Cubital Tunnel Release Surgery

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Q22
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Date Joined Aug 2018
Total Posts : 19
   Posted 9/1/2018 2:01 PM (GMT -6)   
Hi Susie,
I performed various Google searches, but can't seem to locate the article. Did it say if the MRI shows damage to small fibers of the nerve? The neurologist said an EMG does not detect that.

(Seashell)
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Date Joined Dec 2012
Total Posts : 893
   Posted 9/1/2018 6:27 PM (GMT -6)   
If you have small fiber neuropathy, MRI may yield little additional information.

3 mm is about the lowest denominator/size that can be detected by MRI.

The gold standard for detecting small fiber neuropathy is: 1. Qualitative sensory testing (QST); 2. Skin biopsy (microscopic study looking for small sensory nerve fibers in the dermis and epidermis)

Small fiber neuropathy typically is associated with hyperesthesia and autonomic symptoms in the affected area. Example: Sweating or chills (vasodilation or vasoconstriction) and trophic skin changes (shiny skin, motled skin coloring).

Small fiber neuropathy is seen in diabetics, as a side-effect of chemotherapy, and some auto-immune disorders.

Neuropathy can be a mix/combination of small fiber and large fiber sensory nerve interruption.

An MRI can “see” what it can but cannot see/identify at a cellular level or a form/anatomical size less than 3 mm. Ex. It takes several million cancer cells coalescing to form a 3 mm lung lesion first visible on MRI.

The elbow MRI will be able to clarify some aspects of your pain/sensitivity but may not hold an all inclusive answer.
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

straydog
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Date Joined Feb 2003
Total Posts : 16804
   Posted 9/2/2018 8:53 AM (GMT -6)   
Q, I stand corrected, lol. I have gone back & looked at many articles at the major health facilities. What I did was google MRI & small fiber neuropathy & came up with the same as Karen. I looked at an article by the Cleveland Clinic & skin biopsy & QSART is the gold standard for dxing it. After reading several of these articles, I think if your neurologist is suspecting this as your issue, you need to discuss the above testing. The article I read in the beginning was an older article. When I get time I will search archives here at HW & see if I can find anything.


I just googled "how to diagnose small fiber nerve neuropathy" & the Cleveland Clinic's article is listed. I urge you to do this & read their article. You may want to print it off & show it to your neuro.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Post Edited (straydog) : 9/2/2018 8:28:23 AM (GMT-6)


(Seashell)
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Date Joined Dec 2012
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   Posted 9/2/2018 9:29 AM (GMT -6)   
Susie:
You did not post anything incorrect. Rather, there are limits to what can be “seen” with MRI and it is good for people to know it’s limitations.

Physicians have become reliant on CT and MRI imaging (and on the radiologists’ interpretation) such that people can be incorrectly dismissed and told “you are A-OK, see you in 6 months” with a MRI without gross findings of pathology. Not all ailments have an anatomical origin that can be diagnosed with a CT scan or MRI. Small fiber neuropathy is one. Any ailment with a physiological basis (functional basis, how the body works) but will not be amenable to imaging as a diagnostic tool. Examples: Slow motility of the GI tract, such as gastroparesis.

Physicians are losing the art of listening to patients, conducting a thorough physical exam, and thinking outside of the box in making an accurate differential diagnosis. It can leave patients languishing and suffering, needlessly.
Karen

Post Edited ((Seashell)) : 9/2/2018 8:32:29 AM (GMT-6)


Q22
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Date Joined Aug 2018
Total Posts : 19
   Posted 9/8/2018 7:40 AM (GMT -6)   
Hi Everyone,
My occupational therapist fitted me with a custom rigid arm splint to wear during sleep. My first impressions are that I don't like it. It will certainly prevent your arm from bending, and won't slip down, but it's very hard, and gets uncomfortable to wear. My arm felt very nervy after about 5 hours the first night. She added a little cushioning around the elbow, but none anywhere else.

In my opinion, these custom splints should have internal cushioning.

I have a Hely Weber generic night brace too, and that would be far more comfortable.

Post Edited (Q22) : 9/8/2018 8:10:12 AM (GMT-6)


straydog
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Date Joined Feb 2003
Total Posts : 16804
   Posted 9/8/2018 11:33 AM (GMT -6)   
Q, thanks for the update. Since all have last posted, I ran across a post here at HW that a member was dx’d by way of skin biopsy & Qsart. This was done by his neurologist. He did not have an injury or surgery. I just want to let you know this in case things do not get much better. Something to consider.
Susie
Moderator in Chronic Pain & Psoriasis Forums

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 893
   Posted 9/8/2018 6:53 PM (GMT -6)   
Q22:
Wearing the newly formatted splint for a full night’s sleep may be too lofty of a goal, at least initially. I would suggest wearing the splint for a shorter period of 2-3 hours at a time, building tolerance and wear time from there.

Wearing a sleeve of cotton stockinette can also be immensely helpful. A thin sleeve of stockinette absorbs normal perspiration and moisture and prevents chaffing. Cotton stockinette is available from
Any medical supply or home care company. It comes as a roll in widths measuring 2” up to 8”. Cut the length of stockinette needed and allow extra to roll back as a shirtsleeve cuff at both the proximal
And distal ends.

Almost every custom molded splint will need a few initial “tweaks” to remold areas of undue pressure, friction, or bony prominence. Most often, problematic areas can be mitigated by using a heat gun to reshape the polypropylene. Foam padding with an adhesive backing can also be affixed to areas of the splint with a cutout to unweight specific pressure points. Make a note of problematic areas or use a felt pen to identify areas of discomfort or concern when meeting with the therapist in follow-up.
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Q22
New Member


Date Joined Aug 2018
Total Posts : 19
   Posted 9/18/2018 1:13 PM (GMT -6)   
Sounds like the elbow MRI didn't tell us much. It said elbow tendonitis, or tennis elbow.

Now, they offered me some meds for nerve pain, so I'll accept those this time.

It doesn't really feel like I have tennis elbow, but there could be inflammation.

I asked the nurse about the nerve, and she wasn't sure how much the MRI would show about it.

When I had my cubital tunnel surgery in March, I was glad to have found a surgeon who does the less invasive endoscopic release where they don't move the nerve, and the incision is smaller. However, some research I did states that severe case outcomes are not as good with the endoscopic release because there is traction on the nerve when the elbow is bent.

Post Edited (Q22) : 9/18/2018 12:16:46 PM (GMT-6)

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