Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic medial elbow pain and paresthesias in the ulnar nerve distribution (4th and 5th digits). Symptoms are exacerbated by prolonged elbow flexion and nocturnal positioning. Denies trauma, neck pain, or radicular symptoms. Reports progressive weakness in grip strength and occasional clumsiness with fine motor tasks.
Clinical Examination Findings
Inspection reveals no visible atrophy of the intrinsic hand muscles or hypothenar eminence. Palpation of the cubital tunnel elicits positive Tinelโs sign. Elbow flexion test is positive for reproduction of paresthesias within 60 seconds. Sensory testing shows diminished light touch sensation in the ulnar nerve distribution. Motor strength 4+/5 in interossei and adductor pollicis. No evidence of ulnar nerve subluxation during flexion.
Treatment Protocol
Conservative management initiated: nocturnal elbow extension splinting, activity modification to avoid repetitive flexion, and NSAIDs as needed. If symptoms persist or progress to motor deficit, surgical consultation for ulnar nerve decompression or transposition is indicated.