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  • Saw specialist but not convinced I need surgery

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    Old 08-09-2006, 10:06 AM   #1
    Koot
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    Saw specialist but not convinced I need surgery

    I damaged my ulnar nerve on May 3. I was working around the house that day doing some sanding that fatigued my arm and hand. I later went to the driving range and hit some golf balls. After hitting maybe thirty golf balls I felt pins and needles in my left palm pad and little finger, and half of the ring finger. I tried hitting maybe six more golf balls and then stopped.

    After researching what I could have done to myself on the Internet I felt that I had caused a trauma to the ulnar nerve in my hand. The day I hurt it I was already fatigued in my hand and felt like I may have cut-off a large amount of blood supply to the hand by gripping the golf club's grip too strongly when hitting golf balls...and thus the repetitive pounding of hitting balls caused a trauma to the ulnar nerve in the palm pad area of the hand.

    For the first week or two my hand was really bad with a clawed little finger and severe pins and needles, however it has slowly gotten better and now I don't have a claw finger and the pins and needles sensation is much reduced, but I still have the pins and needles sensation to a much lesser degree...and my fingers are somewhat weak. The palm pad has a slight aching feeling and might be a little tight as if it is slightly swollen. I've never had any pain in the elbow area or forearm - just a little tightness in the forearm is all. However, the muscle between the base of my thumb and forefinger (used for pinching) has wasted away, but I have regained a [very] small amount of this muscle and my thumb knuckle doesn't raise up as quickly when I try to pinch something like a piece of paper. (It's been three months now since I damaged the nerve.)

    I saw my family physician and he recommended a nerve conduction test, which I had done. The conduction test was analyzed and an appointment was setup with a nerve specialist at The Hand Center at Wake Forest University - Baptist Medical Center located Winston-Salem, NC. I saw the specialist today.

    The hand specialist tapped around my hand and arm and took an x-ray of my hand to make sure I hadn't fractured the hook of the hamate bone. He told me the problem with my hand is entrapment of the ulnar nerve at the elbow. (I've never had any pain in the elbow.) I was surprised to learn that my problem was at the elbow. I assumed the problem was actually in the hand because it started after I was sanding and hitting golf balls.

    Considering that my hand has actually gotten better over the past three months, instead of getting worse, I was hopeful the doctor would think a non-surgical approach would be chosen...but that was not the case. He recommended surgery at the elbow using the transposition procedure. I am not convinced this surgery is necessary. Nor am I convinced the nerve is actually damaged at the elbow.

    (I hate to say it but I realize these doctors make their money by performing surgery...and thus "maybe" he recommended surgery when it might not be necessary.) I have heard and read so many scary stories about people having ulnar and medial nerve surgery that did not solve their problem due to being misdiagnosed, and having unneeded surgery that made their symptoms worse. This makes me even more suspect about what has been recommended to me. I would hate to have surgery in the wrong area (elbow versus hand) and possibly have future problems due to the surgery when my nerve "could" fully recover without any surgery. I am not convinced I need surgery. I am also not convinced the doctor is planning on operating in the right place to help me.

    I am trying to figure out what I should do next. What would you do?

    Get a second opinion? Wait another month or two to see if it continues to improve further?

    I'm looking for some advice.....

    Last edited by Koot; 08-09-2006 at 02:07 PM.

     
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    Old 08-09-2006, 05:51 PM   #2
    photonut1998
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    Re: Saw specialist but not convinced I need surgery

    i work as a typist and i have both carpal and cubital tunnel. both are covered by work comp, and my doctor said that ulnar nerve problems can come from repetive use of the hand, like in my case. if you are unsure of your doctor's recommendations, i would get a second opinion. i've had carpal and cubital tunnel surgeries on my left arm with good results, and yesterday they did the same to my right arm (hence my poor grammar)

     
    Old 08-09-2006, 06:38 PM   #3
    Koot
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    Re: Saw specialist but not convinced I need surgery

    I wish you a full recovery from your recent surgery on your right arm.

    I guess I should be more confident in the doctor's diagnosis and surgery recommendation for me. I just can't believe I don't have any pain or symptoms in my elbow area, which is where he'll be operating. Maybe that is the way nerve damage works on the body...symptoms in a remote area from where the actual damage is located.

