Ulnar neuritis/neuropathy, surgery, no improvement - what's next?

October 4, 2022 7:38 PM

Following 20+ years at a computer keyboard, at least half of those with pretty good ergonomics, I developed repetitive stress injury (RSI) eventually diagnosed as an ulnar nerve issue. I did all the noninvasive treatments (saline/steroid injection, PT, focused bodywork, 'nerve glides'), but none of that worked. Eventually I settled on decompression surgery, a short procedure which releases tissue that is binding the ulnar nerve. The surgery and recovery went well, but 4+ months on, the problem is worse.

Currently without fancy insurance, I am wary of paying exorbitant amounts out-of-pocket to see either an occupational therapist or a surgeon for advice on next steps. Is the United States, so you know the drill-- pay $500 to talk to someone for 20 minutes. Recognizing that YANMD, what might folks recommend? I feel like I am at the end of treatment options, but I have to think there must be more out there.

(Before anyone asks, I use voice-to-text to run my computer now, and I have cut my need for typing and mousing by about 90%.)

posted by falcon42 to Health & Fitness (8 answers total)

Best answer: If you have or have had acid reflux, wheat sensitivity, or Helicobacter pylori infection, the parietal cells in your stomach which produce the acid, but also the receptor protein which allows you to absorb B12, could be less functional than normal, and that could lead to B12 deficiency, which in turn causes neuropathy, even if you are getting what would ordinarily be more than adequate B12 in your diet.

You’ve mentioned GI issues previously, and lack of stomach acid can cause those along a number of pathways.

Megadoses will give you enough B12 even without the receptor protein in the stomach however, and there are several brands out there to choose from. My hematologist recommended 7000-10,000 mcg a day for a week every other week. I think the sublinguals are probably the best because there’s also a B12 receptor in saliva. The brand I chose is Jarrow.
posted by jamjam at 8:26 PM on October 4, 2022 [1 favorite]

For many years, I didn't take more than 100%DV of B12. B12 doesn't work that way for some people. Everything I read insists that you can't overdose on B12, your body will dispose of what it doesn't use.

If it's a B12 issue, don't be scared off by the %DV in the prescription jamjam was given. The dosage my partner was told to use as a "loading dose" for being vegetarian and having low B12 was 1000mcg daily for 3 months. At 3 months they retested his b12 and he was still low-ish, so he's still on the loading dose. A non-loading dose for a typical vegetarian might be more like 1000mcg 2x/week. I told my doctor I was taking B12 and the doctor didn't bat an eye.

I don't know the answer to your question, but jamjam's theory is feasible. B12 deficiency is common. Nerves can heal, but they heal slowly.
posted by aniola at 10:25 PM on October 4, 2022

Best answer: Glucosamine with chondroitin and MSM, helped me recover from shoulder surgeries.I don't take it all the time. It helped with cellular level inflammation, that is the best way to describe it. Research the pt you need.
posted by Oyéah at 10:27 PM on October 4, 2022

Best answer: This is a long shot, but since you didn't mention in your post, I'll say: I developed ulnar neuropathy a few years back. At my first my doctor presumed it was from desk work, but we realized pretty quickly (for one thing, my problem started when I changed jobs from one with a lot of desk work to one with less) it was actually due to my sleeping position. Didn't matter what I did the other 16 hours of the day because I was in a position that exacerbated my neuropathy for eight hours every night. Once I trained myself out of that, my ulnar neuropathy essentially disappeared. Nowadays it flares up maybe once a month, rather than every single day. Something to consider.
posted by telegraph at 4:07 AM on October 5, 2022

I'd follow up with what telegraph says (and it's not a longshot): have heard from multiple members of my care team that ulnar neuropathy can be caused, or exacerbated, by bending during sleep. In my own experience, wearing elbow splints (at bedtime only) does help. Also as I type this (uncomfortably) I am reminded that negative pitch for keyboard and mouse is a good thing, and although at first my excellent Kensington trackball seemed to provide relief, over time the pronation required to use it just seemed to make things worse. Had better luck with Goldtouch vertical mouse, and soon will be trying equivalents from Logitech and Kensington.
posted by armoir from antproof case at 5:14 AM on October 5, 2022 [1 favorite]

My issues are not as serious as yours. I'm getting good results from wearing wrist braces at night. I'm sure you're doing this already, but your question doesn't say so.
posted by JimN2TAW at 8:14 AM on October 5, 2022

Response by poster: Thanks all. I was not familiar w/the B-12 issue, for starters. I have tried braces at night.
posted by falcon42 at 6:02 PM on October 6, 2022

Was your Dr sure that the cause was in the ulnar nerve area and not [also] elsewhere? Did s/he entertain or test for Thoracic Outlet Syndrome? And was any imaging of the cervical vertebrae done?

I'm sorry you're dealing with this, really, as I am dealing with similar and know the frustration. Besides the bracing, some things that have helped me are targeted massage therapy and... not doing certain movements that I find make it worse. Beyond just the day-to-day (I too have a job dependent on a computer and keyboard): my physical therapist had recommended some really easy exercise to target the triceps (as I had become extremely deconditioned)} and they felt GREAT and I could see and feel a marked improvement in muscle tone, but it led to additional tightness in the lower triceps and elbow which made the symptoms of UNE (and/or ToS) much worse. I stopped and soon noticed an improvement.

Curious about your braces use at night: were you using braces for your elbows, not your wrists? Was it repeated and consistent use? I ask not only because I have found some relief when wearing (and sticking to wearing) them, but there seems to be consensus that bracing is pretty important for UNE / Cubital Tunnel Syndrome.
posted by armoir from antproof case at 12:09 PM on October 8, 2022