Moderate to severe ulnar entrapment

Dear Ask The Doctor: Hi, I have been suffering with various symptoms of RSI on both of my arms for 8 months now. It started with intense pain in the wrists, and weakness in the hands especially in the smaller two fingers. I was diagnosed with Tendonitis and was given anti-inflammatories for a month (diclofenacs) that didn't seem to make any improvement. After visiting an Orthopaedic surgeon he prescribed me with stronger drugs (etoricoxib) and was told to wear wrist splints which seemed to help. In the mean time I had quit my computer-based job as I was unable to work and rested my hands for 2 months. I also went to physiotherapy where I was given some sort of ultra-sound and electricity therapy that didn't seem to work. It was around this time 3-4 months after onset that the lower part of my palm, the wrist and elbow started swelling up and the numbness on the ring and smaller fingers increased. Visiting a neurologist I was given a nerve conduction test and was told that the ulnar nerve is pressed with delayed CMAP on both arms and absent SNAP on the left arm. I was given a strong dose of Methycobal and was told to wear elbow support. It's been a over a month now since then and there has been some decrease in the numbness but nothing dramatic. I am very disappointed because nobody has been able to give me a definite answer on my condition having been diagnosed with tendonitis, carpal tunnel and ulnar tunnel by different doctors. Nobody really knows how to fix it but it doesn't seem to be serious enough for surgery. My current physio has told me that I should accept that it is a chronic condition but I am not sure what that means. Am I going to have this forever or is it going to get better or worse over time? Is there anything else I could do to treat it that I haven't done yet? (also note that I have been doing stretching exercises for the past 6 months every hour given by the physio.) I have recently been sent away from a neurologist because they told me I don't need to do another nerve conduction test for another 3 months and was given no other treatment. Am I to continue wearing the elbow support and wrist splints? My hands and arms have become very weak and I find that I cannot do some manual tasks. Treating this problem is very important as my livelihood depends on it, and after 8 months the problem continues with a not very confident and confusing medical support. Please help. Thanks, M.

Dear Mark:  your electrophysiologic study (conduction test and EMG) shows a moderate degree of nerve damage,if the compression of the ulnar nerve continues your symptoms will get worse. The symptoms of ulnar nerve entrapment can vary from mild transient numbness in the ring and small fingers to clawing of these digits and severe muscle atrophy of the hand muscles, also may report severe pain at the elbow or wrist with radiation into the hand or up into the shoulder and neck. You may at this point have a hard time in opening jars or turning doorknobs. Early fatigue or weakness may be present if you do a work that requires repetitive hand movements. If you rest on the elbows at work, increasing numbness may appear throughout the day.The suggested conservative treatment consist of: postural education (i.e.: avoid resting on elbows at work, using elbows to lift the body from bed, and resting elbows on car windows while driving), using an anterior elbow extension splinting (if necessary), and correction of ergonomics at work should correct the transient numbness. Anti-inflammatory medications also are useful to relieve nerve irritation. Oral vitamin B-6 supplements may be helpful for mild symptoms. This treatment should be done out for 6-12 weeks, depending on patient response. Surgical intervention is indicated if symptoms get worse despite adequate conservative treatment.