    I'm guessing (right now) that I will go through with the surgery even though I have some doubts about the success I'll have.

    I'm rather perturbed that some of my hand's small muscles are now wasted and will not fully recover. So much for waiting to see if my nerve damage would heal by itself without surgery!

    I guess my love of golf for which I have played for four decades is now a pastime for me, which I hate like hell. (I retired four months ago and was only able to play golf as a retiree for two weeks before this nerve problem happened. So much for enjoying retirement!)

    Good luck to you........


    Quote:
    Originally Posted by photonut1998
    i work as a typist and i have both carpal and cubital tunnel. both are covered by work comp, and my doctor said that ulnar nerve problems can come from repetive use of the hand, like in my case. if you are unsure of your doctor's recommendations, i would get a second opinion. i've had carpal and cubital tunnel surgeries on my left arm with good results, and yesterday they did the same to my right arm (hence my poor grammar)

    Last edited by Koot; 08-09-2006 at 06:38 PM.

     
    Old 08-10-2006, 04:30 AM   #4
    curiousforever
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    Re: Saw specialist but not convinced I need surgery

    I would go with the doc's suggestion. You don't want more permanent damage.

    I had pain both in my elbow and in my hand - the joints of my fingers - as well as pins/needles.

     
    Old 08-10-2006, 09:13 AM   #5
    Koot
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    Re: Saw specialist but not convinced I need surgery

    Yes, you are probably right that I should go with the doctor's suggestion.

    I'm having a hard time dealing with the idea that the wasted muscles in my hand will not recover, especially the thumb dorsal interosseous muscle - the large muscle between the thumb and index finger over the back of the hand. This is the muscle used for pinching and is so imprortant for doing various tasks with your hands...not to mention supporting the golf club at the top of the backswing. I'm pretty depressed about it, especially since I just recently retired. I know things could always be worse...but it's still a real bummer for me.

     
    Old 08-10-2006, 06:45 PM   #6
    Koot
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    Re: Saw specialist but not convinced I need surgery

    Since I do not have any pain or sensation in my elbow area or arm (it's only in my hand) why does my doctor think the problem is in my elbow versus the Guyon's canal in my hand?

    Was the doctor's diagnosis based solely on the nerve conduction velocity tests I had, which someone else did and yet another person read?

    Was there something about my hand the doctors saw that indicated beyond any doubt that the problem was in my elbow and not the Guyon's canal?

    I'm troubled by the lack of any pain or sensation in the elbow or arm but the elbow is where he'll be doing the surgery.

    Any input would be appreciated.

     
    Old 08-13-2006, 02:47 PM   #7
    Koot
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    Re: Saw specialist but not convinced I need surgery

    I guess no one has any opinions, answers or thoughts concerning my questions. It would be helpful to get at least a few opinions concerning my questions.

    Quote:
    Originally Posted by Koot
    Since I do not have any pain or sensation in my elbow area or arm (it's only in my hand) why does my doctor think the problem is in my elbow versus the Guyon's canal in my hand?

    Was the doctor's diagnosis based solely on the nerve conduction velocity tests I had, which someone else did and yet another person read?

    Was there something about my hand the doctors saw that indicated beyond any doubt that the problem was in my elbow and not the Guyon's canal?


    I'm troubled by the lack of any pain or sensation in the elbow or arm but the elbow is where he'll be doing the surgery.

    Any input would be appreciated.

     
    Old 08-13-2006, 07:17 PM   #8
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    Re: Saw specialist but not convinced I need surgery

    This article reflects why I am troubled by my doctor wanting to operate on my elbow when I have no pain or unusual sensation in the elbow or arm and feel my the problem is likely in my hand (known as the Guyon's canal):

    Bad Golf Grip Can Cause Nerve Damage

    Hand Symptoms Can Include Loss of Sensation, Muscle Weakness
    By Miranda Hitti
    ***** Medical News Reviewed By Brunilda Nazario, MD
    on Friday, November 05, 2004

    Nov. 5, 2004 -- Hitting the links this weekend? Pay attention to your grip, because using an improper golf grip could cause nerve damage to your hand.

