Quote:
Originally Posted by Go Low 
Most of the time the ulnar nerve is damaged at your elbow, where the nerve sits in a small bony groove (the funny bone). Over time this bony groove wears away and the nerve is more exposed (under the skin of the elbow) to various things such as leaning on your elbow, which crushes the nerve. Or it could have been damaged by repeatedly bending the elbow, e.g. too much practice hitting golf balls... As the ulnar nerve becomes damaged it becomes inflamed and each time you bend your arm it damages the nerve further by stripping away the nerve's protective sheath.
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I'm sorry mate but I had to comment after I stopped ROTFL. Bone is very solid and therefore, under normal circumstances, is not subject to wearing away. The nature of the cubital tunnel is that it has 3 boney sides (1 from the ulna and 2 from the humerus), the top is covered with a strong connective tissue layer which holds the nerve loosely in place. There is also padding on top of the nerve which is the fat tissue in the skin. One thing most people don't realize is this fat tissue thins out as you get older and is the reason why elderly people bruise so easily. So as you age there is less padding protecting the nerve from compression.
When the nerve is subjected to repetitive, short range movements through the tunnel or is compressed, it can become reactive (inflammatory cycle) and can swell a bit. This has the effect of decreasing the space in the tunnel and the nerve starts to become compressed and trapped which leads to damage(pain, pins and needles, numbness, weakness or atrophy).
The more common situation however, for this issue is where you have a repetitive loading of the flexor compartment in the forearm(all these muscles share a common attachment to the inside of the elbow), which causes fibrotic changes to the tissue in the area(Golfer's elbow). This tends to spread around the ulna nerve and the cubital tunnel as well, as they are neighbors, resulting in restriction to the ulna nerve. When the nerve is not free to slide in the tunnel as it stretches to accommodate movement in the arm it then generates symptoms. The best way to deal with this initially, is the Ulna nerve stretches discussed above.
Quote:
Originally Posted by Go Low
Depending on how badly your ulnar nerve is damaged, which can be determined by electrical shock tests to your affected fingers, palm and thumb, the specialist (doctor) may want to operate to repair it. He will repair the damaged sheath and reconstruct the nerve if necessary. He will also likely move the nerve from its current position in the bony groove to a couple of inches up on the inside of your elbow, closer to the fold of your arm. He'll put the nerve under your muscles for protection. It relieves the nerve from being tightly stretched over the elbow and allows it plenty of room without being stretched. This procedure is called cubital (ulnar)decompression and transposition surgery.
If you require an operation, it is done under full anesthesia on an out-patient basis and takes about 2-4 hours of surgery. There is virtually no pain and recovery is pretty quick, but it depends on how long the nerve was damaged before it is repaired. The sooner you get it looked at (and operated on if it needs to be repaired) the better and faster the recovery...and the likelihood of full recovery. You will be able to hit golf balls in two weeks or so, but you will experience some tingling and loss of strength for many months at a decreasing level. Nerves heal at the rate of about one inch per month, therefore (even though the nerve is actually only damaged in just a one or two inch length) the entire length of the nerve from elbow to finger tips (about 18" or so) will require about a 18 months to fully heal.
How do I know so much about this? You guessed it? Mine was caused from years of propping my chin on my left hand with my left elbow pressing on a desktop. And I'm sure hitting golf balls didn't help any. I'm recovering nicely with no problems...
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Glad to hear that you are recovering well from your surgery.
What a lot of doctors don't say(at least in australia) is that before you resort to surgery you should first explore more conservative options(and this does not mean leaving it for years before looking at doing something). I think the reason for this is that what they get paid to do, is to cut, so that is what they tend to recommend. Or another way to put it is "Hand a man a hammer and the whole world starts to resemble a nail".
Patients should be looking at the manual therapy options for 6 mths, and if the symptoms have not improved significantly, then resort to surgery, unless it is an extreme case where the hand is verging on useless or in great pain to begin with. The manual therapy should include work directed at the nerve for the best results possible.
Now the reason for this is that once the surgical knife slices the skin there is marked damage to the tissues in the area and the scaring from the surgery can lead to further complications down the track or in the recovery phase. In this particular surgery, it changes the position of the nerve, and while that may relieve the symptoms, it also makes it far more complicated to stretch the nerve if it is needed at a later date. This has implications for shoulder and neck problems as well as if there is further shortening of the ulna nerve. So if the issue can be resolved without the surgery, all the better for the patient.
I hope this is helpful for you.
Christopher
PS. On a side note, occupational health and safety guidelines do not recommend adopting the "thinker pose" while surfing the web, I think that might be more the trigger of your problem then the golf.
