Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chief complaint of paresthesia and numbness involving the right small finger and ulnar half of the ring finger. Symptoms are intermittent, exacerbated by prolonged elbow flexion, and occasionally associated with nocturnal awakening. Patient denies neck pain, radicular symptoms, or history of trauma. No weakness in grip strength noted, though patient reports occasional clumsiness with fine motor tasks.
Clinical Examination Findings
Right upper extremity examination reveals normal muscle bulk in the forearm. Tinelโs sign is positive at the right cubital tunnel. Elbow flexion test is positive, reproducing paresthesia in the ulnar nerve distribution within 60 seconds. Fromentโs sign is negative, indicating intact adductor pollicis function. Sensation is diminished to light touch in the right 5th digit and ulnar aspect of the 4th digit. No atrophy of the first dorsal interosseous or hypothenar eminence.
Treatment Protocol
Conservative management initiated including nocturnal elbow splinting in extension, activity modification to avoid repetitive elbow flexion, and NSAIDs as needed for discomfort. Patient advised on ergonomic adjustments for workstation. Referral for nerve conduction studies (NCS) and electromyography (EMG) to assess severity and rule out proximal compression. Follow-up in 6 weeks to evaluate clinical progress.