# Ulnar nerve issues



## Adodero (Jul 16, 2009)

Since I started riding about 3 years ago, I've had pretty consistent problems on prolonged downhills with pain and weakness in my hands. The problem becomes particularly bad when I am on an extended downhill that is steep and requiring a lot of braking (the majority of my riding is extended downhills). 

The pain I experience is excruciating, once it starts on a ride it just becomes more and more common as time goes on until the ride is over. It feels like my fingers are going to separate from my hand and unless I stop, I face loss of control or grip strength. 

I've had several bike fits done, owned several bikes period, tried numerous pairs of grips (Ergons, ESI, Rev suspension, Chromag, all to name a few) and they don't help. I've had carbon bars, alloy bars, I've shifted the bars around to try different sweep angles both as an experiment myself and as recommendations from a fitter. I've tried larger tires, better suspension components, different setups of all sorts. I've seen physical therapists and done yoga. I've routinely worked with a skills coach to ensure my body position is correct and I'm not death gripping the bars. Nothing helps. 

Off the bike I get tingling and loss of coordination in my outer two fingers, but it's relatively minor compared to what I experience on the bike and typically after long rides. After prolonged rides, I will sometimes get a pinch in my wrist if I bend my hand a certain way. Aside from that, the symptoms are not that bad off the bike.

I finally gave up and saw a doctor, they are doing a nerve conduction test in two weeks, but what I understood was that the test was more to determine if there was nerve damage and, if so, how much time I'd have to stop riding for. The doctor more or less told me that would probably be the suggestion, basically stop riding for a few months to let the nerve heal and return to normal activity. The exception would be if a nerve study shows entrapment. Unfortunately, I've been down that road twice already and the pain returns after a brief delay. I'm uneasy ending riding for effectively the winter and ending my riding goals for next year for something that is not going to be a solution and hasn't worked in the past. 

It's not super encouraging that I've seen other posts here that said people with similar problems had to see multiple doctors before one finally agreed to operate and solve the problem by releasing the nerve. I'm not a doctor and I'm more inclined to trust what those who are would say, but I struggle to grasp the idea that time off is going to fix this problem and it isn't just going to continually reoccur. I'm in no rush to get under a knife, either, if there is another solve. 

I was curious if anyone else has had similar issues that could share their experiences. Did anyone experience similar symptoms, spend time letting the nerve heal, then see a complete elimination of the symptoms long term?


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## TwiceHorn (Jun 18, 2014)

Have you tried "flossing" exercises? I have an ulnar nerve problem that manifests at the elbow mostly and the flossing exercises are an immense help. You can find them online.

Mine is provoked mostly by "hyperextending" (overstraightening) my arm at the elbow as in carrying a toolbox or suitcase or the like. There seems to be a minor entrapment issue at the elbow. Occasionally, I can feel a bit of numbness in the last two fingers while riding, but I think the flossing helps that too.


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## Cuyuna (May 14, 2017)

The EMGs are to determine the cause/location of the nerve compression. They aren’t going to just determine if there’s damage without proposing a solution, assuming there is a solution.

What kind of work do you do?


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## Adodero (Jul 16, 2009)

Cuyuna said:


> The EMGs are to determine the cause/location of the nerve compression. They aren't going to just determine if there's damage without proposing a solution, assuming there is a solution.
> 
> What kind of work do you do?


I work with computers, I'm not a typist but I do spend a lot of time at a keyboard.

I think my fear is that the doc seemed to gravitate towards several months off from riding to let the nerve heal, although the tests next month were gonna be the main factor before offering an official opinion.

The reason I'm a bit nervous about that is because I've been down that road before and it returned, so I'm not sure what that would solve if something isn't changed to prevent it from being reinjured.



TwiceHorn said:


> Have you tried "flossing" exercises? I have an ulnar nerve problem that manifests at the elbow mostly and the flossing exercises are an immense help. You can find them online.


I've tried some exercises but they didn't seem to help much, although a quick google search shows these are a bit different than those I tried. I'll give them a shot and see if it helps.


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## Cuyuna (May 14, 2017)

It’s premature for you or your doctor to speculate on what your recovery process is going to be before you even know what the diagnosis is. Compression of the nerve at the elbow or at the wrist is fairly common. If conservative measures (as you’ve already tried) don’t work, there are effective surgical solutions.


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## Impetus (Aug 10, 2014)

Get a referral to see a physical therapist, or an Occupational Therapist who is 'Hand-Certified'.
Unless you've had trauma, there's no reason to think the nerve is "damaged" or needs surgery. You likely need strengthening and or mobility at a joint or two. I won't be surprised if it's not even your wrists. neck and shoulders are common contributors. 

