ulnar nerve palsy affecting motor function: any experience, recovery time, etc?

[Frank9755]

I'm currently not able to move the fingers of my left hand as much as normal, particularly from side to side.  So, when I pour shampoo onto my hand, it leaks through and, yesterday, when I paid in a shop, the coins dropped between my fingers before I could tip them into the shopkeeper's hand.  Some keystrokes don't work as well on a keyboard, and, my signature looks different every time, and not much like it used to do.

I managed to get this on the IPWR in Australia last month.  I put it down to a particular stretch where there was a storm-force cross-wind and, after the temperature dropped by 10 degrees in a  few minutes, I got cold and my hands went numb, so I was gripping my bars way too tight with my left hand, to keep the bike on the road.  Of course it could just have been cumulative from the previous 4,000km. 

Either way, my left hand was pretty sore for a day or so and has had the impaired movement since.  I've not had this before.  I've had numbness after, and during, long rides (have at the moment) and that goes away.  I've researched it and there are some good articles (like this one http://www.physio-pedia.com/Cyclist%27s_palsy) which give me some confidence that it will recover.  But it's not getting noticeably better yet.  So I wondered who else had had it and how it progressed?

[LittleWheelsandBig]

It can take many months. When I first started doing long brevets (>1000km), it took up to six months to gradually come back. I never get it more recently, once I worked out what was causing it.

[Sea of vapours]

I had it a couple of years ago to what sounds a similar degree to you (though on rather fewer kilometres). It stayed that bad, with distinctly impaired lateral motor strength in particular, for about three weeks and then recovered to nearly normal over a further two weeks (I made notes on this at the time so those times are reliable). Completely recovered after seven weeks, so far as I could tell at the time, and no further recurrence after working out what might have caused it.

Clearly, recovery rate is going to vary somewhat, but I was relieved to find that, whilst mine showed no discernible improvement for several weeks, it did then progress to full recovery relatively rapidly.

[chrisbainbridge]

Hi Frank
I have personal experience as a patient and a hand surgeon.

Generally the nerve will recover over a few months. I would not expect to see anything for about 6weeks with steady progress after that.

Some Vit B12 supplements "may"be of benefit.

[hellymedic]

Expect around 6 months for recovery to near its completion.

Recovery may not be complete as some damage can be permanent.

Try very hard not to repeat/worsen the injury by easing pressure on the heel of the hand at frequent intervals and attending to glove/handlebar issues.

I suspect people get this more in their non-dominant hand and it is not discovered until quite late as lack of dexterity is discovered later.

I was cycle-camping alone, somewhere north of the Arctic Circle¹ when I realised I couldn't bring my little finger into my hand at all...

... and made matters worse 7 years later on a 1000km brevet, though there'd been a massive improvement in the interim.

It affected my swimming as the little finger just wafted in the breeze rather than acting as an oar.

1) Not a time and place to abandon if there's no blood'n'guts

[Frank9755]

Thanks for the comments.  Reassuring that everyone did seem to get a decent, if not full recovery.  And no-one is recommending amputation!  I'm only at 4 weeks, so early days, and I'm not cycling, other than a 10k commute a couple of days a week, to give it chance to recover.

It is my dominant hand so I noticed it straight away: when I dived into a hotel they asked me to sign their form.  I could hold the pen, but the resulting squiggle wasn't much like my signature and wasn't even in the place where I'd intended to write it!

[Frank9755]

Update: just in the last two days I've noticed this starting to improve.   

I met Zigzag on Thursday evening and was showing him my hand with no sideways movement in the fingers at all.  The following morning, as I was lying in bed before getting up, I tested it and thought I could see some small degree of movement in some fingers.  Multiple tests during the day confirmed it.  This morning there's definitely a bit more.  So, although it's far from better, I am very pleased and relieved to see signs of it starting to heal. 

For the record, yesterday was 4 weeks and 2 days since the day I believe I did the main damage.

[Genosse Brymbo]

Frank, this sounds exactly like the problem I had with my right hand after PBP2015.  The 6 months recovery time mentioned upthread are what I experienced, although I had twinges for up to a year after.  I found it very distressing at first, thinking my hand was permanently disabled.  Hang in there; it does get better.

[hellymedic]

The issue has been given the epithet 'cyclists' palsy' for some reason...

[chrisbainbridge]

I had a meeting with a colleague (another hand surgeon) who also cycles this week and had this about 18 months ago.  we bot reckoned as experts in the whole field of hand injuries that we reckoned it got back to about 95% but both of us thought it was never 100%

[hellymedic]

You did well to get 95% recovery, though I don't know exactly how this is quantified. I never recovered any power to adduct my little finger and I don't think this is my MS (though that did affect my ulnar digits fairly early on).

