♪ Bob and Brad ♪
♪ The two most famous physical therapists on the internet ♪
- Hi folks, I'm Bob Schupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- Well, in our opinion, of course, Bob.
- This is bone apart, Napoleon Bonaparte, get it?
- Yeah. (laughs)
Anyways. - Today, Brad,
we're gonna talk about cubital tunnel syndrome.
It could also be cell phone elbow,
I think it's been referred to.
- Right, right.
- Or it could be a disc problem.
- Right, we've had a number of people,
at least two people request this.
So it took me a little while to get at it,
but here we got it.
- We are responsive to you.
- You better believe it, so...
- Speaking of which, Brad, by the way,
if you are new to our channel, which a lot of you are,
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- Right.
As far as a response, it may take a little while sometimes.
- That's right. - We get booked up.
But anyways. - A lot of comments.
- On cubital tunnel syndrome, okay?
Cubital tunnel syndrome in the big picture is pain,
numbness, tingling, nerve symptoms from here all the way up
and it goes to the pinky and half of the ring finger.
- Okay. - They call that a dermatome
and that's where you typically feel the symptoms.
- It's kinda like when you hit your crazy bone.
- Yep.
- That's that same symptom you're gonna get,
'cause it's the same nerve.
- Exactly, in the same location, actually,
the cubital tunnel is right there,
when you hit that and you get that little shock going up
and it hurts and it makes you go like this.
And once I said a bad word, when that happened.
- I'll bet you did.
- Yeah, anyways. - All right.
So when you get that, those symptoms,
the big thing as a therapist,
the first thing I think about is where is it coming from?
Is it here?
- Or is it from the neck? - Or is it up here?
Or it could be the first rib.
- Sure. - You know?
So we need to clear that out.
I'm gonna show you really simple test,
this isn't conclusive.
But if you can sit there and you have the symptoms
and you think maybe you have this diagnosis,
first let's look at the neck, sit up with good posture.
You're gonna look down, look up, rotate to the right
as far as you can, rotate to the left as far as you can,
do a chin tuck and then do a chin tuck
and look way back as far as you can.
If you can do all that
and it does not change anything in your arm
or those symptoms,
that's indicating it's probably not in your neck.
- Especially also, I tend to see it connected, Brad.
I mean, you'll get pain up here also in your neck.
- Right, right.
- Or the other test, I'll just mention the other test
that you could do real quick,
where you just turn and go back.
- Sure. - And then push down.
- Right, right.
- So you turn your head, go back a little bit
and then push a little pressure down.
- Push straight down.
- That's squeezing the nerves a little bit.
And so if that sends pain down the arm or increases it,
that can be a possibility too.
- Right, yeah, so if you do that
and it makes it worse,
there's a good chance It's not from this,
it's from up in your neck.
I do have three tests we're gonna go through
to help confirm it is from here as well.
- Okay.
- But first of all, let's look
at the anatomy of this a little bit more.
So we're looking at the ulnar nerve
and unlike carpal tunnel, that's the median nerve,
that's a whole 'nother story.
- Right. - But they actually travel
with each other.
The ulnar nerve is at C8, so at the low neck,
this red tubing represents grossly where it goes,
it comes through here it goes...
- There's no C8, Brad, so T8? - C.
- C7? - I looked it up yesterday.
In my book, it said C8.
- No kidding. - It did. (laughs)
- It's T1 then.
- Yeah, well the nerve is C8.
- The nerve's C8.
- Right, there we go. - Okay, I thought you were
talking about the vertebrae. - Right, exactly.
- Gotcha. - We're talking
about the nerve.
A little technicality, let's go on.
So here's the nerve
and you can see it travels literally right through here,
underneath here, and up underneath the first rib
and that's where it can also get trapped,
usually not so often though.
We're gonna assume it's not because we're gonna do the test
down here later to help confirm this.
It goes under the arm.
Now look at this, this is important, I think.
The mechanics of this,
can you see where the nerve is going?
And here's that gap you can feel right in here,
that tunnel, the cubital tunnel.
Now watch when you flex your wrist,
watch how that nerve can stretch.