    That's what happened to a 62-year-old male amateur golfer who had muscle weakness and loss of sensation in his left hand for two months. Experts at the Mayo Clinic in Jacksonville, Fla., detected nerve damage in the hand.

    The problem, say the doctors, was an improper golf grip. The right-handed golfer had been applying pressure from the end of the club to an area between the two small bones of the wrist -- a passageway in his left hand called Guyon's canal -- that contains the ulnar nerve.

    This nerve runs down the inside of the arm and elbow, and it's what tingles when you hit your funny bone. It controls strength in most of the hand and provides sensation to the pinky and ring fingers.

    Testing confirmed muscle and nerve damage in the man, but the hand looked normal in MRI images.

    Doctors told the man to stop playing golf for a while. He ignored that advice, modifying his grip to see if the problem would go away. It did, and the man is still playing golf with no problems.

    The case was reported at the annual meeting of the American Association of Electrodiagnostic Medicine by the Mayo Clinic team, which included neurologist Kevin Boylan, MD.

    Most golfers are unaware of this hazard, say Boylan and colleagues, who also want to make neuromuscular specialists aware of the problem.

    [url]http://www.*****.com/content/article/96/103849.htm[/url]

     
    Old 08-13-2006, 08:00 PM   #9
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    Re: Saw specialist but not convinced I need surgery

    Quote:
    Originally Posted by Koot
    Since I do not have any pain or sensation in my elbow area or arm (it's only in my hand) why does my doctor think the problem is in my elbow versus the Guyon's canal in my hand?

    Was the doctor's diagnosis based solely on the nerve conduction velocity tests I had, which someone else did and yet another person read?

    Was there something about my hand the doctors saw that indicated beyond any doubt that the problem was in my elbow and not the Guyon's canal?

    I'm troubled by the lack of any pain or sensation in the elbow or arm but the elbow is where he'll be doing the surgery.

    Any input would be appreciated.
    For me, two nerve tests were done. First one was generalized and would detect carpal tunnel as well as cubital tunnel problems. They stick sensors at various nerve locations along the arm and then use a device that looked somewhat like a taser having two metal points on the business end of it to fire electrical charges into the arm. The array of sensors will then detect and measure the movement of that electrical discharge along the nerves.

    For the second round of testing they narrow a specific problem down by using a needle connected to a diagnostic machine to detect normal electrical activity along a specific nerve. When the audio from this test is put on speaker for the patient to hear and they pay attention to it...on the good side of the nerve the electrical activity sounds like lound static. But then when the needle is moved further along the arm and reaches the problematic section of the nerve, the sound of loud static will suddenly be more quiet or cease.

     
    Old 08-13-2006, 08:21 PM   #10
    Koot
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    Re: Saw specialist but not convinced I need surgery

    Thanks Jube!

    I had the first nerve conduction test you described, but not the one using a needle. I wonder why the doctor felt further tests to narrow down the exact location was unnecessary? I would very much like to know exactly where the pinch or entrapment is located, if nothing more than for my own satisfaction.

    Can you, or anyone else, tell me how common it is to have the second test (using a needle) to pinpoint the exact location of the nerve problem?

    For the life of me I am not convinced the doctor is planning on operating at the correct location. Maybe the first test reveals without question the problem is in my elbow but I would like further convincing. Maybe I can talk someone into giving me the needle test. The results of that would convince me.

    Thanks again.

    Last edited by Koot; 08-13-2006 at 08:22 PM.

     
    Old 08-14-2006, 03:09 PM   #11
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    Re: Saw specialist but not convinced I need surgery

    Quote:
    Originally Posted by Koot
    Thanks Jube!

    I had the first nerve conduction test you described, but not the one using a needle. I wonder why the doctor felt further tests to narrow down the exact location was unnecessary? I would very much like to know exactly where the pinch or entrapment is located, if nothing more than for my own satisfaction.

    Can you, or anyone else, tell me how common it is to have the second test (using a needle) to pinpoint the exact location of the nerve problem?

