Sunday, February 26, 2012

Medical Diaries #1: Cubital Tunnel Syndrome

Hello my lovely bloggy buddies :)
I'm so sorry I've been missing for quite some time now lol. Been trying to focus on school and dealing with medical drama! I'm going to be trying to focus the following few (not sure sure how many) posts on medical ddconditions. These are somewhat for myself because I am struggling to really grasp what this means for me as a person and have all of these things at once. I encourage you to join me on this journey if you want to learn more about any of these conditions, if you want to see a little bit more about me, and if you want to give me some encouragement maybe! Lol :) So here we go....
I want to start on this first post talking about Cubital Tunnel Syndrome. This is something that is extremely current in my life right now. I am not sure how many of you knew or recall, but I was diagnosed with Carpal Tunnel in July of 2009. I turned around, opted for the invasive surgery, and had both of them in less than a month before starting my senior year of high school. Upon having the surgery, I had the ultimate success! It was amazing and the best I had felt in soooooo long. However, less than one year later, I began to get numbing sensations in my left arm AGAIN. Ugh! Imagine my confusion and disappointment. I kept it to myself, but after a period of time, I couldn't wait anymore. Here's what I found out from the neurologist:
"What is Cubital Tunnel Syndrome?
Cubital tunnel syndrome is a condition brought on by increased pressure on the ulnar nerve at the elbow. There is a bump of bone on the inner portion of the elbow (medial epicondyle) under which the ulnar nerve passes. This site is commonly called the “funny bone”.  At this site, the ulnar nerve lies directly next to the bone and is susceptible to pressure. When the pressure on the nerve becomes great enough to disturb the way the nerve works, then numbness, tingling, and pain may be felt in the elbow, forearm, hand, and/or fingers."


CTS is mainly caused by pressure put on the ulnar nerve at this point of the elbow. The nerve is very exposed because it's on the outside of the bone. This pressure can simply be from leaning it up against a table or the door in the car when you're driving. Due to this pressure, the nerve can click back and forth over the medial epicondyle bone. This sustained irritation will cause mcuh stress on the nerve resulting in numbness for prolonged periods of time. Otherwise the pressure can derive from simply holding the arm bent for long periods of time. This will stretch the nerve over the bone and cause the pain and numbness also.

As I have continuously stated, numbness is a tell-tale sign that something with the nerves is wrong. Then there are ways of figuring out where the problem is. If the numbness in the hand is in the thumb through middle finger, it is a problem in the wrist. However, if it is the ring and pinky fingers, it is the ulnar nerve running through your elbow. You may also notice that you have trouble pinching, occasional clumsiness, and dropping things. 

Help meeeeeeeeeee!!!
To diagnose, you will most likely start at your PCP. He/she will start by testing your muscle strength, tenderness and receptiveness to tapping of the nerve at the elbow, and speed of the numbness when elbow is bent. Once this is seen as a definite problem, you will be sent to a neurologist who will conduct two tests: electromyography (EMG) and a nerve conduction study (NCS). This will determine definitely where the problem area is and rule out for example a pinched nerve. These tests are painful, I'm not going to lie to you. Not unbearable, but definitely uncomfortable! Chances are if you are having these problems, you will be hurting for a bit afterwards as well. The NCS measures the reaction time of the nerves. They can do this test for any part of your body, but in this case it will be only in your hands and arms. The EMG is measuring the muscle. It involves a needle stuck in a few different muscles. 
The first plans of treatment are easy fixes that you should pray will work! The number one strategy is splinting. Essentially you need to train yourself to relieve pressure on your elbows. You will have to wear a brace throughout the day for extra padding and support on the outside of your elbow (the ulnar nerve) and as a reminder - do NOT rest on this elbow! At night you will wear a brace preventing you from bending or curling your arm at the elbow while you sleep. 