And if that nerve actually pops
over like that, that's a problem.
That may not be able to get corrected without surgery.
If you're feeling that pop over
and you're having some real symptoms.
- You're gonna need to see a physician about that one.
- Yeah, then you gotta get in and see a physician.
But oftentimes if you just go like this
and you're holding your cell phone up like this
and you're feeling that, it may be just pulling it,
we need to break some tissues loose,
some scar tissue possibly.
And it's going through the flexor muscles
which is just meaty muscle right here in your forearm.
We're gonna show you a treatment,
what you can do with that to help reduce symptoms as well.
And then a nerve goes right up
to that pinky finger and part of the ring finger as well.
So now that you understand the anatomy of it.
- Yeah, good demonstration, Brad.
- Yeah, okay then.
- So what are the tests?
- Okay, the tests.
First one is the tap test.
- All right. - These are very similar
to carpal tunnel tests.
- Sure. - The Tinel?
- Yep, exactly.
So here's that tunnel.
You can feel your medial epicondyle, your acromion,
and it's right in between there.
You can flex your elbow slightly
and you just start tapping on there.
You'll tap for 30 to 60 seconds.
And when you're doing that, if it's flared up,
it more than likely is gonna irritate the symptoms.
- Start getting the symptoms, tingling.
- Yep and it's gonna go right up that same area
that where the nerve goes, okay,
the next one is you can put your finger in that groove,
this one's a little more aggressive
and you roll back and forth across there.
And this one, like I said, is more aggressive.
I don't have any symptoms, no problems,
I can roll in there pretty aggressively
and have no problems.
It's when you hit it hard, when you bump
into a corner,
- Right. - But no problems there.
But if you got it, that should set it off as well.
And then the next one is you go like this
and put your hand back like this.
You can do this with both hands.
And that will stretch that nerve, like we talked
about here and that may set it off as well.
- Yep. - So those are three tests.
- All makes sense. - If all three
of 'em are positive, you probably
for sure have got cubital tunnel syndrome.
So one of the nicest things
to treat this is not what to do to it,
- [Together] But what not to do to it.
- Exactly. - So you don't continue
irritating the problem.
So the first one is just like in the car,
you put your elbow right on that armrest
or on a chair, especially...
- I see a lot of, Brad and I work with a lot
of patients in wheelchairs and some of those armrests
on the wheelchairs are really hard.
- Right.
- And I have people come up to me,
I'm getting this tingling in my pinky.
- Yep. - And it's just
from them leaning on that chair.
- Right here.
Just getting that, now this is a steel arm rest here.
That's gonna be terrible on it,
if I had a flare up with this.
- So if you're at the office and you have armrests
on your chair and you're leaning on 'em all day
or you're just get in this habit,
that alone can be causing your symptoms going on.
- Exactly.
So get rid of the armrests, put some cushions on there,
sometimes you can just take a towel
and put a towel under to cushion it,
so the force goes up in the meat of the arm instead
of at the elbows, it could be enough.
- Right, exactly.
Good.
- And range flexion.
So you're gonna not use a cell phone,
you're gonna avoid doing things
where you're putting that elbow all the way
to the end of the range.
- Maybe get a headset or something else.
- Sure, yep, If you got the phone, exactly.
- If you're on the phone a lot, right?
- Right, absolutely.
- Next thing.
Full extension of the elbow all the way out,
sometimes that will flare it up too,
it'll irritate or pinch that nerve.
- You're kind trying to stay
in this mid-range here, aren't you, Brad?
- It's listen to your body.
If something irritates it, don't do it.
- You're trying to get the nerve to calm down, right?
- Exactly. - And while you're trying
to do that, that's when you wanna avoid these things.
- Right and there's a stretch,
if you're gonna try and stretch it out,
you're stretching these muscles, one of them,
one of the stretches can be like this
or like this, and you do wanna stretch the muscles
and you can stretch that nerve a little bit,
but if you overstretch and you pull that nerve too hard,
it's gonna irritate it.
And that can be no fun for about one or two days.
- Right.
