0:00

We've talked a lot about different joints

0:02

in various things that can happen to

0:04

them. We've discussed the bee's knees. We've

0:06

even talked about elbows when it comes

0:08

to golfers and tennis players, But.

0:10

Recently I had a friend all me and tell

0:13

me that both of their hands were. Going numb

0:15

and they started freaking out while they were

0:17

at work. Now. If you're not in

0:19

healthcare, the first thing you going to do

0:21

is try googling your symptoms which this person

0:24

actually couldn't do. So they ask Siri, hey,

0:26

what's going on with my hands and of

0:28

course everyone's favorite digital assistant that doesn't really

0:31

do that much responded, you're probably die And

0:33

so therefore my friend had a panic attack.

0:35

But. What really happened. They. Compress their

0:38

elbows while they're typing. And. Suddenly

0:40

they develop numbness in they're pinky and

0:42

ring fingers and on that side of

0:44

a hand by the owner nerve know.

0:47

everyone's initial instinct is to call his

0:49

carpal tunnel but it turns out that

0:51

when it has to do with the

0:53

elbows, it's called something very very different.

0:56

This is Owner Neuropathy at the Elbow

0:58

also known as Kibble Tunnel Syndrome Some.really

1:00

cuts on Paul, your friendly neighborhood internist

1:03

and gastroenterologists. We're leaving all kinds of

1:05

nutrients and vitamins behind it. Wouldn't be

1:07

talking again about the Elbow with owner.

1:09

Nerve. Entrapment. Number.

1:24

For we get started with talking about the

1:26

Owner Nerve and how it gets in trapped

1:28

and freaks people out of. Go ahead and

1:31

talk a little bit about anatomy and what

1:33

we're going to do is take you back

1:35

to the break Your plexus. I know many

1:37

of you are having nightmares right now to

1:39

think about your days and anatomy during basic

1:42

science years. Be Owner Nerve arises from the

1:44

break Your plexus within the axilla region. We

1:46

know this is a continuation of the Media

1:48

cord and contains fibers from the spinal roots

1:50

of see eight to T one after arising

1:52

from the plexus and then distance between. The

1:55

acc slurry artery in the accessory vain

1:57

media li. During his travels it

1:59

goes through. Cubicle Tunnel a tissue opening

2:01

located under the only bump in the

2:03

elbow which everybody called the media at

2:06

the Can dial This is also known

2:08

as you're funny Bones and if you

2:10

ever heard it is not laughing matter

2:12

if then goes beneath. The muscles on

2:14

the inside of are formed in runs

2:16

alongside the median nerve and of course

2:19

the owner bone if then divides into

2:21

smaller branches that supplied innovation to the

2:23

side of your hand and in the

2:25

hand is has both sensory and motor

2:27

function. It breaks up industries and three

2:30

branches. The Palmer Cutaneous branch which

2:32

innovates the skin of the media has

2:34

a the hand. It dorsal detainees

2:36

page which aims to skyn of the

2:38

media live in the has fingers and

2:40

of course the associated dorsal hand of

2:42

that area and then of course the

2:44

superficial brands but in of is the

2:46

palmer surface of the medial one of

2:48

the have fingers. That's why those two

2:50

things like the pinky and the ring

2:52

finger only gets affected Seven a motor

2:54

standpoint it helps with flexor copy owners

2:56

and the medial half of flexor does

2:58

it harm pro funders and if I'm

3:00

giving you flashbacks to anatomy exam I'm

3:02

sorry. Therefore we know that it involves

3:04

be hype of your. Muscles. And.

3:06

Medial to unbuckled of Doctor Paul

3:08

Assess. The. Interest: the I have defected

3:11

part of a hand and the Palmeiras

3:13

gravest remember. We know that the owner

3:15

nerve can be affected the wrist but

3:17

it's also extremely susceptible injury at the

3:19

elbow which were gonna be talking about

3:21

now. The honey up east present?

