Pins and needles

[97BlackC5]

Whilst cycling in this morning, I was giving this matter some thought. Pins & needles in the fingers could be caused by ill fitting gloves! IE too small, I noticed that my left hand middle & ring finger of my glove was a tad tight around the base of these fingers, that comprised with pressure exerceted on the palm of the hand through riding, could I guess, reduce blood circulation to my fingers thus causing pins & needles!

[drfrank]

Almost certainly due to ulnar nerve compression.

[milu]

Tell us more DrFrank....

[drfrank]

the nerve comes out of Guyon's canal and begins to run a more superficial course. The pressure applied to the palm whilst riding is distributed over directly over the nerve. The squashing causes the symptoms of pins and needles and sensory disturbances. It resolves but can be uncomfortable, I tend to find it improves when I wear gloves.

It is the same effect experienced with carpal tunnel sufferers, the nerve (median in this case) gets squashed in the carpal tunnel.

[johnny senna]

drfrank said:

the nerve comes out of Guyon's canal and begins to run a more superficial course. The pressure applied to the palm whilst riding is distributed over directly over the nerve. The squashing causes the symptoms of pins and needles and sensory disturbances. It resolves but can be uncomfortable, I tend to find it improves when I wear gloves.

It is the same effect experienced with carpal tunnel sufferers, the nerve (median in this case) gets squashed in the carpal tunnel.

I agree. The problem is not vascular (or blood pressure) related either. It's the ulnar nerve getting squashed. Gives you pins and needles in the ring and small fingers, plus weakness of the fingers to an extent (for me anyway). Try adjusting your grip position all the time. Try putting less weight through your hands and grip the bars a little less tightly. I found that I got less pins and needles after a while as it happens.

Edited by johnny senna on Sunday 8th November 09:05

[Gnarlybluesurf]

The only way to be sure is to get an EMG this will tell you if you have nerve compression that may benefit from surgery. This is a pretty straightforward procedure.

[johnny senna]

Gnarlybluesurf said:

The only way to be sure is to get an EMG this will tell you if you have nerve compression that may benefit from surgery. This is a pretty straightforward procedure.

It's direct pressure on the ulnar nerve when then person is riding that is causing the problem usually though?? I can't see surgery helping that. On the other hand, decompression of the radial nerve is fine for someone getting carpal tunnel syndrome, but we don't really know the diagnosis in the O.P. (i.e. is it ulnar nerve compression he is getting?), so he needs to get that clarified first.

[Gnarlybluesurf]

johnny senna said:

Gnarlybluesurf said:

The only way to be sure is to get an EMG this will tell you if you have nerve compression that may benefit from surgery. This is a pretty straightforward procedure.

It's direct pressure on the ulnar nerve when then person is riding that is causing the problem usually though?? I can't see surgery helping that. On the other hand, decompression of the radial nerve is fine for someone getting carpal tunnel syndrome, but we don't really know the diagnosis in the O.P. (i.e. is it ulnar nerve compression he is getting?), so he needs to get that clarified first.

Ofcourse a good history is always the key to diagnosis. My point was a negative EMG would push you into trying different grip set ups, riding positions etc where as a positive EMG would suggest whilst all these things would help he may ultimately benefit from some intervention. Ultimately he's not going to get an EMG without seeing ortho/neuro where a more detailed history and examination should give a better idea but failing the blinding obvious my guess would be he'll end up with and EMG anyway...

[johnny senna]

Gnarlybluesurf said:

johnny senna said:

Gnarlybluesurf said:

The only way to be sure is to get an EMG this will tell you if you have nerve compression that may benefit from surgery. This is a pretty straightforward procedure.

It's direct pressure on the ulnar nerve when then person is riding that is causing the problem usually though?? I can't see surgery helping that. On the other hand, decompression of the radial nerve is fine for someone getting carpal tunnel syndrome, but we don't really know the diagnosis in the O.P. (i.e. is it ulnar nerve compression he is getting?), so he needs to get that clarified first.

Ofcourse a good history is always the key to diagnosis. My point was a negative EMG would push you into trying different grip set ups, riding positions etc where as a positive EMG would suggest whilst all these things would help he may ultimately benefit from some intervention. Ultimately he's not going to get an EMG without seeing ortho/neuro where a more detailed history and examination should give a better idea but failing the blinding obvious my guess would be he'll end up with and EMG anyway...

I'm not sure I 100% follow your thinking. We are probably talking about ulnar nerve compression when Garlick is riding his push bike, right? It is the compression of his hands pressing against the bars that is squashing his ulnar nerve, not an anatomical problem (as per carpal tunnel syndrome where decompression surgery frees the median nerve and all is well). Therefore, there is no surgical solution to his ulnar nerve compression problem. So why do nerve conduction studies? The diagnosis is obvious, and surgery won't help him. He won't have some rogue piece of his anatomy compressing his ulnar nerve. What is compressing his ulnar nerve is 4 stones of upper body weight going through his upper limbs. You can't do an operation for that. He needs to wear gel padded gloves, and loosen his grip slightly on the bars, and keep on repositioning his hands. This worked for me.
Americans are fond of doing medical tests despite the diagnosis being obvious. We British doctors should be above this!
I sincerely hope that an orthopaedic hand surgeon doesn't come along and say I am talking sh~te.

[drfrank]

100% agree with Johnny Senna, why do a test for something you know the cause of ? EMGs should be reserved purely for an equivocal history/examination.

I rarely send any of my carpal tunnel patients for EMGs as a well taken history and thorough examination will usually give a diagnosis.