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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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Hello. I am 21 years old, and part of my left hand has been

Resolved Question:

Hello. I am 21 years old, and part of my left hand has been numb for a year. I saw a neurologist one month after the onset of my condition, who monitored me for 5 months, made electrical measurements (electrodes on my skin - no needles), and said I should get ulnar nerve transposition surgery.
I saw a surgeon at that point, who examined my hand too, and told me that there was no such need at the moment. He said that because my hand still moves perfectly, has no noticeable strength loss, and the only symptom is still the numbness.
A few months have passed since, with no change at all. Any advice for me?
Submitted: 11 months ago.
Category: Neurology
Expert:  Dr. Frank replied 11 months ago.
Welcome to Just Answer. I am an Adult Neurologist and was contacted to answer your question.

Hello. The key to your answer lies in the exact conduction values from that EMG/NCS study. How much conduction block was measured? How much did the ulnar motor amplitude drop? what does your ulnar sensory potentials look like, is there temporal dispersion?

If you have your study, paste in the results and I will try to give you a better answer. From a clinical perspective, without weakness, I would not do an ulnar transposition at your age, unless you are a softball pitcher, or have some reason to keep traumatizing your ulnar nerve (?). The sensory component should improve with treatment over time. The nerve regenerates.

Please get back to me if you have questions I can answer. Dr Frank T
Customer: replied 11 months ago.

Thank you for your reply.


Unfortunately, I do not have access to the exact values of my studies at this point. I do remember, however, the doctor mentioning that the only parameter that had been significantly influenced was the amplitude. It was lower than the corresponding amplitude on my right hand by a factor of at least 20. The reaction latency was fine too, without temporal dispersion.


After taking vitamins, all amplitudes increased a little, but the big difference remained. I also recall the doctor asking about cramps; indeed, since the numbness started, I have been getting them occasionally. They usually resolve within 1-2 seconds though.


 


(I am aware that, without providing the study itself, you cannot produce a good reply. Maybe the above can still help in some way? )

Expert:  Dr. Frank replied 11 months ago.
Hi. well the general rule is a drop in conduction velocity in the ulnar motor from above to below the elbow of 10 m/s change, or an amplitude difference between arms of 50%, those are the criteria for surgery, at least where I trained and worked. In a young woman, the drop in amplitude is probably more noticeable to you. But I would not get too aggressive in surgical options, without evidence of fasciculations or Positive sharp waves on the needle exam of ADM or the first dorsal interosseus (you certainly should get a needle exam before consenting to surgery)

so your reply suggests that you do not meet criteria for surgery, but that you are obviously injured and need treatment. There are more conservative treatments, rather than the ulnar transposition. You can place a probe into the cubital tunnel to do a neurolysis, and release any adhesions that could be causing this change. Please get back to me if I can help. Dr Frank T
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
Dr. Frank and 2 other Neurology Specialists are ready to help you
Customer: replied 11 months ago.

I will look into the options you mentioned. Most importantly, I am now convinced to not rush into surgery.


Thank you very much!

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