Changing contact points: Look after your pudendal nerves!

[chrisbainbridge]

Well, it is a neurapraxia which should recover 100% according to the books and what we tell patients so it is a salutary lesson to find it is untrue!

[hellymedic]

I'm not sure how I can be sure this is 'just' a neurapraxia.

I can be sure there was no 'trauma' in that there was no violence. I can't tell if this compression has damaged only the nerve or also its blood supply, damaging the nerve more/further/longer.

[zigzag]

good to hear your hand is improving!

[chrisbainbridge]

Sorry that should have been neurapraxia/axonotmesis.  We know that the schwann cells are still intact and therefore the axons should just regrow down the same tubes.  With a short period of rein nervation then motor end plate loss is unlikely.

[hellymedic]

Thanks..
These 'lesions in continuity' seem sometimes to fail to recover completely.

Both my own ulnar nerves and various anonymous men's pudenda (with whom I have been in private e-correspondence) have never been quite the same.

I think there is more detail in the various 'recovery from/After effects of LEL/PBP' threads.

[Phil W]

My hands were like those of an old man after the Wild Atlantic Way Audax last year. I was barely able to do the button flies up on my casual shorts after the ride. I put this down to putting enormous pressure on my hands and wrists when trying to keep a forward view after Shermer's neck struck. Up to that point my hands were doing fine.  Recumbent since has been great with none of the pressure points or challenges of riding my road bike a long way. The hands have recovered well but took longer than both LEL and PBP (which took about three weeks) to get back to normal.

I reckon a good five months before fully recovering. I couldn't straighten my ring or little finger for a few weeks due to the damage.

[simonp]

I have had this. More than once. Always fully recovered afaict. Left hand every time.

[Genosse Brymbo]

I had a meeting with a colleague (another hand surgeon) who also cycles this week and had this about 18 months ago.  we bot reckoned as experts in the whole field of hand injuries that we reckoned it got back to about 95% but both of us thought it was never 100%

It may well be that detailed before and after clinical tests would show less than 100% recovery, but in practice I can perform all the tasks I need to without restriction or pain.  In particular guitar tremolo technique is actually improving, but that's probably just practice.  Now playing attempting to play Eduardo Sainz de la Maza's Campanas del Alba

[rob]

Only had it once after a very wet DIY 600.   At the penultimate cashpoint control I couldn't grip my card to take it back out of the machine so it kept it - cue tetchy strop 40k from home.   I used the local costa for my final control when I got home and dropped my change on the floor.   I had to get someone to pick up a pound coin for me as I couldn't grip it.   When I got home I could turn my key in the door.

As others have said it did go away and I fully recovered.   It was also in my dominant - right - hand.

When I visited the osteopath for a general catch up she did work on my forearms a little which was where the trouble seemed to stem from.

[hellymedic]

Sorry that should have been neurapraxia/axonotmesis.  We know that the schwann cells are still intact and therefore the axons should just regrow down the same tubes.  With a short period of rein nervation then motor end plate loss is unlikely.

I have hypothenar wasting.

As I posted earlier, when the dominant hand is affected people react swiftly...

[McWheels]

Quite separate to cycling, I think, my right hand has been on the decline for 11 years. Post ulnar nerve decompression in the elbow (09) and rib resection (10), the decay has slowed, but this year I notice my thumb won't naturally get under a ball I want to throw. Also affects grabbing a glass off a table.

It's been called Thorasic Outlet Syndrome, although I remain uncertain it's up in the shoulder. What I really want is my hand back!

[hellymedic]

I presume your thoracic outlet syndrome diagnosis was supported by nerve conduction tests. Your surgeons have obviously worked hard to unpick your nerves from that which has compressed them.

I don't know if you can get any further improvement.

[chrisbainbridge]

There are a number of possibilities. Really too many to mention this n a short post.

If you have had a thoracic outlet release and an ulnar nerve release and still have problems then you will never have a or am hand again.

Continuing deterioration is another problem and may suggest that you have some other condition going on. Could be worth a trip to GP and then one of the big peripheral nerve surgeons in Derby, birmingham,Stanmore,Leeds.

[McWheels]

There have been a number of nerve conductions done on me. The last worked its way up the arm and finished getting great thumps of electricity from bits of the upper spine. At no point could I say it was pleasant, but it was also really interesting.

But it took 2½ years for anyone to do the first one of those, everyone was convinced it was cold related and therefore Reynaulds. Cold really doesn't help and I lose my remaining dexterity dreadfully quickly. My grip is also half that of the left, and the work I get through I should be able to crush walnuts. The lesson here is that in 2005/6, I should have been a lot more demanding and caught this earlier.