- Once you get a nerve irritated from overstretching it,
it flares it up and it needs time to settle down
and you won't be happy with yourself if you do that.
- Stretching it is not necessarily bad,
but you're gonna wanna do it very gently
and very controlled and not increasing pain while you do it.
- Right.
And then the next one is,
and this is an important one,
this one's a little bit harder to control.
But when you sleep at night, you may end up rolling
or putting pressure on that spot
and finding yourself waking up with a real sore
or bad flare up of the symptoms.
- You got some pillows right here?
- Yep.
So, at night when you're laying down, if you can adjust it,
so the pressure's going through your tricep in here
and this is one where you gotta get some pillows out.
Still, you need a pillow for your head,
but here there's no pressure on that elbow
or on that sore spot.
And you're gonna lay like this and you're gonna say,
well yeah, but when I sleep, I'm gonna roll,
these pillows are gonna fall on the floor
and that is true to a degree.
But if you tell yourself before you sleep,
this is how I need to sleep, you can train yourself.
- Yeah and you can start and maybe you have
to readjust in the middle of the night,
but if you're on your side,
you can put two pillows like this and like this.
And I'm on my side. - Sure.
- And again, no pressure on the elbow,
there's a lot of things you can do using pillows
to try get...
- If you just ignore it and your sleep on it,
you're still addressing the symptoms to help it out.
Okay.
- So what are some of the other treatments, Brad?
- Some of other treatments, you can use a splint.
If you just need, if it's so flared up
and this is irritated at full extension,
you can go to the pharmacy, look it up on online,
you can get an elbow splint
where it's gonna hold it in one spot.
A lot of times the splint just reminds you not to use it.
- Sure.
- It doesn't always lock it in one place
but once it's on there,
and when you're thinking about something else,
just touching that elbow, same with knee splints,
is that you won't use it and your mind subconsciously knows.
- Right and gives you some help that way.
- Exactly.
The next one is these muscles,
the flexor muscles right here.
Remember that nerve goes through here and
through the flexor muscles?
You want to get in there
and you're gonna work those muscles.
- You're not going over the nerve.
- Yeah. - You're working
into the muscles themselves instead.
- This is one of those things that if you're doing it
and it makes the symptoms worse,
you're gonna need to back off, you're going too hard
or in the wrong spot.
So you wanna work it so that it feels good,
it's allowing the symptoms to relax and release.
Then you know you're doing it right.
Sometimes people go
with their forearm because your fingers will get tired.
- After with their palm?
- Yeah, the palm.
What'd I say, forearm? - Forearm. (laughs)
On the forearm. - Yeah, on the forearm
with the palm, the heel of the palm,
and get in there and work it like that.
- It's not a bad one for a lot of people,
especially if you do a lot
of typing or a lot of overuse type of injury.
- Yep, people that do a lot of hand work.
- So last one, Brad?
- Last one is a stretch I alluded to before,
is bend the elbow like this, hand up,
so the fingers go right towards your jaw,
take this hand and continue to flex the elbow.
- Now again, this is one you're gonna do very gently.
- Right.
- Because you're gonna start,
you want to get further and further.
Well, we show people,
it's called nerve flossing actually.
And you can just gently, but eventually you can get up
to like this that we can see,
if you can make the eyes on both sides.
Can you do it on both sides, Brad?
- I can hardly, you know my arms aren't that flexible.
But in school, there was a name for that, but...
- I have a lot of times people just start like this.
- Yeah. - And then eventually,
they get up into here where they got the glasses
or whatever they call it.
- And there's some people that just like me,
when I'm 80 years old,
I won't even have the flexibility to get to here.
So you may have to go to here.
- Again, very, very gentle.
You do not wanna fire that nerve up.
So you're just kind of pushing into the a little bit,
each day try to work it a little bit further.
- Five to 10 repetitions and then forget about it
for a few hours. - Exactly.
That's right, don't be overdoing this one.
- Exactly.
All right, so that's cubital tunnel syndrome in a nutshell.
Good luck with it and I'm sure with these techniques,
you're gonna have some success.
And Bob, what do you got to say?
- I have nothing else to say, Brad.
Thanks for watching.