Is It Too Late for Conservative Treatment?
I'm a 30-year-old woman working in marketing, spending the majority of my time in front of a computer, and I primarily use my right hand. I deal with several health issues including Crohn’s disease, hypothyroidism, and POTS. My current medications are Skyrizi, Synthroid, Metoprolol, and Slynd. Recently, I've been experiencing discomfort primarily in the last month, although it has lingered for a few months now. I live in the United States. I consulted an upper extremity surgeon due to persistent numbness affecting my right fourth and fifth fingers, as well as my palm and the back of my hand. Having previously undergone surgery for cubital tunnel syndrome on my left side after a nerve injury, I was somewhat familiar with what I was dealing with. That surgical procedure involved a submuscular transposition, which I have no regrets about. Before seeking medical advice, I utilized tips I learned previously and invested in an ergonomic mouse and an elbow pad. During my last visit, my doctor provided me with a night splint and advised that I use a brace during the day for additional support. However, the nighttime splinting hasn't been effective; I consistently wake up to find it removed, with no memory of doing so. After a brief examination, the surgeon recommended an EMG. He indicated it was likely cubital tunnel syndrome but wanted further confirmation of its severity. During his assessment, he noted a slight weakness in my hand, which I concurred with, recalling a recent incident where I dropped a salt shaker multiple times just a week before our meeting. I had the EMG done recently, and the results showed that both the median and radial nerves were functioning well, but there were no sensory signals detected from my ulnar nerve at the cubital tunnel. Fortunately, the nerve appeared normal both above and below the elbow, and there was no indication that my muscles had been compromised during the tests. The EMG specialist remarked, "there's a complete block at your elbow," after multiple nerve conduction studies in that area. He also observed that my elbows hyperextend, which he suggested could be contributing to my issues, though he didn't believe there was any weakness in my hands. I pressed for further explanation regarding my condition and he clarified that without addressing the compression, my situation would likely deteriorate, but he also noted that he wasn’t a surgeon. This raises a question: Is it possible for me to recover fully and experience no symptoms in the future, or have I missed the opportunity for successful conservative treatment? I want to avoid rushing into surgery, yet I am not keen on prolonging my current struggles only to end up in the same place a few months down the road. I am seeking guidance on how to approach my upcoming appointment and what key points to consider.
Answers (1)
8/16/2025, 12:40:55 PM
OpenHealth AI
It sounds like you are facing a challenging situation with potential cubital tunnel syndrome and discomfort in your hand, particularly as it affects your daily activities and work. Given your existing health conditions and the insights you've received from healthcare professionals, it’s understandable to want to explore all options before considering surgery. Let's break this down.
Main Points
- Current Diagnosis: You have a confirmed issue with ulnar nerve compression at the elbow, characterized by sensory block.
- Conservative Treatment: There are still options available that might help alleviate your symptoms before considering surgical options.
- Next Steps: Focus on non-invasive strategies and prepare specific questions for your next appointment to discuss your condition further.
Explanation
Cubital tunnel syndrome occurs when the ulnar nerve, which runs around your elbow, becomes compressed. This can lead to numbness, tingling, or weakness in the hand—particularly affecting the fourth and fifth fingers. Your recent EMG results indicate significant nerve compression, which is a critical consideration.
Although conservative treatments, like splinting and ergonomic adjustments, have helped many individuals, their efficacy can vary from person to person. Given that you are experiencing significant discomfort and functional limitations, it is important to weigh your options carefully.
Prioritized Next Steps
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Review Conservative Measures: Continue to use the brace during the day and explore other options if the current one isn’t effective. You might try different types of night splints that you may tolerate better, or additional ergonomic adjustments to your workspace.
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Physical Therapy: Consider consulting a physical therapist who specializes in upper extremity issues. They can provide personalized exercises that may help reduce nerve compression and improve your hand strength and functionality.
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Lifestyle Modifications:
- Take regular breaks from using your right hand, especially during long periods of computer work. Try to elevate and stretch your arm periodically.
- Avoid positions or activities that put extra strain on your elbow, like resting your elbows on hard surfaces.
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Prepare for Your Next Appointment:
- Discuss the potential benefits and drawbacks of continuing conservative measures versus surgical options.
- Ask about additional treatment options that might be available to you, such as steroid injections or different types of splints.
- Inquire specifically about the relevance of your elbow hyperextension and whether modifying your activities might help.
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Monitor Your Symptoms: Keep a detailed log of your symptoms, including any changes when you implement new strategies. This can be helpful for your healthcare provider to understand your condition's progression.
Lastly, it's reasonable to be proactive about your situation. If you feel that conservative measures are becoming ineffective or your symptoms worsen, don’t hesitate to discuss surgical options. Avoiding rash decisions is key, and having an open dialogue with your surgeon about your concerns will help you both find the best course of action.
Feel free to reach out if you have more questions or need further clarification.
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