Source: Am an orthopedic PT working in an out-patient sport clinic.


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## Cuyuna (May 14, 2017)

ARandomBiker said:


> Get a referral to see a physical therapist, or an Occupational Therapist who is 'Hand-Certified'.
> Unless you've had trauma, there's no reason to think the nerve is "damaged" or needs surgery. You likely need strengthening and or mobility at a joint or two. I won't be surprised if it's not even your wrists. neck and shoulders are common contributors.
> 
> Source: Am an orthopedic PT working in an out-patient sport clinic.


Seeing a physical therapist might be a great idea....if prescribed by a doctor after an actual diagnosis is made. The symptoms are very suggestive of ulnar nerve compression, wrist or elbow (cubical tunnel syndrome), but yes...maybe nerve root at the neck. Need a diagnosis before embarking on blind empiric treatment.


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## Impetus (Aug 10, 2014)

Cuyuna said:


> Seeing a physical therapist might be a great idea....if prescribed by a doctor after an actual diagnosis is made. The symptoms are very suggestive of ulnar nerve compression, wrist or elbow (cubical tunnel syndrome), but yes...maybe nerve root at the neck. Need a diagnosis before embarking on blind empiric treatment.


I actually take a little offense to that last statement. I don't know what you do for a living, but a Physical Therapist has a clinical doctorate degree much like a dentist or chiropractor and is absolutely qualified to assess as a primary practitioner. If the impairment is deemed out of the scope of practice and not a neuro-musculo-skeletal issue, then refer back to a specialist. 
In most states, direct access to PT service is a right, you don't need a referral from a Dr. I try to keep my patients PCPs in the loop, because it builds trust.

Transient numbness and and tingling in extremities is not indicative of a surgical need and is very likely to respond to conservative management. 
I advised him to seek a referral from a physician. 
Based on the experience of the patients I literally treat everyday, a physician is quite likely to say "Hmm... numbness in the pinkies only while you cycle? I'm gonna suggest you try PT" and write the prescription the same as he would for painkillers or antibiotics, and wish you well before he heads off to see the next appointment.


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## Cuyuna (May 14, 2017)

ARandomBiker said:


> I actually take a little offense to that last statement. I don't know what you do for a living, but a Physical Therapist has a clinical doctorate degree much like a dentist or chiropractor and is absolutely qualified to assess as a primary practitioner. If the impairment is deemed out of the scope of practice and not a neuro-musculo-skeletal issue, then refer back to a specialist.
> In most states, direct access to PT service is a right, you don't need a referral from a Dr. I try to keep my patients PCPs in the loop, because it builds trust.
> 
> Transient numbness and and tingling in extremities is not indicative of a surgical need and is very likely to respond to conservative management.
> ...


I didn't say there was a surgical need, I said there was a need for a diagnosis. As a physical therapist, you're going to treat a patient without using all of the diagnostic info available to actually understand what you are treating? You're going to treat ulnar nerve compression symptoms without seeing EMG's? Just kind of wiggle the guy's hands around and hope that his symptoms get better? Sorry, that's dangerous and does not serve the patient's best interests.

The OP didn't report "numbness in his pinkie", he said _"The pain I experience is excruciating, once it starts on a ride it just becomes more and more common as time goes on until the ride is over. It feels like my fingers are going to separate from my hand and unless I stop, I face loss of control or grip strength. "_ This is in both hands, by the way. It is a problem that has been going on for three years, and significantly impacts the OP's lifestyle.

He needs to see a real doctor first, who can subsequently determine whether or not physical therapy is indicated.


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## Impetus (Aug 10, 2014)

We'll just have to agree to disagree. 


@Adodero: Good luck man. I've had nerve issues (in my leg) and it sucks. Hope you find the right people to get it sorted out quickly.


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## Adodero (Jul 16, 2009)

Thanks for the discussion and feedback.

I'll try to be patient and wait out the results. We have a beautiful riding season right now, but it's a downer that I have to stop so frequently to let my hands recover and that it is so painful/tiring, but reading some of the other posts here, I should be grateful. I'll find out in 2 weeks and post what comes of it. 

I think it's worth pointing out that I saw a physical therapist a little while ago for this problem. The exercises and stretches she gave me didn't seem to help, but she was the first one to point out it is related to my Ulnar nerve. 

I feel like I may not be clearly communicating to the medical folks I'm seeing about this how severe the pain is. I think everyone seems to have some level of hand discomfort on certain rides depending on various factors, especially in the outer two fingers, but mine is above and beyond what anyone I've met experiences. I think the PT and docs seem to see it more on what is slightly above common and not to the extent that I feel. 

