Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I am an operating room nurse and must rely on fast reflexes to hand off instruments to the surgeon. Lately, the ring and pinkie fingers have been going numb. If I straighten my elbow right away, it seems to help. What can I do to avoid losing the use of my hand for work? I don't mind telling you I'm pretty panicked I might lose my job.

Answer:

You may be experiencing a problem called cubital tunnel syndrome or CubTS. Cubital tunnel syndrome is a condition that affects the ulnar nerve where it crosses the inside edge of the elbow. The symptoms are very similar to the pain that comes from hitting your funny bone. When you hit your funny bone, you are actually hitting the ulnar nerve on the inside of the elbow. There, the nerve runs through a passage called the cubital tunnel. When this area becomes irritated from injury or pressure, it can lead to cubital tunnel syndrome. Numbness and tingling of the ring and little fingers are the most common symptoms associated with cubital tunnel syndrome. At first, the symptoms may be intermittent or transient (on and off or come and go). Sometimes there was also pain along the medial (inside next to the body) border of the elbow. Gradually, the symptoms may become constant and weakness of the hand muscles can develop. Decreased dexterity and grip strength along with increased clumsiness when using that hand would be a definite problem in your line of work. The best thing to do is get a medical evaluation and diagnosis. See a hand specialist who will most likely check your past medical history first. Has there anything that could contribute to these symptoms (e.g., previous elbow fracture, fall on the elbow, sleeping on that arm, repetitive elbow flexion)? Several clinical tests to check for possible mechanical irritation, friction, or compression on the ulnar nerve. These tests are referred to as provocative maneuvers. For example, gentle tapping over and around the nerve were positive for causing the symptoms to get worse. Putting the elbow in a fully flexed (bent) position for three minutes is positive if again the position causes the ring and small fingers to go numb. The anesthesiologist/patient had a positive flexion test. Other typical clinical testing includes pressing on the nerve (called palpation) to see if it is tender. Palpation while moving the elbow may also show that the nerve moves in and out of the natural groove (cubital tunnel) in the bone where it should remain all the time. This type of nerve subluxation (partial movement out of the groove) or dislocation (nerve displaced out of the groove completely) can contribute to the problem. Early diagnosis and treatment may be your saving grace. It could be as simple as a short course of antiinflammatories or using an elbow extension splint at night. Don't wait. Avoiding permanent nerve damage is important for you. Richard L. Hutchinson, MD, and Ghazi Rayan, MD. Diagnosis of Cubital Tunnel Syndrome. In The Journal of Hand Surgery. September 2011. Vol. 36A. No. 9. Pp. 1519-1521.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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