The Guru offers advice to Brandon, who gives a concise history of double crush syndrome

October 1, 2014


Can ulnar nerve compression at the elbow right near the medial epicondyle (cubital tunnel) cause pain where the fcu inserts into the Pisiform normally associated with fcu tenoditis? or vice-versa? I seem to have pain associated with both.

Long story:

I was reading your response to to an FCU tenonditis issue:  I am in a somewhat similar situation.

I’ve had constant, bi-lateral, pain in my FCU where it inserts into the Pisiform for over 3 years now. I use to be an avid rock climber/fitness nut but have not touched a hold or weight for these 3 years. I can not even use a remote control with out discomfort. I am also a software engineer and notice my pain is exacerbated by my usage of the computer, despite spending thousands on ergo devices.

My pain is characterized mainly by heat and tightness near the FCU and pisiform, although its hard to accurately explain. I also sometimes get cold hands mainly near the area mentioned above spreading to my pinky and ring fingers. After about a year of these symptoms my ulnar side of the elbow started becoming extremely sensitive and experience some of the same pains described above. This comes about when my elbow is bent or even when I am laying on the bed. The only time my elbow a wrists do not experience pain is when I lay on my stomach with my hands under my thighs, or walking with my hands in my pocket. My elbow is so sensitive that a T-shirt rubbing up against it can cause the feeling of hitting your funny bone, even a fan blowing on it can be irritating.  Also, I randomly get shots of nerve pain to my pinky when I jar my shoulders such as when jumping, or if I go running with my elbows bend at the side my hands with quickly become completely numb and tingly.

I have been to multiple doctors, most tell me its tendonitis and a few sent me to EMG tests under the thought of bi-cubital tunnel. I have had an MRI on my wrist and both elbows, which showed nothing abnormal. I have had 3 EMGs of my wrist/elbows, all of which could not show signs of ulnar nerve compression (one had a slight hint of compression – although the most recent, a few months ago, showed nothing).

The doctor who performed my EMG and also a previous PT (I forgot to mention I was not responsive to PT, where I did nerve glide exercises and deep tissue massage of forearm/upper elbow)  told me I should get an MRI of my neck area as the issue might be higher up. My current doctor wants to perform decompression of my ulnar nerve to treat me for cubital tunnel.



October 1, 2014


You give a really good, concise history of a double crush syndrome – It is suggested that compression of the nerve at one location makes it more sensitive to effects of compression in another location, because of impaired axoplasmic flow. This is not always, and certainly in the year dot research demonstrated with nerve conduction tests. However it doesn’t just happen, it’s always due to something else….and your most likely cause is screaming out, but nobody has looked there yet…despite having bilateral symptoms.

And that’s your cervical spine.

You’ve got really jazzed up neural symptoms, which sounds double crush like, but they happen due to the way your head sits on your neck because you’ve got a super stiff thoracic spine…and you spend most of your days in front of a screen. Until you are given the ability to move better through your thoracic spine, keep your head in a more optimal position to take the constant excessive load off of your myoneuarlfascial (!) interface you will continue to get symptoms.

So DON”T let anybody stick needles or knives into your cubital tunnel – surgeons are great at dealing with structural issues, but in spite of any decent or relevant radiological or NCT evidence to suggest that you’ve got a structural issue, they don’t grasp the simplicity of it’s the way you are functioning is the issue and not structure which is at fault.

You need to get yourself in front of a decent physio (I’m sure I can suggest someone near to you if needs be) who can relate your pain and pathology to your dysfunction – you need to be given the ability to move better, and then shown how to control this motion.

This is not an overnight job and will at a guesstimate take a good few months to see a decent return, but I think you need to really understand the why’s, what needs to be done and when to see change.

Good Luck – it’s all to play for!

Guru Responded

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