It's also possible she has a point. I ride 5-6 days per week in Pisgah, which is pretty steep, chunky, eroded, and can be taxing. Going from a nearly completely sedentary lifestyle 3 1/2 years ago to what I'm doing now has probably been more taxing than I realize and it's not unlikely that I failed to account for the level of use my arms are seeing in the last 1-1.5 years of riding that frequently. I think I'm just hoping it's more of an obvious solution to an obvious problem and less something I'm gonna have to gamble on several months of riding and hope it heals.


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## Cuyuna (May 14, 2017)

Adodero said:


> Thanks for the discussion and feedback.
> 
> I'll try to be patient and wait out the results. We have a beautiful riding season right now, but it's a downer that I have to stop so frequently to let my hands recover and that it is so painful/tiring, but reading some of the other posts here, I should be grateful. I'll find out in 2 weeks and post what comes of it.
> 
> ...


I dunno. I thought your description of your symptoms was pretty compelling. From here, behind my keyboard, it certainly seems problematic enough that a full-on diagnostic approach is warranted. Cubital tunnel syndrome is a *****, if that's what you have. It's the first thing that I thought of and it's not even in my particular surgical specialty. It's pretty clear to me from what you've written that the onus is on your doctor to prove that it isn't. Looks like that one's in the works in a couple of weeks. Bravo.

I had pretty severe pain and numbness in my hands (thumb, index, half of middle finger) when riding. I waded through all the bike-fitting knee-jerk nonsense here, finally got a right carpal tunnel release. I was back on my bike without any more pain in that hand within two days. Getting the left one done in about two weeks. Whether or not your problem has a surgical solution, I hope your outcome is as good as mine was.


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## 11053 (Sep 19, 2009)

OP- I've had Ulnar nerve transposition surgery on both elbows. It was a life changer for me. Put me back on the bike after year's of frustration and trying every non surgical option out there.
Background- I've been riding MTBs for over 30 yrs. For 20 of those years have ridden almost daily.
For 16 years- rock climbing was what I lived for. Climbed almost daily for 16 years.

Ulnar nerve pain appeared. I wrote it off to tendonitis. Rehab/PT/Stretching/Supplements/Cortisone shots/lifestyle alteration/painkillers etc, etc were all ineffective treatments. Had it diagnosed as several different things. Went through 5 years of insane nerve pain. Was told to stop climbing and riding. That was an unacceptable solution for me.

Finally found a doctor who was very experienced with ulnar nerve compression symptoms and high level athletes(arm surgeon for several professional baseball players). She diagnosed it quickly and said she had a fix. I didn't believe her at first after years of floundering in seeking relief/treatment. Did all the tests and doc said she was certain what the issue was. Fortunately I knew someone who was/still is a world class rock climber with the same issues who went to this doctor and received effective treatment. That bolstered my confidence. Went under the knife and it was fixed. Almost instant relief from the pain. I let it go too long in my right arm before surgery and I have some residual nerve damage, but I can ride my bike everyday, kill it at the bike park for 60+ days in the summer, trail build several days a week and for the most part live pain and weakness free. I lost many years to seeking correct diagnosis and attempting non surgical fixes.
Sometimes surgery is the right answer.
Before surgery I was at the point where I couldn't sit on a bike and grab the handlebars for more than a few minutes before experiencing crippling nerve pain and weakness in both hands.

If you trust the diagnosis, surgery can be a fix. Cool big scars on both elbows is the usual souvenir. Life is short and there are lots of trails that need to be ridden.


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## Adodero (Jul 16, 2009)

The doc made it sound like there was a threshold for nerve damage that I didn't meet, which was a relief I suppose. He also said there wasn't any indication of entrapment either in my wrist or elbow. Basically the 'hard' indicators of a problem didn't show much...

...but there was a >50% difference in the left and right ulnar nerve (I suppose this is reaction time but he used a medical phrase I didn't catch), indicating that there is likely a problem in the left that's progressively getting worse but isn't bad enough to meet their normal markers. 

My follow up is in the AM to discuss treatment but it sounds like it's gonna be a few weeks off riding, possibly more occupational hand PT, and cross training. I need to improve my upper body strength so that's not a terrible thing, but at the same time, I think I was hoping for a more concrete problem. I am afraid that I'm gonna be chasing my tail over this, but I suppose an increase in upper body strength, revisiting physical therapy with a new PT, and a few other little things might make a difference. 

Again, the question I'm left with is that I've done this before, been off the bike 6-7 weeks, the pain went away, but returned again later. What is to keep the same thing from happening again here?


