Cubital tunnel syndrome, tennis elbow, golf elbow - Not to be confused with carpel tunnel syndrome!

What is Cubital Tunnel Syndrome? CTS is often considered another RSI disorder involving a type of ulnar nerve compression neuropathy. It is considered the second most common peripheral neuropathy of the upper extremity.

What we refer to as the ‘funny bone’ is actually the site of the ulnar nerve that runs from the side of your neck down the arm, crossing the elbow and ending at the fingers. The ulnar nerve is the principal motor (outgoing) supply to the intrinsic muscles of the hand. If people ignore such warning signs from the body, chronic cases may result in the wasting of small muscles of the hand and, of course, the muscles of the forearm where the ulnar nerve runs.

Compression of the ulnar nerve – most commonly in the inside part of the elbow – can cause tingling sensations in both the ring and little (often called pinkie) finger. In some people, sensory loss is often the first symptom, and if not addressed could progress into clumsiness in hand use. The ulnar nerve can become inflamed, which is common in many types of RSI. CTS can feel like an ‘electric shock’, as when you hit the ‘funny’ bone in your elbow.  

Symptoms

Some people experience soreness around the elbow joint on the side where the ulnar nerve is located. This can cause weakness, extreme tenderness and shooting pain, hand pain and hand and thumb muscle weakness which could affect grip. Symptoms of CTS could also be present in medial epicondylitis commonly known as ‘golfers elbow’. 

Some Causes are:

Overuse (RSI – repetitive strain injury) such as:

·      Excessive weight lifting;

·      Carrying extremely heavy items on a regular basis;

·      Overuse of smart phones/tablets that also affects posture and neck;

·      Constantly leaning on a bent elbow when working/studying or reading;

·      Direct injury to elbow/site of ulnar nerve;

·      Keeping elbow bent for long period of time.

Compression from another entity such as:

·      Haematoma;

·      Synovitis secondary to rheumatoid arthritis;

·      Ganglion cyst;

·      Soft tissue mass – tumour;

·      Thickened cubital tunnel retinaculum (or arcuate ligament) of flexor        carpi-ulnaris muscle;

·      Infective process such as tuberculosis;

·      Humeral fracture with loose bodies/callus formation;

·      Spurs – known as osteophytic bony spurs – arising from the          epicondyle/olecranon;
.     Osteochondroma (overgrowth of cartilage and bone occuring at the end of the bone near the growth plate - a common non-cancerous growth);

·      Compression of ulnar nerve in the hand or nerve roots in the neck.

Treatment

Best thing you can do is cease all activities that either caused it or exacerbate it. However, few people will comply 100 percent here, especially if it affects their work or sporting activities. They must be encouraged to at least cut right back, otherwise no matter the type of treatment received the problem will never fully resolve. This could contribute to underlying weakness where it can flare up again soon in the future.

Ideally a support splint should be worn in bed at night to keep the arms straight at all times and limit movement.  Elbow pads can protect during the day.

I use Bowen therapy to treat this disorder and anti-inflammatory remedies, particularly homeopathics or herbal medicine. Bowen therapy has helped many RSI cases of all types, and, providing the patient complies with supports and reduces or eliminates activities that contribute to CTS, then this can be resolved in many cases without surgery. It is also important to work with the correct Bowen therapy sequences to help CTS resolve, and I may also use acupressure. However, there are always exceptions, and people who are stubborn and refuse to cease activities may need surgery.

 

Acupuncture can also be very helpful.

I also work with liniments that are applied the full length of the nerve 2 – 3 times a day, aiding circulation and ‘feeding’ the nerve with nutrients. Stifled blood flow affects the nerves; this occurs when there is any injury, impingement and compression on nerves or some of the above-mentioned causes.

Tennis Elbow

Tennis elbow or golfer’s elbow can be mistaken for CTS and vice versa. Tennis elbow pain is located on the outside of the arm where the forearm meets the elbow. This is another RSI condition where the tendons at the end of the extensor carpi radialis brevis (ECRB) muscle can develop small tears. This obviously results in inflammation and causes further stress to the rest of your arm, triggering pain when you lift or grip things. Never leave these symptoms untreated. When chronic, it takes much longer to resolve. I have to wonder why people allow such problems to continue and then can become incapacitated with extremely chronic situations. 

 

Causes of tennis elbow

 

When hitting a back hand during tennis you put additional stress on the forearm muscles, which contract every time you hit the ball. When you are learning or develop a poor technique or grip the racquet too tightly, this adds further stress to the tendons connecting the forearm muscles to the elbow. Tendons can develop small tears. So it is important for even novices to get some professional tuition when playing tennis. Playing incorrectly repeatedly results in a greater chance of developing tennis elbow.

The same applies to all racquet sports and any activities in your line of work that requires you to constantly repeat certain arm movements such as:

·      Painting!

·      Carpentry

·      Tree cutting, including over-use of chainsaw

·      Stacking shelves continually

·      Playing certain types of musical instruments

·      Being a chef, cook or butcher

·      A factory worker on an assembly line

Golfer’s Elbow (GE)

 

On the other hand, golfer’s elbow focuses on the inside of the elbow and can also develop tears of tendons. GE is an injury to muscles that flex wrist and fingers. The site of it being the medial epicondyle which is a bony bump on the inside of the elbow where these muscles attach. Therefore golfers elbow is correctly called medial epicondylitis or medial elbow pain.

Symptoms

Pain when attempting to grip items or resisted wrist or finger flexion. Pain can be present when muscles are stretched, including tenderness over the bony epicondyle due to inflammation.  There could be trigger points in the wrist flexor muscles. Some people may experience stiff necks and tenderness, including median nerve irritation. In GE, elbow movements can be pain-free, but gripping anything will generate pain.

 

Causes

Once again, RSI often due to:

·         Golf swings – especially if incorrect swing

·          Lifting weights – overuse and incorrectly

·          Even shaking hands (if you have a lot of people to greet!)

·          Degenerative changes in the muscle tissues at site of medial epicondyle.

In all the above cases people can present with what is known as ‘referred pain’, which may confuse an accurate diagnosis.

Treatment for Tennis and Golfer’s elbow

Again I use Bowen therapy since the techniques extend themselves for all RSI disorders when correct sequences are applied. Rest should always be encouraged along with elimination or reduction of all activities that exacerbate the condition.

The same applies as for cubital tunnel syndrome. Appropriate liniments applied 2 – 3 times daily and regular treatments should be received. People who do not follow through with remedies and weekly treatments take longer to resolve and some may not. My observations are that one must be consistent.

As mentioned above’ there are always exceptions to the general case. However, it is far better to have correct treatment and see how your body responds.

Many of the nerves that run down the arm conduct messages to the extremities – the hand and fingers. If you suffer any injury resulting in compression of any one of these nerves, you will experience problems with hand and finger use. I have seen many people recover from any of the above without the need for surgery, often in a 4 – 6 week period. Bowen therapy helps the body’s healing response more quickly.

My advice would be to also take preventative measures. If you are involved in any of the tasks or sporting activities mentioned above on a regular basis, it would be a good idea to have regular treatments to ensure no RSI of any type develops. Whenever it does, you need to be take prompt action and be consistent with regular treatments. At least with Bowen therapy (which is non-manipulative), treatments are only weekly for a while, then at longer intervals as improvement occurs. However, with other modalities you may be expected to attend 2 – 3 times a week.

Contact me today if you are suffering from any of the above symptoms for a Bowen Treatment on :   0403 231 804 or email lyncraven@bigpond.com

Website lyncraven.com