3:23

well, they could call you because siri

3:25

freak them out or they'll describe one

3:27

of the following scenarios. One. Example

3:30

can be when the bender elbow the

3:32

owner of remember has to stretch around

3:34

and bony ridge of the meal at

3:36

Ferndale. If it's being compressed and the

3:38

blood supply is depressed for a long

3:40

period of time, it can cause some

3:43

numbness in pencil symptoms and neuropathy. For

3:45

example, many people sleep with their elbows

3:47

bent under their pillow which can aggravate

3:49

the symptoms of that on their nerve

3:51

compression and others a nerve slides out

3:53

from behind the com dial when the

3:55

elbows bent over time. That sliding back

3:58

and forth irritates the nerve sheath. and

4:00

can lead to symptoms of neuropathy. Leaning on

4:02

their elbow for long periods of time, for

4:04

example, on the arms of a chair as

4:07

they're typing, can also put pressure on the

4:09

nerve. In addition to that, localized injuries in

4:11

which fluid build up in the elbow for

4:13

other reasons can also cause swelling that can

4:15

compress the nerve. The more concerning is the

4:17

one that we've all experienced, which is a

4:20

direct blow to the inside of the elbow

4:22

that can cause pain, electrical sensations in the

4:24

hand and numbness in the little and ringed

4:26

fingers. In other words, we call that hitting

4:28

your funny bone. And as I

4:30

said before, it's not funny at all.

4:32

Lastly, baseball players. Throwing a baseball puts

4:35

a large amount of stress on the

4:37

inside of the elbow and this can

4:39

lead to ulnar nerve irritation for what

4:41

we call pitcher's elbow. So

4:43

which of these symptoms is the most

4:45

common? It turns out that those sensory

4:47

symptoms of numbness and anesthesia, especially after

4:50

things they do that are going to

4:52

cause compression or irritation are the most

4:54

common. Thankfully, motor symptoms are not as

4:56

common, but they can range from just

4:58

some weakness in the hand and dropping

5:01

things to full-on claw hand deformity. Now

5:03

there is a condition known as Guion-Kennell syndrome,

5:06

which is actually compression of the distal ulnar

5:08

nerve at the level of the wrist. Think

5:10

of this as like carpal tunnel syndrome, but

5:12

instead affecting the median nerve, it affects the

5:14

ulnar nerve. But we're going to focus primarily

5:16

on what happens with the actual elbow and

5:19

what you can do next. Now,

5:21

in addition to the history and what your

5:23

patients are actually complaining of, you can see

5:25

some things on exam. You can actually see

5:27

flattening of the median border of the forearm.