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## Cuyuna (May 14, 2017)

If there is nerve damage, whatever the "threshold", why in the world would he wait to eliminate the cause? His plan is to wait until the nerve is _really _damaged? That makes sense? I simply don't understand the concept.."there's a problem, and it's causing nerve damage, but we're going to wait until it hits our nerve-damage threshold to fix it. Too bad about your lifestyle..."

Is this guy a surgeon, or a neurologist? If a neurologist, take you records, especially the EMG's, and see an orthopedic surgeon. If he IS a surgeon, go see a different one for a second opinion. It doesn't sound like anyone is explaining this problem to you very well.


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## Adodero (Jul 16, 2009)

Cuyuna said:


> If there is nerve damage, whatever the "threshold", why in the world would he wait to eliminate the cause? His plan is to wait until the nerve is _really _damaged? That makes sense? I simply don't understand the concept.."there's a problem, and it's causing nerve damage, but we're going to wait until it hits our nerve-damage threshold to fix it. Too bad about your lifestyle..."
> 
> Is this guy a surgeon, or a neurologist? If a neurologist, take you records, especially the EMG's, and see an orthopedic surgeon. If he IS a surgeon, go see a different one for a second opinion. It doesn't sound like anyone is explaining this problem to you very well.


I actually have a followup tomorrow morning with a different doc than the one that did the study and that's the main question I need addressed: What is keeping this from reoccurring after the nerve heals?

The thing I do not entirely understand is why I'm so sensitive to it when others are not. I have friends who run their bikes all screwed up without a problem, so there must be some factor with me that's causing me to be more sensitive to it.

The conclusion I walked away with on the test today was that I don't meet the thresholds for what they'd consider to be serious impact/damage, but that the differential between me right and left indicates that there is some compression there. They pretty explicitly ruled out entrapment in the wrist or elbow.

One way or another, I'll be consulting with another doctor for sure, regardless of what the answer is. I feel like I have enough of a grasp on how this impacts me day to day that even if they gave me the answer I 'wanted', I'd still want to discuss it with someone else.


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## Cuyuna (May 14, 2017)

You may have a grasp of how this impacts your life but it seems that your doctors don’t.


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## Adodero (Jul 16, 2009)

Cuyuna said:


> You may have a grasp of how this impacts your life but it seems that your doctors don't.


For sure. I think they are reverting to their experiences and knowledge, but it is concerning that the discussion around reoccurrence just kindof falls flat.

I'm also curious if the EMG will show entrapment in areas if there isn't significant damage. It seems to be a running theme in some of the cases I've read about where nothing was done surgery wise until there was damage, so it makes me wonder (not knowing exactly how it works) if it won't show entrapment unless the damage reaches a certain point.


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## Cuyuna (May 14, 2017)

Adodero said:


> For sure. I think they are reverting to their experiences and knowledge, but it is concerning that the discussion around reoccurrence just kindof falls flat.
> 
> I'm also curious if the EMG will show entrapment in areas if there isn't significant damage. It seems to be a running theme in some of the cases I've read about where nothing was done surgery wise until there was damage, so it makes me wonder (not knowing exactly how it works) if it won't show entrapment unless the damage reaches a certain point.


Bear in mind that your doctor works for you. You are hiring him/her just like you'd hire a plumber or electrician, but it's your job to make him/her aware of your expectations.


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## scatterbrained (Mar 11, 2008)

Something to think about; it's possible that you simply aren't engaging in any activities outside of cycling that irritate the nerve. I had issues with numbness and pain for years, but is was often random (outside of cycling). It wasn't until we were renovating our house that I really triggered a serious problem with both my ulner and median nerves in both arms. It was so bad that I couldn't lift my arms (I could feel the nerve being stretched when I did). My arms swelled up pretty bad and we had to get some high dose steroids to control the swelling. I was off the bike for a total of 4 years (two moves in the interim slowed the treatment), and for the first summer when this happened, I couldn't even shave, and eating was a serious issue. I ended up having surgeries on both elbows and both hands. Now I only have issues if I spend too much time with a phone to my ear, try to wax a car, or when I try to ride an elliptical machine. The inability to ride an elliptical machine without irritating the nerves was what kept me off the bike for an extra year after surgery.


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## Adodero (Jul 16, 2009)

I guess I'll offer an update here, but it's not a good picture. 

I went to the ortho late last year and had a nerve conduction study done. The total cost of all the visits was over $1200 and got me nowhere. The advice of my ortho was to take 3 months off riding and wear padded gloves when I ride. The fact I had done both of these things to not avail didn't seem to sway her opinion that it was going to solve the problem. It's kindof mind boggling to me that I can say "I did that, it didn't work" and there be no valid response. 