This does not always work though. That is the ultimate problem. Surgery is the next option. This works exactly as Carpal Tunnel Syndrome works. It completely depends on the circumstances. There are a couple different options for surgery, there is not only one. Option One is moving the nerve from the outside of the bone to the inside of it and covering it with a layer of fat. This protects the nerve and should relieve the symptoms. The other option is to trim or remove that bony bump. Both procedures will be difficult to recover from, but with physical therapy and patience it will happen.

Post-Surgery
Currently, I am looking more seriously into the surgery. After going through my third EMG and NCS, I was diagnosed with this syndrome. I did the splinting for months and still use them at night. However, my elbow (mainly the left) continuously gets worse. I can barely even touch my elbow for the pain, the numbness has increased dramatically leaving me with numb fingers for whole days sometimes, I have difficulty pinching, and my grasp is much weaker. It's scary to see how dramatically this can increase in a few short months. I believe that the surgery would be beneficial, but if it goes wrong, it goes drastically wrong and could end in paralysis of my whole arm. This decision hasn't been made yet, but trust me, I'll let you know when I do! 
For those of you who are still with me, thanks so much for sticking through this looooooooong post : ) I appreciate it. I hope you learned something! I highly recommend that if any of these things sound at all familiar to you, get it checked out! It can't hurt, truly.
Talk to you all again soon, much love,
Hannah

7 comments:

  1. Not a doctor, but the level of pain and numbness you describe indicates that you should have surgery as soon as you can. The longer you wait with severe symptoms, the less likely your surgery will be completely successful. (Speaking from experience, having had two surgeries after waiting with symptoms for two years. Though I am much better, I still have minor daily problems.) Even so, CuTS surgery has a very high success rate, with 70-80% seeing complete recovery, most of the rest seeing at least some improvement. Only less than 1 in 1000 result in the drastic problems such as paralysis, usually the result of other conditions. So don't wait too long. You might want to check out our forums to discuss your case with others. Good luck!

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    1. Hi Timm!
      Thank you so much for your comment :D it was such a surprise but sometimes the best thing lol. I appreciate all you said. It's a scary and confusing situation for me at the moment. I feel like I need to talk to my neuro again. In October he had wanted to try splinting and hold off on surgery for as long as we could. Well the splinting didn't help and my symptoms are dramatically worse in my opinion. Most of my pain right now is stemming from this, you know? Anyway, you probably won't even get this so I'll stop rambling now lol!
      Thanks again,
      Hannah

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  2. Oh Hannah, this sounds horrible! I will be praying that the best decision gets made and that everything turns out well. *hugs*

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    1. There! It's finally letting me comment on yours :) Thanks so much, Jess. It's not fun at all honestly. I try not to drag all my blogging buddies into this, but I think that this is a good place for me to get this out on, you know? No one has to read it if they don't want to and most don't, so why not? Lol....hope you had a fantastic birthday!

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  3. (((((((big hugs))))))) and lots of prayers sent your way.

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    1. Thanks ange :) really appreciate it! *hugs*

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  4. Hi Hannah:

    I think you have an amazing attitude towards your CTS and now CuTS. Thank you so much for your detailed description of CuTS. It is EXTREMELY helpful. I have recently started experiencing the numbness that is the first sign of CuTS in the middle and "pinky" finger.

    Sometimes I also experience spasms of pain which come and go as they are doing right now. I have been trying to figure out what sleep position is best so that I can sleep well while keeping my arm straight through the night. I think sleeping this way will help me to do my daily routine without generating numbness.

    One thing I have done is I got myself Dragon Naturally Speaking (DNS) which means I am no longer using the keyboard to type. DNS is absolutely amazing and if you work with it i.e. train the software and yourself it works wonders. It will open documents, save them, take dictation, edit, make paragraphs/ punctuations etc.

    The software is expensive about $ 200 (Amazon is selling it), otherwise your local software store. There are both Mac and PC Versions. Had I known how error free it works I would have got it YEARS AGO. Ahh well!!!

    If you have any suggestions or advice for me to cope with CuTS more effectively, I would be most grateful. I will check your blog every now and then.

    Thanks so much for sharing. And hope you are already feeling better in the months since you posted about your CuTS.

    Best,

    Barry

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