Jonathan Aarons M.D.

Ulnar tunnel syndrome is an uncommon cause of pain and numbness in the hand.  There are three main nerves of the hand; the median nerve, the radial nerve and the ulnar nerve.  The ulnar nerve supplies sensation to the 5th finger and one half of the 4th finger.  Compression of the ulnar nerve can also cause weakness of the pinch and grip of the hand.  The symptoms of ulnar tunnel syndrome include pain, numbness and burning of the 4th and 5th fingers of the hand as well as muscle weakness.  Causes of ulnar tunnel syndrome include trauma and fractures or repetitive injury such as in using a jack-hammer or long distance bicycling.  Rapid weight gain, rheumatoid arthritis and pregnancy are also associated with this disease.  Testing includes X-rays to look for fractures and MRI scans to look for growths or tumors in the wrist.  Electromyography (EMG) and Nerve Conduction Studies (NCV) are useful to determine the exact sight of nerve compression and to look for other causes of the symptoms such as a herniated cervical disc or diabetic nerve damage.  Treatment begins with conservative modalities such as rest, splinting, physical therapy and medications such as non-steroidal anti-inflammatories.  Injection into the area of nerve compression with a local anesthetic and a steroid may decrease the symptoms.  In patients who do not respond to conservative treatment, surgery may be indicated to release the nerve entrapment.

Cubital Tunnel Syndrome is a cause of pain and weakness in the arm due to compression of the ulnar nerve near the “funny bone”.  The symptoms of cubital tunnel syndrome include tingling in the pinky and ring finger, weakness of the hand grip and a claw-like deformity of the hand.  Wartenberg’s sign is an indication of cubital tunnel syndrome and occurs when the fifth digit assumes a position slightly away from the other fingers of the same hand.

The causes of cubital tunnel syndrome include trauma and repetitive motion of the arm.  Diagnosis is obtained uses electromyography (EMG) and Nerve Conduction Studies(NCV) to test the electrical properties of the ulnar nerve.  X-rays and MRIs of the arm are useful to exclude tumors and fractures.   Cubital tunnel syndrome is often confused with golfer’s elbow and cervical disc problems which have similar symptoms.  Treatment begins with conservative modalities such as heat, ice, physical therapy and splinting, non-steroidal anti-inflammatory medications and rest.  Injections into the area with a local anesthetic and a steroid may decrease the inflammatory process thereby reducing symptoms and providing more efficient physical therapy.  Severe symptoms may require surgery to release the nerve compression or move the nerve.

The Anterior Interosseous Syndrome is a painful condition of the forearm.  The anterior interosseous nerve is a branch of the median nerve, located just distal to the elbow.  This nerve will be compressed by tendons and nerves in the forearm, particularly the pronator teres muscle or by abnormal blood vessels in the area.  The patient with Anterior Interosseous Syndrome will have pain and weakness of the forearm and hand.  The affected extremity will have weakness of grip and difficulty making the “OK” sign with the thumb and forefinger.  The cause of anterior interosseous syndrome is usually trauma or repetitive motion injury, but may also be associated with Parsonage Turner syndrome.  X-rays and MRIs of the arm are useful to exclude fractures and tumors.  Electromyography(EMG) and nerve conduction studies (NCV) are used to exclude other causes such as a herniated disc in the neck.  Treatment begins with conservative modalities such as heat, ice, physical therapy, non-steroidal anti-inflammatory medications.  Injection of a local anesthetic and a steroid into the area may decrease inflammation and pain.  If conservative treatment is ineffective, surgery to release the compression of the nerve may be needed.

Radial Tunnel Syndrome is a painful condition of the arm and hand.  It is caused by entrapment of the radial nerve by a number of different potential problems, such as fibrous tissue, abnormal blood vessels and muscles.  As the nerves exit the spinal cord in the neck, its roots form the radial nerve.  The radial nerve runs down the outside of the arm near the elbow before entering the radial tunnel.  The radial tunnel is a path formed by muscle and bone that the nerve passes through.  As it exits the radial tunnel, the nerve passes below the supinator muscle, which is responsible for helping you to twist your arm as if you were using a screwdriver.  The pain of radial tunnel syndrome is constant.  It is worsened by supination of the wrist.  Muscle strength may be weak and it may be difficult to hold objects in your hand.  The pain may radiate up into the upper arm or into the hand.  Radial Tunnel Syndrome may be easily confused with Tennis Elbow, which has similar symptoms.  X-rays and MRIs of the hand and arm may be useful to exclude other causes of pain such as fractures and tumors.  Electromyography and Nerve conduction studies may be useful to determine the exact point of nerve injury and exlcude other causes such as tennis elbow.  The treatment of radial tunnel syndrome begins with conservative modalities such as physical therapy and non-steroidal anti-inflammatory medications.  Injection of the radial nerve with a local anesthetic and a steroid may decrease pain and allow more effective treatment.  Failure of conservative modalities may require surgery to release the nerve from its entrapment.

Cubital Bursitis is an uncommon painful problem occurring on the front of the elbow around the antecubital fossa.  A bursa is a sac of tissue which may contain fluid or fat that aids in protection and lubrication of joints and tendons.  Bursitis is an inflammation of that sac.  The most common cause of cubital bursitis is repetitive mechanical trauma, such as occurs using exercise equipment.  Other inflammatory diseases such as gout and rheumatoid arthritis may be associated with this problem.  The most common symptom is pain, swelling and loss of motion of the arm.  There is usually a swelling in the area of the antecubital fossa.  Diagnosis of cubital bursitis is made clinically by history and physical exam.  MRI and ultrasound of the area are useful to determine the size and extent of the problem as well as to exclude other causes of pain such as tumors.  Treatment begins with conservative measures such as heat, ice, non-steroidal anti-inflammatory medications and physical therapy.  Injection into the bursa of a local anesthetic and a steroid may decrease pain and allow more effective physical therapy.  Continued pain and functional restriction in spite of treatment may require surgery to remove the inflamed bursa.