Cranky Nerve Syndrome - Part 1

July 2020

It is a very typical story - a young woman came to see us with pain over the lateral aspect (outside) of her right elbow. The pain came on gradually, with no particular injury episode, starting 3 or 4 months ago. Picking up and holding her toddler had become very painful. She saw her GP who told her it was 'tennis elbow', but wearing a tennis elbow strap only increased the pain, and doing the tennis elbow stretches she found online also made the pain worse. She saw a physio who tried forearm massage, dry needling and light wrist dumbbell exercises. Again - her pain seemed to get worse instead of better.

Tennis elbow - painful sensitisation of the tendons on the outside of the elbow - is a very common cause of lateral elbow pain. But it is certainly not the only cause, and 'cranky nerve syndrome' is a commonly overlooked possibility. Sometimes nerves become irritated and 'cranky' when they are being compressed in a specific location. Carpal tunnel syndrome is a well known example of this. However, nerves are sensitive to all sorts of other irritating factors, and once they get stirred up it can be a real challenge to get them settled down again!

'Cranky nerve syndrome' may not be an official medical diagnosis, but it is a nice, simple way of describing a sometimes complex problem, and it is less of a mouthful than calling it 'peripheral nerve mechanosensitivity'!

One reason this problem is so complex is the wide range of possible contributing factors and underlying causes. This young woman had some things going on in her life which we often see as key drivers of the increased nerve sensitivity:

She was extremely busy and stressed, with 2 young children and part-time work in an office.
She often felt isolated and unsupported, as her partner does fly-in, fly-out work on a mine site.
Her sleep patterns were very poor - she would often stay up late to get some 'alone time' for herself once the kids were asleep, but then had broken sleep and an early wake-up from her 18-month-old.
She had a history of depression and anxiety, not being actively treated at present.
Her desk job and lack of regular exercise routines meant that she was generally lacking in strength and physical condition.
Her toddler had been sick on and off for several months, and she was picking him up and holding him a lot more than usual.

This patient had none of the 'classic' signs of nerve problems; no pins and needles, no numbness, and no weakness - all signs that a nerve is not able to transmit impulses properly. In her case, the nerves are actually 'hyped up', and are sending more messages than usual. Activities, positions and tasks that these nerves would normally tolerate very well have become a cause of pain. The good news for this patient is that her pain is not because of any damage or injury. Her nerves, tendons, muscles and joints are all healthy and intact, just sensitised. This can feel very counter-intuitive for some patients. Pain does a very good job of making us feel as though something really bad is going on! And cranky nerve pain can be genuinely horrible pain - sometimes deep and searing, sometimes burning, sometimes sharp and stabbing, sometimes heavy and aching.

We did a very thorough examination of this patient's arm, and we could reassure her that her tendons and joints were very normal, healthy and robust, just as they should be for a woman her age.

So, how do we treat her?

If we don't need to immobilise, rest or protect the body to allow an injury to heal, the focus of treatment can turn to the nerve sensitivity itself.

How do we calm down a cranky nerve?

Find out in Part 2...