5:30

If You do an exam of sensation, they

5:32

might lose sensation on the distal interphalangeal joints

5:35

of the fourth and fifth digits. They may

5:37

be hypo-phenar eminence loss. You Also want to

5:39

abduct and adduct the thumb. They will have

5:41

a loss of adduction and a loss of

5:43

adduction of the fingers. There may be clawing

5:46

of the fourth and fifth digits or slight

5:48

clawing if it's very, very advanced. And Of

5:50

course, they can also have sensory and trophic

5:52

changes that are not described here. In Other

5:55

words,: you want to do a good hand

5:57

exam and it's important to do it to

5:59

both. In one, maybe more compressed

6:01

in the other because remember some people

6:03

lean on one elbow, more common be

6:05

the other but they change hands when

6:07

they get tired with that history and

6:09

mind and physical exam. You can then

6:11

basically saying with all of that together

6:13

and knowing the anatomy of the area

6:15

but you made the diagnosis and so

6:17

therefore it's a clinical diagnosis. If

6:19

you're unsure however the diagnosis of on

6:22

the neuropathy can then be confirmed by

6:24

electoral diagnostic testing when you know hundred

6:26

percent sure or maybe they have come

6:29

pending or contaminants symptoms of median nerve

6:31

entrapment as well. The lead singer

6:33

super old school and you're like less than

6:35

I did the clinical in history by want

6:37

to confirmatory physical exam. It turns out that

6:40

just like carpal tunnel syndrome there's the tunnels

6:42

test. There's. Also tunnel test for

6:44

the elbow and awaits performed is my

6:46

firmly practicing the area over the on

6:48

the nerve in the owner groove and

6:51

a little to distill the over the

6:53

kubo tunnel. This will then we produce

6:55

some symptoms of neuropathy in pairs these

6:57

as or even full on pain in

6:59

the owner innovator regions of the hand

7:02

especially in the fourth and fifth digits

7:04

Now pocus or point of care ultrasound

7:06

can also be used as someone is

7:08

very very well advanced and experienced in

7:11

doing so on ultrasound on the neuropathy.

7:13

At the Elbow so some sickening of the

7:15

nurse and altered echoes in the city. It

7:17

actually is the next I'm studying since only

7:19

used by those were August he trained in

7:22

it. but it has excellent deal with the

7:24

specificity of almost eighty to ninety percent. But

7:26

for the vast majority of your patience with

7:28

cubicle tunnel Syndrome, you'll be able to make

7:31

the diagnosis clinically. It's a witty going into

7:33

next month, the next step and management is

7:35

actually going to be conserved, this therapy rather

7:37

than surgery. In fact, in turns out a

7:40

two thousand and sixteen for cleaners, youth and

7:42

insufficient evidence. To actually recommend as

7:44

treatment between. I'm concerned with

7:46

a surgical some logic dictates

7:48

like title least invasive First.

7:51

You're gonna recommend some lifestyle changes this

7:53

should be. Avoid leaning on the elbows

7:55

when see that are driving. Consider using

7:57

the other hand when you're holding your

7:59

phone. Against your ear and we know that

8:01

for those of us from the eighties in

8:04

was those phones were huge of it. didn't

8:06

really have great thing to do to hold

8:08

them up to your ear. this happened a

8:10

lot. Recommend using a soft foam elbow pads

8:12

to reduce the inadvertent compression of the elbow

8:14

change for the peace and sleeps a the

8:16

using something to brace the elbow or padding

8:18

that does less compression than those patients who

8:20

sleep at night. You can also recommend a

8:23

toll rap or maybe a rigid brace for

8:25

the towel wrapped. Tend to be better at

8:27

night as the bridge braces can be somewhat

8:29

uncomfortable and affect. The Sleep. It's essentially

8:31

been. were of not compressing your elbows

8:33

when the city so definitely don't take

8:35

the middle seat on the site. Yes,

8:38

all planes when constable and for six foot

8:40

two like me is super uncomfortable. But again

8:42

let's not talk about the specifics of airlines

8:44

and England Boeing both as a sense of

8:46

topics. But again the unspoken rule is that

8:48

the middle person the think it's both armrests

8:50

in own issues that seat if you had

8:52

this issue. And patients also like

8:54

to try Ice wraps are various forms

8:57

of physical therapy occupational therapy to help

8:59

as well The truly just removing the

9:01

ascending movements and or practices that we

9:03

have this habit using held the most

9:06

the would give it about six months

9:08

a patient's get better than you continue

9:10

the conservative measures but it's they're not.

9:12

Then the next up a monument is

9:15

typically the Hammock Surgical Consult. To.

9:17

Decompress the on the nerve. But.

9:19

Again, remember when I said earlier,

9:21

the data on comparing conservative versus

9:23

surgical measures aren't that comment because

9:25

the condition itself doesn't have that

9:27

with great data Most patients after

9:30

decompression, the owner. Me: Feel better

9:32

others may not. It's hard to predict

9:34

what's going. there is and as alone

9:36

seat of of conflicting on the natural

9:39

history in the concerns of management for.

9:43

The vast majority of total do this

9:45

type of only know up with is

9:47

typically gets better with concert the management

9:49

and that ladies and gentlemen take care

9:51

of. Our friend recently had numbness in

9:53

their hands and fingers and it wasn't

9:55

as felt I wanted. Enjoyed this podcast.

9:57

I'll see all next week. I'm definitely.

10:01

International and.