What An Ulnar Nerve Injury Is Like

Submitted by Brian on November 2nd, 2012 at 2:54 PM

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ulnar nerve; Vote_Crisler_1937 wanted me to make him look cool

An MGoUser with a college sports history who had a similar injury to the one Denard had emailed to give some perspective on what he's dealing with at the moment. It's below.

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Brian,

I am wondering about how Denard's nerve injury has affected his passing the last couple years.

Some background with my experience with the injury:

After 4 seasons of B1G baseball I had an ulnar nerve translation surgery.  Until I had that surgery I had very extreme and unpredictable pain in my throwing elbow.  There were days I could go 5 innings against Iowa, and days where after 9 pitches against MSU I hit two guys in the back because I suddenly had no ability to control the ball, eventually being unable to grip it, feeling constant shocks in my fingers and my forearm muscles compressing my bones like a trash compactor.

Some days I could not sit without biting my lip in a car or movie theatre because gently setting my elbow on the armrests was too intense so I imagine slamming it on the turf would have ruined my day as well.  After the surgery, (16 week recovery so not an option for Denard) all of that was gone and my arm felt virgin again.  literally, the first time I threw off a mound my accuracy was the greatest it had ever been and I hadn't thrown a pitch in 16 weeks!  This injury is a chronic overuse injury that started early in my freshman year and became unbearable my senior year.

So my thought is that perhaps this injury is not at all new, and during the times it is really hurting Denard, again, times that are not so predictable, I would bet that it greatly hampers his ability to throw a football with accuracy. To the extent that the coaches are aware of it this can certainly change play-calling.  Perhaps some of his arm-punts or Tacopants slings are a result of him feeling that familiar SHOCK as he releases the football.  Though I guess I have never seen him rub his arm so then again maybe not.

Your thoughts?
Vote_Crisler_1937

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I'm pretty sure this is a newly developed thing with Denard since if he'd had something similar last year, Michigan would have put him under the knife in the offseason.

I don't think it's affected his play much. When Denard has armpunted this year it hasn't been much of a surprise. When he's stepped into his throws they've been accurate. When he's gone all woogly not so much.

Comments

Erik_in_Dayton

November 2nd, 2012 at 3:00 PM ^

It's possible that Denard has had some weakness in his right hand that he hasn't even been aware of (I'm not saying that this would be the primary reason for his interceptions).  The ulnar nerve in my right arm was pinched a few years ago, and I didn't realize how much weaker it was relative to my left arm until my doctor tested it.   Denard may find himself feeling better than he thought possible once this is fully treated after the season is over. 

ThWard

November 2nd, 2012 at 3:04 PM ^

For plunking MSU players in the back.

 

Re  "days where after 9 pitches against MSU I hit two guys in the back because I suddenly had no ability to control the ball"

NoMoPincherBug

November 2nd, 2012 at 3:04 PM ^

Denard had an elbow injury to his thowing arm in 2011.  I am certain of it as I recall it was mid season and was labelled "a boo boo" at the time.  Whether this is related to that injury is not known, or is not being disclosed... however there was a similar injury last year which was documented in the press and on this website in some form or another.

Ziff72

November 2nd, 2012 at 3:14 PM ^

None of us know but we did sleep at a Holiday Inn so let's all speculate Oliver Stone style.  Earlier in the week when we were talking inverted veer and horrid offense I was linked to a 2010 Offenses every snap video.  From there I watched those 2010 clips and was sad.   The Iowa clip was interesting as if you remember Denard came out of the game after being hit right above the elbow on an innocent enough looking play. I wonder if that was the start of the trouble?   I don't think it has anything to do with bad passes, but that could have been the beginning of his troubles with that arm.   Starts at about the 7:20 mark.

 

http://www.youtube.com/watch?v=R5EWTnzimOg&feature=relmfu 

Wendyk5

November 2nd, 2012 at 3:26 PM ^

I have herniated discs in my back and neck and have experienced the "shock" the poster speaks of. It was in my shoulder, and completely freaked me out. Like being struck by lightning. Very, very painful. 

Knight

November 2nd, 2012 at 3:34 PM ^

I suffered an ulnar nerve contusion when I got beaned on the funny bone playing baseball. My lower arm went numb instantly and my hand locked up. I stayed in the game but after realizing that I wasn't regaining enough movement in my arm I came out. As the hours passed I was gaining more strength/grip. I was completely fine after a couple days other than the annoying soreness when gripping things. The nerve was sensitive for a few weeks and the slightest bump would aggravate that funny bone feeling, although only briefly.

