Ulnar nerve Hypermobility


July 2018 - Clinical Diagnosis of Bilateral Cubital Tunnel Syndrome, by Advanced Physiotherapy Practitioner in Orthopaedics. Hyperextended elbow of -20 degrees, grip strength weak on left side, blunting tactile sensation of left ring and little figure. Tinnels was positive at cubital tunnel, mild wasting of hypothenar eminence on the left. Was advised to wear a split for eight to twelve weeks, with no improvement referral to Neurologist.
May 2019- Dr Sait Consultant Orthopaedic Surgeon. Tinel’s sign is positive with ulna nerve, the left hand there is weakness of the abductor digiti minimi along with some wasting of the small muscles of the left hand. Advised to wait for EMG results.
June 2019- Dr K Weyrich Neurologist. Classic history and neurological examination in keeping with bilateral ulnaric nerve entrapment. There is constant disturbed sensation in ulnar dermatome with also weakness on the left four out of five and minor wasting of the hyperthenar eminence on the left. Referred for a nerve conduction study at KCL.
August 2019 – EMG study revealed normal findings, no evidence of an ulnar nerve lesion.
September 2019- MR Khwaja SpR in Orthopaedics. Bilateral paraesthesia’s left worse than right in ulna nerve distribution. Definitive passive dorsiflextion on hyperextension of the 5th MCP joint beyond 90 degrees, passive hyperextension of elbows and knees beyond 10 degrees. Tinels sign is positive despite negative EMG study. Sent for MRI of neck.
October 2019- Dr Sait Orthopaedic Surgeon. MRI came back showing no abnormality. No nerve root compression or spinal canal stenosis. Referred to Neurologist.
November 2019 – Dr Weyrich – during the clinical consolation was under the impression though motor involvement not only sensory disturbances. Patient has continued with physio. Requests another follow up as there is no explanation for symptoms. Depending on finding would consider asking Jeremy Bland Canterbury to perform an Ultrasound.
December 2019- Further EMG study shows no new findings
July 2020 – Dr Ben Schieber rheumatologist – ultrasound of elbows and ankle which confirmed ulnar nerve subluxation and peroneal tendon subluxation Suggested pain management and continued physio.


Doesn't look as though I've ever seen you despite that comment from Dr Weyrich about asking me to look at the ultrasound (or at least I seem to have no record of anyone by your current name).  Ultrasound by a rheumatologist is generally done with a somewhat different emphasis compared to my approach. They are interested in joints and the mechanics of tendons and ligaments whereas I'm more interested in nerves. I know a little about their field and they usually know a little about mine but we are not the same. 

Ulnar nerve subluxation is somewhat controversial, some studies suggest that it may actually protect against ulnar nerve trauma rather than being a problem - we don't know for sure would be my view at present.

It is certainly possible to have false negative nerve conduction studies for ulnar neuropathy, though relatively rarely in my experience if there is definite wasting and weakness of the small hand muscles. I would have to judge that for myself I think.

Where were the nerve conduction studies done - all at Kings? JB 


No I haven't seen you, the comment from Dr Weyrich was at end of last year and when i spoke to my GP in April due to coronavirus all further referrals was being on hold and have currently have had no further developments for appointments. Would it be possible to arrange an further examination with yourself or would I need to be referred back to Dr Weyrich? Assuming you have a long wait list as well.

Yes both nerve conduction studies was completed at Kings by Dr Fiahlo.

Interesting the difference in approach between yourself and rheumatologists, I was recommended to see one on the bases of my hypermobility and possible diagnosis for Ehlers-Danlos syndromes however this has not been directly tested as of yet.

From my own perspective the symptomatic pain increases when my elbow is bent and quite an intense pain over the groove where the nerve runs and the typically 'hitting funny bone pain'. The motion of 'popping' and rotating the joint can somewhat relive the pain however I been advised to not do this and wear a metal brace at night to keep the arm in a straight position. Currently the pain is worst at right top corner of my wrist just under my hand which goes along the right side of the hand, a very heavy dull tingling pain. Also recently have pain along the top of the forearm just below the elbow which runs down to my middle finger, however this is not the same tingling pain, a dull ache pain. Many thanks Charlotte


My waiting list is a bit odd at the moment. I have a lot patients waiting for the specialist carpal tunnel clinic but almost no queue for other things so all I woud need to see you would be a referral from someone. Any of the involved doctors or your GP could do that. The chances of me being able to add very much is fairly slim - Dr Fialho is very good - but I'm happy to take a look if someone wants me to. JB

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