it for as long as I remember.

My Visit with the Neurologist

March 25, 2008

My initial consultation with the neurologist consisted of a basic examination. I took off my shirt and he examined my upper body and made me perform several motions, including holding my arms out, moving my arms and neck, manipulating my fingers and having me grip his fingers to test my hand strength. It was a brief examination. He then scheduled me for three diagnostic tests to pinpoint my problem. These included an EMG (Electromyography, the testing the electrical activity of muscles), X-rays and an MRI (Magnetic Resonance Imaging).

I had the X-rays taken at a local clinic. After putting on a lead apron, the technician took x-rays of my neck and shoulder areas while standing up.

To have the MRI performed, I had to go to a different facility. I had to remove my clothing down to my underwear and don a surgical gown. I was led to the room where the MRI machine was located and was instructed to sit upon the sliding table. The technician briefed me on the upcoming process and told me what to expect. I laid down on the table and the technician left the room. It was just like you would see on television. The sliding table transferred my body into the MRI machine. I was told to lie very still and not move at all. I was also told not to swallow if I could help it. The MRI began to make noises, some of which were quite loud and annoying. After several minutes it was over. The hardest part of the whole thing was trying not to swallow.

For the EMG I had to return for a second visit to the neurologist's office. The EMG test is how they tested the condition of the nerves in my arm from my shoulder down to my fingers. They did this by sending a jolt of electricity from one point to another along my body and measuring and recording the electrical conductivity. The only problem with this test is that they stick a needle into your body "down to the nerve" selected to be tested. When the electricity is turned on, you feel an electrical shock. Some of the shocks were relatively painless. Some of them hurt a lot. It was similar to touching an electric fence. Overall, this was not a very enjoyable medical test procedure.

After all the testing was completed, I was called for another meeting with the neurologist to discuss the results. When he entered the room I noticed that he was not smiling.

HE TOLD ME I HAD THREE PROBLEMS

- My first problem was that I probably had carpal tunnel syndrome.

- My second problem was that I probably had a pinched or damaged nerve in my arm.

- The third and most serious a problem was that the MRI indicated that I had four bad disks in my neck. He indicated that I might need surgery to fuse the disks and recommended that I make an appointment with a neurosurgeon to discuss the matter further.

I noted to myself that he used the word "probably" a lot. He could not give me definitive answers as to what was the exact cause of the weakness and atrophy of the muscles in my hand and fingers.

Consultation with the Neurosurgeon

The thought of surgery on my neck scared me a little and I quickly made an appointment with a neurosurgeon in my area (after checking out his credentials). I was told to bring a copy of the MRI results with me.

At my initial consultation, the neurosurgeon reviewed the MRI results and performed his own examination of my hands, arms, shoulders and neck. He confirmed that I had four bulging desks in my neck which required an operation to correct. He then described the specific operation needed to fix this.

I asked him how quickly he thought I might need the operation. He could not give me a definitive answer and said that for my neck to get in that condition it might have taken a lifetime. It takes years and years, in some cases, for disks to bulge and go bad as in my case. It was up to me and how I felt to determine when I needed the operation.

He also could not tell me the exact cause of the problem with my hand and fingers but he thought that the most likely cause was a pinched ulnar nerve in my arm. I got the impression he was guessing, but it was an educated guess of a neurosurgeon.

Thinking back, I did remember many times sitting in my chair at the computer and having my right arm tingle. It always rested upon the armrest of my chair at the same location. I would often have to move my arm and flex it into a few times for the tingling to go way. It didn't occur to me then but I was probably pinching the ulnar nerve at the time and causing the damage. It makes sense. I now take great caution where I place my arm.

I still have the problem with bulging disks in my neck but I am trying to postpone neck surgery for his long as possible.

Muscle Atrophy Conclusion

I now believe that my problems with my fingers and my loss of muscle in my hand was caused by pinching the ulnar nerve in my right arm by resting my arm repeatedly against an armrest. To prevent further injury I use great care whenever I rest my arm.

I am told that whenever muscles atrophy, they never come back, no matter what you do. The most I can do is to strengthen the remaining muscles that I have in my hand and to prevent further damage.

To try to regain some of the strength and dexterity in my hand and fingers and to delay the inevitable neck operation, I eat only nutritional foods and do daily exercises and stretches, paying particular attention to my hands, shoulder and neck areas.

I believe (but I don't know for sure) that this is helping me as I have had no more tingling sensations of my arms or fingers now for almost two years.

