Need Info/Advice (and questions below)

The palmar aponeurosis.

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Question: Since august 1997 I have RSI symptoms like those you described for your right arm. In my case both arms are affected but maybe not so strong. I am carefully listening to this list for 8 months and learned a lot (thanks!). Now I want to give back my experience and I have some questions below.
To my knowledge (please correct me) you describe the symptoms of UNS (ulnar nerve syndrome) or cubical tunnel syndrome (is this the same? one of my doctors said: the ulnar nerve lies in the cubical tunnel (YES! – this list needs an FAQ; I also suggest a glossary (please excuse my extensive usage of parentheses :-))) I’ve got a loss of grip strength – things just slide through my fingers, even though I’m holding on tightly Up to now I have only been to an “German: Internist” (specialist in internal diseases; my family doctor), X-Ray examination of my hands (result: nothing) and twice to a neurologist. The neurologist tested the strength of my grip of all fingers / in all directions and said “loss of grip strength” is a symptom for UNS.
my funny bone feels like it’s being hit constantly. I think the “funny bone” is exactly the cubical tunnel with the ulnar nerve. This nerve controls the “little finger” and the ring-finger (middle finger?). The nerve in the carpal tunnel controls the thumb and the forefinger. My funny bones also feel like being hit, when I bend/flex my elbows a lot and after working with the computer … my shoulder hurts, and it always feels like I’ve got  insects crawling on that side of my neck. Not in my case.
 I wake up four or five times a night with my hand asleep. Me too! The sleeping position seems to be an important point concerning UNS. Flexing the elbows too much can damage the ulnar nerve. The last three months I tried not to flex my elbows at night. My neurologist told me to put my arm(s) in a tube/pipe if necessary. I work with computers constantly, and I’ve slowed my typing down from over 100 wpm to about 75-80, and I’ve reduced the amount I do, … Me too! I gave up touch-typing and reduced the amount I do.
 … but it’s not making much difference, … I think in my case not to touch-type (not to use all ten fingers) is very important, because this way I am saving the fingers controlled by the ulnar nerve. My situation now is: If I touch-type only for three minutes I feel a tingling in my hands in the evening. Using only two or three fingers I can do keyboard work for hours. I followed an advice in the RSI archive and removed the armrests of my arm chair. This has two advantages to UNS people. First, you can more easily let your arms swing as a micro pause. Second, if you give too much pressure with your elbows on the armrest you can damage the ulnar nerve. A lot of keyboard work with an armchair is probably the reason why I got RSI. The neurologist measured the speed of my nerve conduction and firstly found nothing special. He told me the normal speed is 40 to 60 meter per second and my measuring’s were about 55 m/s. We were just about to finish the session when I told him (the neurologist) that I strongly have the opinion to have UNS symptoms (thanks to this list and the RSI archive).
Then he measured a line/route above the elbow and found 40 m/s (right arm) and 35 m/s (left arm). Suddenly he recommended surgery if there is no improvement within two months. Does anyone on the list have experience with this situation? <————– !!! I now try to avoid surgery through improving posture, doing  a lot of (micro) pauses and following all the other useful hints on this list. I also consider going to physiotherapist, Chiropractor, osteopathy or …  Can somebody tell me what is best having UNS? <————– !!! I hate my desk (too high), I have my keyboard on my lap, and i have foam gripe rubber stuck under it to stop it slipping. Very good idea, this minimizes the flexion of the elbow. Please ask me if you have questions? I am not an expert but I think getting into this matter helped me a lot and is good for developing a consciousness/awareness for the body and the situation.

Answer:  To my knowledge (please correct me) you describe the symptoms of UNS (ulnar nerve syndrome) or cubical tunnel syndrome  ANT/AMT can also cause poster’s symptoms. It is only UNS/cubital tunnel syndrome if it is caused by problems in just that area (as you say later on). Really she needs an expert diagnosis from someone who knows about nerve conditions, including ANT/AMT and trigger points. The problem is finding someone who has knowledge of all three areas!
The neurologist tested the strength of my grip of all fingers / in all directions and said “loss of grip strength” is a symptom for UNS This can also be a symptom of trigger points in the relevant muscles. As the ulnar nerve only affects the “little finger” and half of the “ring finger” it should not be the cause of the loss of grip strength in the other fingers. It could be a problem with the median nerve or you could have ANT/AMT as well. Occasionally i get weakness in one of my fingers or one of them starts twitching. I can turn these symptoms off by finding the trigger point in the relevant muscle – quite astounding really!
I wake up four or five times a night with my hand asleep. Me too! The sleeping position seems to be an important point concerning UNS. Flexing the elbows too much can damage the ulnar nerve. The last three months I tried not to flex my elbows at night. My neurologist told me to put my arm(s) in a tube/pipe if necessary. When my UNS symptoms were bad i too found keeping my arm straight at night helped. If it is just your hand it is probably the wrist that is the problem. Second, if you give too much pressure with your elbows on the armrest. You can damage the ulnar nerve. A lot of keyboard work with an armchair is probably the reason why I got RSI. A lot of people suffer as a result of leaning on their elbows at a desk, not just RSI sufferers (according to my physio.)
We were just about to finish the session when I told him (the neurologist) that I strongly have the opinion to have UNS symptoms (thanks to this list and the RSI archive). Then he measured a line/route above the elbow and found 40 m/s (right arm) and 35 m/s (left arm). Suddenly he recommended surgery if there is no improvement within two months. Does anyone on the list have experience with this situation? I got my UNS/cubital tunnel problem by leaning on my left elbow when i typed (i did not touch type, btw). My problem seems to be the nerve just above the elbow, (as well as the elbow itself) running up towards the arm pit for about 2-3 inches (5-8 cm). If i press on it or lean it against the back of a car seat it starts the tingling in my arm. Also doing some exercises starts it up. When it was really bad the only thing that helped it was ultrasound along the line of the nerve above and below the elbow – this stopped the problem after about four sessions. However when i had a nerve conduction/velocity test it was normal (including measuring above the elbow.) So i am not as bad as you. Now-a-days i just have to be careful, so i don’t start it up again. Sometimes massaging along the line of the nerve, pulling/pushing the nerve up/down the arm away from the elbow can help. I would ask your neurologist just exactly what they would do, with surgery, to relieve your symptoms.
A book i recommend (as a “glossary of medical terms”) is:
The Anatomy Colouring Book
W. Kapit and L. M. Elson
2nd Edition (the 1st edition has some errors in it)
Publ Harper Collins
ISBN 0-06-455016-8
Price: 10 ukp
This is a good anatomy book, showing which muscle groups perform which movement as well as where they are in the body. It is cheap as it is in just black and white, you are meant to colour in the different parts of the anatomy so you learn them faster! Fortunately for us RSI sufferers this is not compulsory.

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