What is it?
Cell phone elbow is also known as Cubital tunnel Syndrome. The cubital tunnel is on the posterior aspect of the medial epicondyle on the elbow. It houses the ulnar nerve which travels down the arm into the pinky side of the hand. Elbow flexion requires the ulnar nerve to slide and stretch through the cubital tunnel however flexion concurrently causes stretching of the fascia resulting in an oval shape deformation of the cubital tunnel, diminishing the tunnel's volume.
A sustained amount of traction or compression may lead to symptoms of the cubital tunnel syndrome. In addition, ulnar nerve irritation may be caused by compression from direct or repetitive trauma.
Cubital tunnel is commonly seen in baseball, tennis, and racquetball players. Workers who maintain sustained elbow flexion, such as holding a tool or telephone, or those who press the ulnar nerve against a hard surface, like a desk, are at increased risk. Cubital tunnel syndrome has been called “cell phone elbow”.
Patients presenting with cubital tunnel often complain of paresthesia or pain extending distally from the medial elbow into the 4th and 5th fingers. Symptoms may vary from vague hypersensitivity to pain. The patient might notice some motor deficits within the arm and elbow. In more advanced cases, discomfort may be accompanied by loss of grip strength and fine motor control. Night symptoms are common. This condition is usually progressive.
The diagnosis of cubital tunnel syndrome is based primarily on history and clinical findings. Palpation may reveal tenderness at the posterior aspect of the medial elbow. Palpation of the ulnar nerve during elbow flexion will screen for subluxation of the nerve.
Radiographs of the elbow are of limited value except in cases of trauma, failed trial of conservative care, or suspected bony entrapment. Diagnostic ultrasound is a good method for diagnosing ulnar nerve pathology at the elbow. An EMG is generally not necessary unless the diagnosis is in question or the condition fails to respond to conservative care.
Management of the ulnar nerve compression includes activity modification, ice, nerve mobilization techniques, myofascial release, adjusting associated osseous restrictions, and patient education. Activity modification to limit prolonged flexion and direct pressure are important to successful management.
A protective splint at night on the elbow that limits flexion may be helpful. A protective pad to limit repetitive trauma from work or sports may provide some relief. Manual therapy techniques should avoid direct pressure on the irritated nerve.
Rehab is focused on increasing the strength of the flexors and extensors both isometrically and isotonically within a pain-free range of motion. Stretching the pronators can be useful to relieve pain.
The most common duration of conservative care is three months. Consideration of surgical decompression is warranted for symptoms lasting over 12 weeks or in case of significant motor deficit.