Hi all, (scroll down to bottom if want to get straight to question)
My name is Rene. I am a practicing PM&R physician; an avid fan of BBM; and a passionate recreational lifter. Ever since I was a kid, I have had bilateral subluxing ulnar nerves (whenever there is resisted flexion/extension of the elbow) the nerve pops right out of the post-condylar groove. No big deal, just sounds funny on bench and presses. More back story: when I was about 13 yo (I am 30 yo now) I had a compression injury to my right ulnar nerve (fell onto a roller blade brake); never had deficits from it, never had it checked out. Only caveat on the right ulnar nerve: whenever I bump it into something now, it hurts like the dickens (like a tinel’s on steroids). Anyhoo, throughout the latter half of residency, I have been having occasional paresthesias to the right small and ring finger (i.e. ulnar nerve distribution) with deep dips. Solution: don’t go so deep. That worked for about 12 months. Then, this progressed to symptoms with bench and over head press. Now, at this point, the symptoms would only occur during the training session, and resolve in about 30 minutes. What did I do? Changed my approach to doing sets with lower rep ranges (thinking the less the nerve is exposed to subluxation, the better). This worked up until about 6 weeks ago. Now: I have symptoms of paresthesias with straight-armed exercises (like deadlifts), and I have had to back off of any exercises that require resisted elbow flexion/extension (even pin press/bench set to higher levels with less ROM cause symptoms), which really, really sucks.
What do we have objectively:
Ultrasound: fascicular changes in the post-condylar groove of the right ulnar nerve (i.e. the nerve looks honey-combed below the elbow and above the elbow, but at the elbow there is a coalesced, altered fascicular pattern in the post-condylar groove).
NCS/EMG: evidence of motor slowing of the right ulnar nerve at/about the elbow. No evidence of axonal loss/denervation. No evidence of radiculopathy/plexopathy
I am at a stand still here. I am bracing the arm at night, so it doesn’t flex past 35 degrees (been doing so for about a year), and this prevents me waking up at night due to numbness, but the symptoms during the day still come. I have had no loss of strength or overt atrophy, just two episodes of “clumsiness” while I was doing EMGs (these also happened on heavy deadlift days). Short of splinting the arm for 24 hours a day for several weeks, I am not sure what else to do. In my patients, I normally send to ortho at this point for consideration of ulnar nerve transposition. I don’t want to stop lifting. I don’t want to progress into axonal loss if I ignore this. Sigh…
QUESTION: does anyone have personal/client experience with this (ulnar neuropathy at the elbow with subluxation) and/or the surgery (ulnar nerve transposition)? What were the outcomes (I see this surgery done on older patients with severe disease, so my selection bias sees nothing but poor outcomes–the literature says otherwise)? Any pearls of wisdom?
Thanks!