Hand pain

Mentoring Minutes: Cubital Tunnel Syndrome

Cubital Tunnel Syndrome:Part 1

Cubital Tunnel Syndrome: Part 2

REFERENCES & notes: 

Wojewnik B, Bindra R. Cubital tunnel syndrome — Review of current literature on causes, diagnosis and treatment. Journal of Hand and Microsurgery. 2009;1(2):76-81. doi:10.1007/s12593-009-0020-9.

- Most don’t need surgery, unless traumatic injury to elbow structure

- SOL: bone spur, ganglions, callus,

- Froment sign: weakness of adductor pollicus muscle, pt given a piece of paper and holds it together between the thumb and index finger (key pinch) with flexion of the thumb IP joint (because weakness of add poll muscle.

-Positive flexion sign at the elbow with supination and wrist extension reproducing the symptoms up to 60 seconds and ulnar nerve subluxation with elbow flexion can also be seen.

- Treatment: braces, to limit flexion

Cutts S. Cubital tunnel syndrome. Postgraduate Medical Journal. 2007;83(975):28-31. doi:10.1136/pgmj.2006.047456.

 - 2nd most common peripheral nerve entrapment

- The cubital tunnel is formed by the cubital tunnel retinaculum which straddles a gap of about 4 mm between the medial epicondyle and the olecranon

- intraneural pressure associated with elbow flexion are believed to be key issues

-shape of the tunnel changes from an oval to an ellipse with elbow flexion. narrows the canal by 55%. , this compression can hinder blood flow;

-Elbow flexion, wrist extension and shoulder abduction increases intraneural pressure by six times.

- persons at risk_ holding prolonged flexion, prolonged position (tools, phones), pitchers at late cocking phase stresses nerve and tend to have mild boney changes at the elbow;

- 4th and 5th fingers parasthesia, or motor changes (clawing or abduction of little fingers

- elbow flexion test, tinnel, ULTT ulnar

-treatments: avoid prolonged flexion, nerve mobility,

-Cent Eur Neurosurg. 2011 May;72(2):90-8. doi: 10.1055/s-0031-1271800. Epub 2011 May 4.

Cubital tunnel syndrome - a review and management guidelines.

Assmus H1, Antoniadis GBischoff CHoffmann RMartini AKPreissler PScheglmann KSchwerdtfeger KWessels KDWüstner-Hofmann M.

-J Hand Ther. 2014 Jul-Sep;27(3):192-9; quiz 200. doi: 10.1016/j.jht.2014.02.003. Epub 2014 Feb 27.

Outcomes following the conservative management of patients with non-radicular peripheral neuropathic pain.

Day JM1, Willoughby J2, Pitts DG2, McCallum M2, Foister R2, Uhl TL3.

- J Manipulative Physiol Ther. 2010 Feb;33(2):156-63. doi: 10.1016/j.jmpt.2009.12.001.

Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases.

Oskay D1, Meriç AKirdi NFirat TAyhan CLeblebicioğlu G.


Mentoring Minutes: Median Nerve

Welcome to PhysioU’s Mentoring Minutes! Each episode of Mentoring Minutes directly applies a clinical approach with relevant research for effective results.

Peripheral nerve disorders comprise of a range of problems that can significantly affect a patient’s quality of life and function.  In today’s episode of Mentoring Minutes, Dr. Michael Wong will be talking about how to assess common entrapment sites of the Median Nerve.  

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