Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive paresthesia and numbness involving the left small finger and ulnar half of the ring finger. Symptoms are exacerbated by prolonged elbow flexion and leaning on the elbow. Reports associated weakness in grip strength and occasional clumsiness with fine motor tasks. Denies neck pain or radiation suggesting cervical radiculopathy.
Clinical Examination Findings
Left upper extremity examination reveals positive Tinelβs sign at the cubital tunnel and positive elbow flexion test. No significant atrophy of the first dorsal interosseous or hypothenar muscles noted. Sensation to light touch is diminished in the ulnar nerve distribution. Motor strength is 4/5 for interossei and abductor digiti minimi. Elbow range of motion is full and painless.
Treatment Protocol
Initiate conservative management including nocturnal elbow extension splinting, activity modification to avoid repetitive flexion and direct pressure on the cubital tunnel, and non-steroidal anti-inflammatory drugs (NSAIDs) as needed. Referral for nerve conduction studies (NCS) and electromyography (EMG) to assess severity. Physical therapy for nerve gliding exercises prescribed.