So I would guess that Denard will be able to play without the injury hampering him too much, although he will probably have to play through some slight discomfort. However, any hit on his elbow could take him out of the game briefly or permanently.

Vote_Crisler_1937

November 2nd, 2012 at 3:51 PM ^

First, THANK YOU for a front page mention! Im so excited.

I am not sure Denard would have had a translation surgery even if his injury is exactly like mine. This injury, and proper treatment, can be a blindspot to many doctors Denard is likely in contact with. My experience with a B1G training room is that all of the orthopods there are primarily "football docs" which means they are highly qualified at assessing the structural components of knees and shoulders for tears to muscles, ligaments, and tendons.

In my experience, they are specialized in these areas to the exclusion of understanding the smaller parts of the elbow, the nerves, bloood vessels, etc. Our entire staff did not have one elbow/hand specialist. I do not know if M does or not. For me it was simply a case of the the surgeons looking at my ulnar collateral ligament, seeing no tears in it, and send me back to the athletic trainers for rest/ice/heat/stim/ultrasound/stretch/strengthening programs for several years until they couldnt think of anything else to try.

Drbogue

November 2nd, 2012 at 7:07 PM ^

At UofM plastic surgery is one of the leading hand surgeons in the country. Ulnar nerve compression is fairly common and is treated by a hand surgeon via a transposition surgery depending on where the compression occurs. This is a fairly routine surgery (I did about 8 or 9 in 4 months of my dedicated hand surgery rotation during residency). I've said this elsewhere, but this injury sounds a lot more like a traumatic neuropraxia and not a compression neuropathy. Treatment for compression is a transposition, treatment for a neuropraxia is time.

bdstain

November 2nd, 2012 at 11:35 PM ^

This comment is very interesting to me. My son is a catcher - currently a sophomore at UofM. He caught nearly every game for all four years of high school and sumer travel ball and now plays for Michigan's club team. He has battled chronic elbow problems for the past 6 years. During high school it was mostly never ending pain that didn't stop him from playing but rarely went away. The past year, he would have stages when he could throw a runner out stealing but couldn't throw the ball back to the pitcher. He had to come out of a few games because he had no feel for the ball and couldn't throw it to the pitcher. We have seen multiple orthopedic surgeons but our experience has been just as you describe - they evaluate the structural composition of the elbows/ ligament and find no issues. Years of skipping games to rest, ice, ultrasound and physical therapy have not helped at all and we are at a loss for what to do next. We have spent thousands of dollars in surgeons visits with no improvement. How did you end up with the diagnosis of the nerve issue and this surgery? We have been at a complete loss with what to do to help correct this.

Jeffy Fresh

November 3rd, 2012 at 10:19 AM ^

I am an orthopaedic surgeon, with a fellowship in sports medicine.  Elbow issues with throwers can sometimes be difficult to pin down, as often the pain is vague and difficult to pinpoint.  However, an MRI will usually show anything with structural damage that needs to be addressed (typically the ulnar collateral ligament, or "Tommy John Ligament" is a biggie with baseball players).  Part of evaluating the elbow in a thrower should always be paying particular attention to the ulnar nerve.  Tapping the nerve might cause a sense of shock going down the arm into the little and ring finger, or may cause pain at the elbow itself.  To look more specifically at the nerve, EMG/NCV testing can be done.  I disagree with the statements made that sports medicine docs overlook nerve issues, as anyone with any type of competence will have that high up in their differential.

Another problem that is seen occasionally with baseball players, but is rare, is called thoracic outlet syndrome.  That is a compression of the nerves way up in the shoulder area that occurs in the cocking position of throwing a ball, and can cause sporadic weakness.  It is a great masquerader, but that is something you have to think of too with an odd weakness/numbness story.  Let me know if you have any more questions.

bdstain

November 5th, 2012 at 7:55 AM ^

Thanks for the comments.  I pulled out his medical report to review based on this these comments - he actually had an MRI anthrogtram done at UM (Dr Bedi) in Feb 2011 and the report says the ulnar nerve is normal "and situated posterior to the medial epicondyle."  The report suggested a remote UCL sprain and elbow synovitis.  They prescribed physical therapy. Your statements about a possible shoulder issue are very interesting as his PT thought the root cause issue may be more in his shoulder area then his elbow since he had seen no improvement over the past 4-6 years.  He continues to throw weekly as he works out with the club team.  I had him read these comments and he said he doesn't have much numbness but shooting pain instead.  Thanks for the suggestions and I will try to follow up with either the local ortho doctors here in Saginaw area or try to get him back in at UM.  Thanks again for the comments and suggestions - this has been a very difficult thing to deal with for all of us.  He loves baseball and continues to play through the pain.  He/we have had many doctor visits, lots of $$, 3 different sseasons of PT and still no progress.  We just want to understand what it is or how to fix it - it's still hard to beleieve a 19 year old is done with golf and softball and baseball already (one of the surgeons we saw suggested this was the answer). 