Muscle Atrophy from Ulnar Nerve Damage

Muscle Atrophy and the Ulnar Nerve

What is Atrophy?

Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, disuse or lack of exercise or disease intrinsic to the tissue itself. Hormonal and nerve inputs that maintain an organ or body part are referred to as trophic [noun] in medical practice. Trophic describes the trophic condition of tissue. A diminished muscular trophic is designated
as atrophy. ref: http://en.wikipedia.org/wiki/Atrophy

The Ulnar Nerve

The American Academy of Orthopaedic Surgeons (AAOS) describes the ulnar nerve as one of three main nerves in the arm. It starts at the spinal cord/neck, runs beneath the collarbone and along the inner upper arm. At the inner elbow, the ulnar nerve passes through a space called the cubital tunnel. When you hit your "funny bone," you are hitting the ulnar nerve. The nerve then journeys under muscle to the wrist, enters another tunnel (Guyon's canal) and ends up on the outer palm/little finger side of the hand.

Nerve Entrapment

According to MayoClinic.com, nerve entrapment (also called a pinched nerve) occurs when surrounding tissue presses on or squeezes the nerve. This then causes the nerve to become inflamed or damaged and interrupts its function. In the case of the ulnar nerve, impingement can occur at the wrist, under the collarbone or at the spinal cord. However, AAOS notes entrapment of the ulnar nerve most often happens at the elbow.

Causes of Ulnar Nerve Entrapment

Repetitive activities that keep the elbow bent, such as typing or holding a tennis racket, are likely causes, according to AAOS. Leaning on the elbows for prolonged periods or keeping your arms curled up at night may also be culprits. MayoClinic.com notes that obesity, osteoarthritis and heredity can contribute to a person being more prone to nerve damage. An injury that involves a blow to the elbow can cause swelling that pinches the nerve.

Symptoms
AAOS reports the ulnar nerve is responsible for sensations in the little finger and half of the ring finger closest to the little finger. It controls most small muscles in the hand and some larger forearm muscles. Entrapment of the nerve can cause numbness or a pins-and-needles sensation in the ring and little fingers. It can also cause pain along the inside of the elbow. It may result in a weak grip, making it difficult to hold onto items, or may interfere with the fine motor activity required for playing a guitar.

Recovery
See your physician for symptoms lasting longer then a few weeks. Ulnar nerve entrapment may cause muscle wasting. AAOS reports this is irreversible. According to MayoClinic.com, the obvious way to recover is to stop whatever activity caused the issue. Physicians may also prescribe Motrin, Advil or another anti-inflammatory. For debilitating symptoms, surgery followed by physical therapy may be necessary. One surgical option is anterior transposition, during which the surgeon moves the nerve from behind the elbow to in front of the elbow. Your doctor will choose which option is best for you. AAOS reports results of surgery are generally good, but advise it can take some time for nerves to recover.
http://www.ehow.com/about_5521870_ulnar-nerve-damage-recovery.html

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Sent: Wednesday, May 12, 2010 3:07 PM
Subject: Feedback Form

Well this is me to a T. But I've had the neck surgery a year ago...they > tested me for elbow and should pinching after the surgery.. I then > exercised and seemed everything was getting better...then bang after a > hunting trip it all went down hill...actually worst, now I have numbness > in my ring and mid finger, wasting is occurring. WTH
>
> Now what can I do? or who can I see!

Response - Sorry to hear that.

It sounds like the only thing you can do is go back to your doctor to find out what is going on or try another doctor to get a different opinion.

Did you pull or injure something during your hunting trip? After a period of rest you might want to re-double your exercises to see if that will have any effect.

I would also try all different types of exercises like squeezing a rubber ball, using one of those finger strengthening devices, and doing fingertip pushups (or at least getting into that position) to try to strengthen your fingers and to minimize the muscle atrophy as much as possible (I don't know if that will work though).

Several times during the day I would also take the time to pull and stretch each individual finger or area that is giving me a problem.

I am a big believer in moderate and routine exercise and proper nutrition.

I have been postponing my neck operation for as long as possible. I have been doing neck and shoulder exercises twice a day (at a minimum), started swimming again now that it is summer time and watching what I eat and it seems to be doing it for me (at least so far).

Note - you might also try one of those electronic muscle massages like below. I bought one years ago and it sure makes your hand and fingers twitch and jump but who can tell if it does any good. It may be something to look
into.
http://www.amazon.com/Dr-Hos-Muscle-Therapy-Massage/dp/B001456OS2

Good luck.
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