Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chief complaint of intermittent paresthesias and numbness involving the right small and ring fingers. Symptoms are exacerbated by prolonged elbow flexion and leaning on the elbow. Denies neck pain or radiation. No history of trauma. Symptoms interfere with sleep and daily activities.
Clinical Examination Findings
Right upper extremity exam: Inspection reveals no obvious muscle atrophy of the hypothenar eminence or interossei. Tinel's sign at the right cubital tunnel is positive. Elbow flexion test is positive, reproducing paresthesias in the ulnar nerve distribution within 60 seconds. Sensation to light touch is diminished in the 5th digit and ulnar half of the 4th digit. Motor strength is 5/5 in all muscle groups, including the first dorsal interosseous.
Treatment Protocol
Conservative management initiated: Nighttime elbow extension splinting, activity modification to avoid sustained elbow flexion, and avoidance of direct pressure on the ulnar nerve. NSAIDs as needed for discomfort. Referral for EMG/NCS to assess nerve conduction velocity. Follow-up in 4-6 weeks to evaluate for clinical improvement or need for surgical decompression.