    For the life of me I am not convinced the doctor is planning on operating at the correct location. Maybe the first test reveals without question the problem is in my elbow but I would like further convincing. Maybe I can talk someone into giving me the needle test. The results of that would convince me.

    Thanks again.
    The first the surgeon I went to see wanted was to obtain the results of the second round of nerve testing done with a needle. Perhaps different surgeons have different standards as to the amount of testing they will require prior to doing the operation. But you can always check with your primary care physician and/or insurance company to see about getting a second opinion or having additional testing done before giving your approval to have surgery performed.

    I have to go back and see my surgeon on Friday of this week, and it isn't an appointment I'm looking forward to because I haven't experienced very much improvement with the numbness in my fourth and fifth fingers, and I've developed new numbness problems in other parts of that hand after surgery that aren't going away by themselves. So I guess you could say that even with the additional test I had, there's still no guarantee that having the surgery will provide a patient with the perfect fix they hope for.

     
    Old 08-14-2006, 05:29 PM   #12
    Koot
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    Re: Saw specialist but not convinced I need surgery

    Jube,

    I really hate to hear that you aren't recovering as expected. That is one of the things I'm worried about.

    Best of luck to you...

     
    Old 08-14-2006, 05:36 PM   #13
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    Re: Saw specialist but not convinced I need surgery

    Well, I sent an email to my doctor and asked him the important questions I wanted answered. Here is a copy of my email with the doctor's reply (in bold type):

    If you have more questions/concerns, I'll be happy to explain to you at my office. Thanks.

    (1) What is the name of the surgical procedure you will be performing on my elbow?

    Ulnar nerve decompression, transposition

    (2) Since I do not have any pain or sensation in my elbow area or arm (it's only in my hand) what is the basis for your diagnosis that my problem is in my elbow versus [for example] the Guyon's canal, which is the location where I had repetitive stress/trauma...and also where my pain and the pins & needles sensation is located?

    [url[ REMOVED ][/url]

    (3) What was the deciding factor in your diagnosis which ruled-out the Guyon's canal as the problem - was it based solely on the nerve conduction velocity tests, or was it something you saw when you looked at my hand?

    Both

    (4) I'm having a hard time dealing with the idea that the wasted muscles in my hand might not fully recover, especially the thumb dorsal interosseous muscle - the large muscle between the thumb and index finger over the back of the hand. Is there anything that can be done to enhance the recovery of these muscles, especially the thumb dorsal interosseous muscle which is so important when working with your hands and playing golf?

    Early surgery

    (5) As you can tell I am troubled by the lack of any pain or sensation in the elbow or arm but the elbow is where you will be doing the surgery. Being an avid golfer for over three decades I want my chances for a successful recovery to be the best possible. Is the surgical procedure you will be doing on me the same as you would do if your patient was Tiger Woods?

    Yes

    Last edited by moderator2; 08-14-2006 at 07:07 PM. Reason: posted a doctor's website - only a doctor's name, city and state may be posted as per the posting rules

     
    Old 08-15-2006, 08:05 AM   #14
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    Re: Saw specialist but not convinced I need surgery

    Koot, I am a new poster, but I have had carpal and now that's overridden by neuropathy. Carpal is NOT fun.
    If it were me, I would get copies of all the tests and if I could, [depending on where you live] go and get a second opinion. For a couple of reasons: 1- you mite find the second doctor one you like and/or trust more; and 2-you might get a better insight/explanation as to how you should approach any treatments or surgery. It could put your mind more at ease in terms of the what's and when's of whatever you choose to do.
    Remember that nerves, when damaged, die fast. When the source of the damage is removed they grow slower than a snails race [about 1/8th inch per month]!
    Before I got the neuropathy [for other reasons, I think], my carpal did slowly get better over a period of 5 years, and was almost gone when other things happened. I hope this is encouraging, as I mean it that way. Just check out other options as surgeons 'Surge'. There mite or mite not be other choices.

     
    Old 08-15-2006, 11:17 AM   #15
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    Re: Saw specialist but not convinced I need surgery

    if he's doing it at the elbow - you don't have carpal tunnel. ulnar nerve affects the pinky and ring finger and the most common place for inpingement is the elbow. I've had the surgery in both elbows and everything recovered in time.

     
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