Cubital tunnel syndrome

[patterson]

Rip, my brother has been diagnosed with cubital tunnel syndrome. He started lifting about 8 months ago. He had elbow problems prior to lifting but nothing ever diagnosed. The doc determined this after a week layoff and icing didn't make it better, ruling out general tendonitis. He was cleared to lift again why they try other things like arm splints at night and such. His doc said he only lift if he avoids extreme extension or flexion. So he can squat, but what else is the question?

[Mark Rippetoe]

Icing does not correct tendonitis. What are his symptoms?

[Cutter]

Lifting will be generally neutral for cubital tunnel syndrome unless the elbow is held for long periods of time in flexion. Essentially, if his hand is not going numb, he should be fine to do the exercise.

If he truly has cubital tunnel syndrome, he should see a qualified hand surgeon and get it fixed. Most operations for this will result in minimal time off from lifting although there are a few which involve re-directing the nerve under the forearm musculature, and this would require some decent time off.

[Mark Rippetoe]

although there are a few which involve re-directing the nerve under the forearm musculature, and this would require some decent time off.

Sounds pretty gory.

[Cutter]

http://www.wheelessonline.com/ortho/..._transposition

Amazingly it is often the procedure of choice in professional throwing athletes.

[VNV]

Sounds pretty gory.

"Cutter" indeed.

Sounds like a surgeon.

(Chance to cut is chance to cure!)

[Ben Patterson]

After my brother told me he was going to start this thread I figured it would be easier to come here myself.

Here is some back ground information. Pain stated in right elbow, medial side, in 2010. At thsi time it was shooting pains at the joint, no numbness or tingling in fingers. Pain would come and go but reached a point where it was unbearable in 2012. Right medial elbow pain was diagnosed in 2012 as bursitis, but no real swelling was present, it was treated with a cortisone injection, which relieved pain for some time. When pain did return NSAIDS were prescribed but did not do much to reduce pain. At this point I swore off chin-up and pull-ups as that was the only thing I was doing at the time that seemed to agitate it.

Fast forwarding now to march/april 2014, I start lifting and all is well at first. Around may the pain returns in both arms this time but is not significant. I examine form in the exercises that I believe are causing the problem. I find that I was flexing my wrist curing chin-ups and rowing motions. I remove chin-ups again, and reduce the weight on rowing movements to focus on wrist positioning and not trying to cheat the weight up. This is ineffective for relieving symptoms so i take time away from elbow flexion entirely as it seems to be the primary culprit for the pain. All the while my pain levels are slowly increasing.

Now moving to January, I have made an appointment o see a different orthopedist for the pain. During the week or so between setting the appointment and going to see the doc I notice numbness and tingling in the 4th and 5th digit of my let hand. The doctor did an x-ray to look for bone spurs or other things that may show up on x-ray. Nothing there and he refers me to occupational therapy.

A week ago yesterday was my first appointment with the therapist who was initially treating me for medial epicondylitis. He had me stretching, icing, and massaging the flexors in the forearm, he also treated with ultrasound in the office. We did some eccentric wrist extension and flexion movements on my 2nd visit as well as supination and pronation with a light dumbell. He remarked at my ability to use the weight I ended up using with no pain and the epicondylitis. This coupled with his experience with another patient led to his conclusion of cubital tunnel.

As far as exact symptoms are concerned, as well as when I experience them. Elbow flexion combined with finger flexion tends to cause shooting pains in my elbows, i.e. chin-ups, rows etc. If elbow is static and fingers are flexed I am pain free, i.e. deadlfiting. I cannot unrack or rack the bar for a bench press without some pain in my elbow. In the bottom of the press I also experience some pain. As far as numbness, that kicks in immediately at full flexion of my my left elbow, and after a prolonged time flexing my right.

Current treatment plan is wearing splints while sleeping and changing daily habits to keep the elbows more extended for a period of 6 weeks at which time I'll be referred to a surgeon for consult if i t is not resolved. However I was cleared to lift as long as it does not cause issues. The problem is I was unable to ask about specific movements as the therapist is not familiar with barbell training. It seems obvious to me that I should not do anything that causes sharp joint pain. The question is the movements that do not cause pain or numbness. Such as the deadlift, he said to avoid extreme extension of the elbow, but to me "extreme" extension is akin to hyper-extention not simply a locked out elbow joint.

Squats are easy enough to modify hand placement slightly. But what is your opinion on deadlifits, and locking out presses? additionally do you think doing some face pulls with a band would suffice to counter act pressing movements until I can do heavier pulls again pain free?

[Mark Rippetoe]

You have medial epicondylitis (golfer's elbow) in the same elbow?

[Ben Patterson]

That was the initial determination of the therapist. The doctor did not give me a diagnosis per se, the referral paper read "assess and treat". So on my initial visit golfers elbow was the conclusion reached. After an additional visit to treat the golfer's elbow. After a week of following the plan I was given I went back with little change in my condition and the OT did a few more things to evaluate and told me he thought it was actually cubital tunnel.

So to answer your question more directly, according to the therapist, no I do not have golfers elbow.

[Mark Rippetoe]

It might be worth a try to use the tennis/golfer's elbow fix. Look it up on this board.