Hypothenar atrophy, weak thumb adduction. Normal EMG despite clinically diagnosed atrophy? What could it be?

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Tifu

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Before I begin, I'd like to say that I know that I do not have ALS based on my EMG and the fact that these symptoms have been going on for over 3 years, there isn't really anywhere else on the internet that has decent knowledge and experience with neuromuscular disorders like this place, I am sorry if I offend anyone by posting this, and I would never make this post if it wasn't for this subforum existing.

I have atrophy of the hypothenar eminence, first dorsal interosseous, thumb adduction weakness (total froment's sign). This has all been diagnosed by a doctor, I also have sensory symptoms of the ulnar side of the hand and sometimes in between the thumb and index finger muscle. My pain is sometimes in the upper forearm below the elbow and extends to the shoulder. Sometimes I have tingling in the shoulder blade.

I've had a nerve release which gave me no relief, the incision wasn't very big and was located at the medial epicondyle (inner part of elbow). The only notes of the doctor were: ulnar nerve tethered by adhesions just before entering the flexor carpi ulnaris. I have continued to have a worsening of symptoms and paresis/weakness in my hand despite the surgery. I had an EMG before surgery which was clean, and I've had another one after, which was also clean with no abnormalities to report. I've also had a brachial plexus, cervical spine and shoulder MRI which have revealed nothing. The neurophysiologist was surprised by my findings on the EMG, and I am waiting to see a neurologist in a months time

EMG/Sensory and Motor NCS results:
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Despite objective weakness and marked atrophy that is obvious to all clinicians, what else could be going on? I would like to say that my pain and paraesthesia (which has turned from tingling to numbness ever since early 2022, which was 6 months before the surgery) worsens with movement, especially if holding something for a long time in the shower or using a mouse.

Apologies if I have offended anyone by posting this, if there was a better place online to discuss neuromuscular pathologies I would've posted there instead. I would like to say I am not an anxious person in general, I took 2 years to report this because my symptoms were relatively mild and it wasn't until the motor weakness and objective atrophy set in that I sought medical help. Thank you for reading.
 

Nikki J

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PALS
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US
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We are not neurologists nor can we examine you ( videos and pictures are useless so not allowed). We have experience in ALS but as you say your completely normal emg means you need to look elsewhere for answers. My only thought would be to make sure you have had extensive blood work including vitamins. We had someone a while ago with isolated hand weakness that turned out to be due to a vitamin deficiency
 
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