I went to see a PT after a few weeks and paid out of pocket to visit her and see what she thought. She gave me exercises to do to improve flexibility and I started working with a personal trainer, who improved my core and upper body strength. While this reduced the issue slightly, it only had the effect of improving my riding and permitting me to ride faster, which aggravated the issue further. So I end up with the pain no matter what I do. 

In the meantime, I've tried bike fit, grips, bars, even a bigger bike to try and cushion the ride more. All minor improvements.

At this point, I'm convinced the nerve is entrapped. I have burning down my forearm and in my elbow after a day at the bike park, along with discomfort in the outer two fingers. It's fairly normal for me to have this after long days. I guess it's just a matter of finding an ortho that is more willing to listen to me. I'm going to start looking again in the fall and try to find one that has more mx or mtb experience that could possibly relate a little closer to what I am dealing with.


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## Kd5 (Feb 20, 2021)

11053 said:


> OP- I've had Ulnar nerve transposition surgery on both elbows. It was a life changer for me. Put me back on the bike after year's of frustration and trying every non surgical option out there.
> Background- I've been riding MTBs for over 30 yrs. For 20 of those years have ridden almost daily.
> For 16 years- rock climbing was what I lived for. Climbed almost daily for 16 years.
> 
> ...


I know this is from awhile ago but I wanted to ask what the recovery from ulnar nerve transportation therapy was like for you. I have similar symptoms as you for two years, was also miss diagnosed with tendinitis and am finally getting some answers. After trying PT, cortisone shots it seems like the surgery is the way to go. What was recovery like? How long before you could climb / bike again? Thanks


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## 11053 (Sep 19, 2009)

Kd5 said:


> I know this is from awhile ago but I wanted to ask what the recovery from ulnar nerve transportation therapy was like for you. I have similar symptoms as you for two years, was also miss diagnosed with tendinitis and am finally getting some answers. After trying PT, cortisone shots it seems like the surgery is the way to go. What was recovery like? How long before you could climb / bike again? Thanks


I'm about 13+ years out from surgery. All good in the big picture. Still can ride and build trail whenever I want.
Recovery was really quick as far as being pain free= almost instantaneous relief from pain.
Rehab for strength and endurance took a bit longer, but it all progressed quickly. Standard PT ROM stuff. I did one elbow and was so encouraged that I had the other done soon after. I don't remember the specifics, but I was active within a few months of each surgery and better than before within a year.


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## Spugs (Feb 23, 2021)

11053 said:


> I'm about 13+ years out from surgery. All good in the big picture. Still can ride and build trail whenever I want.
> Recovery was really quick as far as being pain free= almost instantaneous relief from pain.
> Rehab for strength and endurance took a bit longer, but it all progressed quickly. Standard PT ROM stuff. I did one elbow and was so encouraged that I had the other done soon after. I don't remember the specifics, but I was active within a few months of each surgery and better than before within a year.


Which type of transposition did you have? I had subcutaneous done four months ago and am still recovering; intermittent numbness still occurs.

How soon after did you have the second arm done, and did you have any nerve pain in your non-surgery arm(s) while the other was recovering because of overcompensating?


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## 11053 (Sep 19, 2009)

Spugs said:


> Which type of transposition did you have? I had subcutaneous done four months ago and am still recovering; intermittent numbness still occurs.
> 
> How soon after did you have the second arm done, and did you have any nerve pain in your non-surgery arm(s) while the other was recovering because of overcompensating?


Subcutaneous.
Doc was super cool and pointed out he fact that if I did 2nd arm prior to year end it would save me big $ due to insurance deductible, so she scheduled me for 2nd surgery 2 months or so after the first and prior to year end and saved me thousands of $.

I was a 5.13 sport climber and 5.11+ Trad climber prior to surgery. Post surgery returned to former grade performance levels.

Climbing ran it's course and I moved on to other things.

The surgery works and the rehab time/residual pain is primarily due to the levels and duration of ulnar nerve impairment pre surgery.


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## Spugs (Feb 23, 2021)

11053 said:


> Subcutaneous.
> Doc was super cool and pointed out he fact that if I did 2nd arm prior to year end it would save me big $ due to insurance deductible, so she scheduled me for 2nd surgery 2 months or so after the first and prior to year end and saved me thousands of $.
> 
> I was a 5.13 sport climber and 5.11+ Trad climber prior to surgery. Post surgery returned to former grade performance levels.
> ...


Wow....a second surgery, two months out. Your recovery looks to have been quite rapid, and it's good to hear that you're back to full strength.

How long was it before both arms were back to 100%? I understand everyone's healing is different but just wanted to ask..


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