It’s Not Always Carpal Tunnel !

Posted by Dr. Podesta on March 17, 2011 with 5,128 Comments

Pain, numbness and weakness in a drummer’s hand or wrist can arise from many different sources. These complaints are most commonly due to carpal tunnel syndrome (DRUM ? issue). However, not all symptoms in the hand are due to this common nerve compression at the wrist.

The ulnar nerve is another nerve that can affect the hand and wrist. It originates in the spinal neck and passes through the arm, forearm and wrist into the hand. Due to its superficial position at the elbow, it is often injured by excessive pressure either by leaning on the inside part of the elbow or by repetitive bending and straightening of the elbow. A second common area of compression of the ulnar nerve is in the wrist as it passes though a tunnel on the pinky side of the wrist called Guyon’s Canal. Injury can be due to direct repetitive pressure overt he palm of the hand (hand percussion) or after a fracture of the wrist. Whether an injury of the ulnar nerve occurs at the elbow or wrist, the end results can severely affect hand function and be devastating or worse career ending to a drummer.

The ulnar nerve functions to provide sensation to the pinky finger and half (pinky side) of the ring finger. It controls most of the small or intrinsic muscles in the hand that provide fine movements in addition to some of the larger forearm muscles that provide a strong grip.
Symptoms of ulnar nerve entrapment or compression frequently begin with a sensation of the hand ring finger and pinky finger ” falling asleep “, which worsens when the elbow and or wrist are bent. Carpal tunnel syndrome has similar symptoms, but involves a different nerve and typically causes numbness and tingling in the thumb, index finger, and middle fingers. Numbness and tingling in the ring finger and pinky finger are common symptoms of ulnar nerve injury. These symptoms can come and go and can occur more often when the elbow is bent. Numbness and tingling in the hand will frequently awaken people sleeping with their elbows bent at night. Aching pain often develops on the inside of the elbow or on the pinky side of the wrist. With a longer standing compression, it may become difficult moving the fingers or manipulating objects. Weakening of the grip and difficulty with finger coordination can occur with more advanced or prolonged ulnar nerve compression. Permanent injury to the hand muscles causing muscle wasting or atrophy is the end result of severe or prolonged compression.

The diagnosis of ulnar nerve compression is suspected when a number of clinical findings are found by your physician such as a positive Tinel’s sign, an electrical shock sensation over the inside part the elbow (funny bone area) or over the pinky side of the wrist, numbness and tingling in the pinky side of the ring finger or in the pinky finger with wrist or elbow flexion. However, the definitive diagnosis is made by performing a nerve conduction/electromyography test (NCV/EMG), which is an electrical test to evaluate, nerve and muscle function

Treatment of ulnar nerve injuries begins with identification and elimination of the cause of the injury. Anti-inflammatory medicine can help reduce swelling around the nerve. Therapy with exercises to help the nerve slide through the tunnels can also help to improve symptoms. Bracing to prevent the elbow from bending at night (night extension splints) and elbow pad worn during the day to minimize direct pressure on the nerve has also been helpful diminishing symptoms. In severe cases however, surgical treatment to relieve compression from the nerve around the elbow and or wrist is necessary.

Drummers are not immune to nerve injuries. It is imperative that we take proper precautions such as warming up and cooling down before and after playing, avoid leaning on the elbow as well as maintaining an ergonomic set-up of our drum kits limiting excessive degrees of elbow flexion for prolonged periods of time. An ounce of prevention is worth a pound of cure.

Filed Under: Articles, Drum Magazine

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