Cheatography
https://cheatography.com
Presentation Management etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Anatomy
- Medial Elbow
- Elbow flexion stretches and slides ulnar nerve through the tunnel (up to 5mm)
- Flexion can stretch retinaculum - ovoid deformation of cubital tunnel
Causes
- Sustained traction/compression of ulnar nerve (elbow flexion) |
- Direct/repetitive trauma (leaning on elbow/soft tissue hypertrophy/osteophytes) |
- Recurrent subluxation |
Demographics/Risk Factors
- Sites of compression: True cubital tunnel
Slightly distal to the tunnel between two heads of FCU (least common) |
- Common in athletes baseball, tennis, racquetball players |
- Workers who maintain sustained elbow flexion (tool/telephone use) |
- "cell phone elbow" - people who lean their elbow against the desk |
- Diabetics |
- Diminished cubital tunnel volume |
- Obesity |
- Elbow varus/valgus |
- Men more than women (women have layer of fat at medial elbow) |
- More common in left side |
Presentation
- Paraesthesia/pain extending from medial epicondyle to 4th and 5th digit |
- Sensory symptoms present first due motor fibres being more deeper |
- Usually progressive |
- Night symptoms common |
- Can radiate to neck/shoulder |
-Advanced cases involve loss of grip strength and fine motor control |
- Late stages will show intrinsic muscle wasting |
- On palpation, tenderness at posterior aspect of medial epicondyle |
- Palpation of ulnar nerve during elbow flexion - feel for subluxation of nerve |
- +ve Tinels of ulnar |
- +ve Elbow flexion test |
- +ve Froments sign |
-+ve Pinch grip/adductor pollicis weakness |
Imaging
- Not usually necessary unless |
- Trauma |
- Failed conservative care |
- Suspected bony encroachment (osteophytes/loosebodies/ossification of UCL) |
- US is gold standard for ulnar neuropathy |
- MRI for suspected ganglions, neuromas and aneurysms of ulnar artery |
DDx
- CTS |
- Cx disc herniation |
- Medial Epicondylitis |
- TOS |
- SOL |
- Pancoast Tumour |
- Syringomyelia |
- Ulnar nerve entrapment in hand/shoulder |
Management
- Activity modification (avoid prolonged flexion/direct pressure) |
- Ice |
- Nerve mobilisation - outstretched handshake to elbow flexion test position |
- Myofascial release |
- Splinting (at night) |
- Protective pad on the elbow |
- Rehab - strengthening flexors and extensors isometrically and isotonically |
- Stretching of pronators |
- Surgical decompression should be considered if symptoms no better within 3 months, symptoms over 12 weeks, siginificant motor deficit |
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