I have been bouncing around from doctor to doctor and each seems to give me a different suggestion of what to do for the elbow pain I’ve been experiencing. My primary pain is around the olecrenon process and medial epicondyle. I’ve been experiencing tingling in my fourth and fifth digits as well as weakened grip (about a 50% reduction in strength). Recently, I have experienced random fasciculations. Bending the elbow up causes severe pain in the same area and I’ve started wearing a brace to hold my elbow straight at night. I’ve been doing physical therapy twice a week and my physical therapist beleives it is a problem with my ulnar nerve. I’ve had x-rays (normal) and an MRI (small joint effusion, everything else normal). I saw a doctor that was recommended to see about a cortisone shot, but that doctor didn’t think a shot would help. I’ve also gone to an chiropractor who just made it hurt worse. It has been almost seven weeks since the injury first occurred, but no one seems to know exactly what to do with me. Right now I just want the pain to stop. Should I go see a neurologist or a orthopedist? Do I need a family doctor to recommend me? Is there a surgery that can help? Any suggestions would be greatly appriciated.
#1 by Anonymous on February 23, 2010 - 11:02 pm
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An EMG could first be done to discover if it is, infact, an ulnar nerve entrapment such as in cubital tunnel syndrome or if there is fibrosis of the acrade of Stuthers (a band of connective tissue that the nerve must pass through) or under the Osborne ligament. Some of these things COULD have been picked up by the MRI, but the report is only as good as the person reading it.
You may need to take your films to a board certified orthopedic hand surgeon. I would not trust the judgement of a general orthopedic surgeon in this case.
Many cases can be treated conservatively, but in some cases where there is persistent obstruction, a surgical release may need to be performed.
#2 by timelady on February 24, 2010 - 5:40 am
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Definitely see a neurologist. You could need surgery, an ulnar nerve release. It is the last resort and very effective and it looks like you’ve done everything else. Needing a recommendation depends on your insurance. If you are wanting to go straight to the source, a neurosurgeon is the person to see, but a neurologist will do nerve condition studies to confirm the diagnosis first and then refer you to a surgeon if appropriate.
#3 by rascal07 on February 24, 2010 - 10:43 am
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I’ve had the same problem on and off for years. I’ve had 2 cortisone shots, and believe me, they work very well. And they’ve lasted quite awhile. I got my first one from my orthopedist, who did my CTS surgery years ago, and the 2nd one from my regular GP.
One thing I notice is that I can’t sleep with my elbow bent and my hand tucked up under my pillow. I wake up in agony when I do that. I try to keep my arm straight at night, too, like you mentioned. It seems to help.
Not everyone benefits from cortisone shots. The doctor has to get it in the exact spot in order for it to be helpful. I think I’d recommend seeing an orthopedist for that. I totally trust mine.
Have you had nerve conduction studies? If you’re getting the tingling in the 4th and 5th fingers, you may have some restriction of the ulnar nerve at the elbow. The studies might help to define what the problem is.
Be sure not to lean on your elbows. That causes problems. Good luck!