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Cell Phone Elbow?

June 13th, 2009 by RamonaBatesMD in Better Health Network, Health Tips

Last Tuesday, this tweet from @AllergyNotes caught my eye.

Call cubital tunnel syndrome a “cell phone elbow” and you make the front page of CNN.com: http://bit.ly/RaXrt and http://bit.ly/TTRfg

Cubital tunnel syndrome I know, but I had not heard it called “cell phone elbow.”  The first link is to the Cleveland Clinic Journal of Medicine article (full reference below).  It is an excellent article and well worth reading.  The second link is to CNN news article picking up the “cell phone elbow” line.

Cubital tunnel syndrome is a nerve compression syndrome (like carpal tunnel syndrome).  In the case of cubital tunnel syndrome, the nerve involved is the ulnar nerve and the location is at the elbow.  From the article

… the ulnar nerve as it traverses the posterior elbow, wrapping around the medial condyle of the humerus. When people hold their elbow flexed for a prolonged period, such as when speaking on the phone or sleeping at night, the ulnar nerve is placed in tension; the nerve itself can elongate 4.5 to 8 mm with elbow flexion……..

As with other nerve compression syndromes, the clinical picture is representative of the nerves enervation.  In the case of the ulnar nerve, this involves numbness or paresthesias in the small and ring fingers.   There may also be numbness of the dorsal ulnar hand which will NOT be present if the ulnar nerve  compression is in the Guyon’s canal at the wrist level (distal ulnar nerve compression).  If the compression is chronic enough, the symptoms progress to hand fatigue and weakness.  The small intrinsic muscles of the hand are important in hand strength needed to open jars.   More from the article

Chronic and severe compression may lead to permanent motor deficits, including an inability to adduct the small finger (Wartenberg sign) and severe clawing of the ring and small fingers (a hand posture of metacarpophalangeal extension and flexion of the proximal and distal interphalangeal joints due to dysfunction of the ulnar-innervated intrinsic hand musculature). Patients may be unable to grasp things in a key-pinch grip, using a fingertip grip instead (Froment sign).

It may be an old joke (Patient: Doctor, it hurts when I do this.  … Doctor: Well don’t do it.), but in the case of cubital tunnel syndrome it fits.  Prevention is key.  Prolonged extreme flexion of the elbow (elbows bent tighter than 90 degrees) is not kind to the ulnar nerve.  Switch hands or use a head set or blue tooth.

REFERENCES

Q:What is cell phone elbow, and what should we tell our patients?; Cleveland Clinic Journal of Medicine May 2009 vol. 76 5 306-308 (doi: 10.3949/ccjm.76a.08090); Darowish, Michael MD, Lawton, Jeffrey N. MD, and Evans, Peter J MD, PhD

Cubital Tunnel Syndrome: eMedicine Article, Feb 9, 2007; James R Verheyden, MD and  Andrew K Palmer, MD

*This blog post was originally published at Suture for a Living*

Tags: Cell Phone Elbow, Cubital Tunnel Syndrome, Nerve Injury, Neurology, Physical Medicine And Rehabilitation