Bellis and Damany recommend keeping a log. Here’s a quick two month summary:
Prior to 11/29/08: I remember periodic pain in the palm of my hands below the ring and pinky finger, particularly when using a laptop. My first memory of this is around October, 06. Infrequent pain in my forearms along the path of the ulnar nerve (elbow to base of palm).
11/29/08: I noticed consistent pain from my elbow to the base of my palm for several days straight over the Thanksgiving holiday. I searched the Internet and self diagnosed cubital tunnel syndrome. I immediately began sleeping with my arms straight. When I returned I went to my physician and she referred me to a hand surgeon.
About a week later: my pain changed to consistent pain in my elbow with periodic nerve “twanginess” from my elbow into my hand: imagine the feeling immediately after the initial shock of hitting your funny bone all the time in both arms. This was consistent until mid January.
Bending my arms any more than 30 degrees is a 6-7 in pain and I have to brace myself mentally to button my shirt, touch my face, drink from a glass, braid my hair, wash my hair, etc.
12/9/08: (check date) I met with a surgeon at the Hand Center at Jefferson. She confirmed my diagnosis, told me to continue sleeping with my arms straight, talked a little too much about surgery for my tastes and ordered an EMG to assess the severity of the damage to my nerves.
12/23/08: The EMG verified the diagnosis of cubital tunnel but indicated marginal severity: there was damage but it was light to moderate. It also showed mild carpal tunnel syndrome. I met again with the surgeon and she prescribed physical therapy and asked that I return in six months for another EMG. I remember telling her that I felt I had about a 10% improvement in pain but couldn’t be sure as consistent pain can be hard to gauge. I also gained some confidence in the surgeon that day as she was no longer talking about surgery: she was taking a conservative approach.
It was at about this time that I began taking 400mg of Aleve twice a day: at breakfast and dinner.
1/5/09: I met with the physical therapist, she found no measurable loss of sensation or motor function. Loss of sensation and motor function are the next step in the syndrome and I am not there… I told her I felt I had improved an additional 10% but was still not sure. She gave me median nerve glides which also work the ulnar nerve a little, hand exercises for carpal tunnel syndrome. She also asked I return the following week with photos of where I work so we could evaluate ergonomics.
1/12/08: I returned to physical therapy with photos of me on the couch, feet up, laptop in my lap, slouched in front of my desk, sitting at the kitchen table and so on. She was appalled but not surprised. She showed me the proper seating position and prescribed a split keyboard, a laptop stand and a keyboard tray. I’m tall enough that the key board tray has proven unnecessary but I am now an expert on and believer in split keyboards. I currently own two. I type with almost no hand pain now. If I remember correctly I was still in pain in my elbows more often than not but it was less at times. It is still uncomfortable to bend more than 30 degrees.
1/28/08: I returned to physical therapy with my Goldtouch keyboard and photos of me in a correct position. J, my physical therapist approved. I am now pain free 10% of the time, have nerve twanginess/awareness of the ulnar nerve from my elbow into my hand about 70% of the time and 4-5 pain 20% of the time. Activities requiring extreme arm bending (buttoning my shirt, braiding my hair, washing my hair, rubbing my face) have gone from a 6-7 in pain to a 1-2. I would say I notice these activities now rather than bracing for them.
2/4/08: I am pain free about 60-70% of the time. I seldom have serious pain or awareness of the full run of the ulnar nerve from my elbow into my hand. I have minor pain in my hand, sometimes my forearm. Activities involving extreme elbow bending still hurt about a 1-2.