samsoccer7

November 2nd, 2012 at 5:12 PM ^

Denard did have an elbow injury last year. I believe he had an infection but it may have been in the same region and potentially led to some scar tissue or fibrosis in the region, possibly predisposing him to further injury of the elbow.

Secondly, it's possible he had this injury last year but it calmed down in the off season thus no surgery. It then could have flared up and the only treatment is more rest, which he won't get until the off season. We won't know. However, if it's lingered since last season, he should have had a pad for it.

RFM

November 2nd, 2012 at 5:47 PM ^

I injured my ulnar nerve in a freak accident. I had immediate and excruciating pain that felt like my whole arm was on fire especially my hand. A few seconds later half my hand was numb. After an hour or so I regained feeling everywhere except my ring and pinky finger. The numbness at the tip of my fingers lasted a week or so but I would have been able to throw a football. I imagine it would have been easy to aggravate though so it might by worth holding Denard out since we're playing a weak opponent.

ca_prophet

November 2nd, 2012 at 5:50 PM ^

... has been becoming more common among major league baseball players - primarily pitchers, as you'd expect - over the last ten years.  My subjective impression is diagnosis of this problem has become more prevalent as more and more pitchers routinely have their arms/elbows imaged and their motions analyzed for more efficient biometrics.

I would imagine that some of that knowledge is making its way into other sports and down to the college levels, possibly slower than we'd like.  (Which is not to say that Denard was improperly diagnosed or that the surgery was appropriate for him in the offseason - it is entirely possible that he's only started experiencing this problem this year, or this week.)

 

blueblood06

November 2nd, 2012 at 10:02 PM ^

I've actually had the surgery in both my elbows.  Mine was more of a structural issue (cubital tunnel syndrome) than injury related, although tendonitis in my left elbow from pitching did make it even worse.  Based on my understanding, it makes sense that Denard would not have surgery.  With cubital tunnel syndrome and tendonitis, the ulnar nerve is constantly under pressure from the tendon and the bone and the only way to stop it and give the nerve a break is to move the nerve.  If it's a one-time injury, the nerve doesn't necessarily have to be moved to heal.  It's more protected in the bone groove of the elbow than it is on the inside of the elbow where they move it to, anyway, so that's a better place for it to heal.  I think this is why they transportation is more for cronic issues and severe compressions that can't stay in the bone groove.

Just my guess.  I'm not a doctor, just a guy with two bad ulnar nerves.

Drbogue

November 2nd, 2012 at 7:13 PM ^

I'm sure that Denard will get plenty of attention from a hand surgeon at U of M. I know some of the orthopedic surgeons who treat the football team (hell, one was my anatomy partner 14 years ago at Mich) and they would likely get him into see the right guy (Chung is a hand guru and holds office hours at University Hospital). We r very lucky to have the docs we have at Michigan. Absolutely top of the line! The interesting part will be how or if they are able to protect Denards elbow on Saturday

bluesalt

November 2nd, 2012 at 11:52 PM ^

I somehow lucked into having two parents who have ulnar nerve issues, and if I just lean my elbows on a table for about five minutes I lose all feeling to my pinky and ring finger, and have limited strength in the rest of my hand.  It can last for days.  Obviously Denard doesn't have it that bad (or, I assume not) but it can recur very easily.  Also, cold weather makes it worse, at least for me, so the weather last week could have played a part.  He shakes his hand a lot, as if he can't get complete control of it, and I wouldn't be surprised if he has some chronic issue.  When I saw him go down this last game, I knew it was his ulnar nerve, but it also made me wonder if this was part of what had been going on dating back to last year.

Also, you can get it corrected with surgery, but at least as of a decade ago a doctor told me the problem would likely come back after 5-10 years, so why bother.  Of course, that could have just been for me, and medicine has improved in the past decade, but that could account for why this wouldn't have been treated surgically in the past.  Regardless, I don't think this is the first time this has occurred, since the reaction seemed to be one of frustration and not fear, which is what you would expect if someone all of a sudden lost feeling in his hand and had no clue why.