- Consider Diagnosis (discuss within peer review)
- Exclude cervicogenic causes and red flags.
- Tight fascial band; subluxing ulnar nerve over medical epicondyle.
- Valgus deformity; hyperextending elbow.
- Blow to elbow/ Prolonged elbow flexion (e.g. frequent guitar playing or sleeping pattern).
- Repetitive and/ or heavy motion at extreme of elbow/flexion/extension (e.g shovelling or working underneath car).
- Paraesthesia ring and little fingers.
- Aching medial side elbow / arm; worse leaning on elbow.
- Sensory changes more common than motor (motor fibres deeper).
- May be weakness of grip.
- May be wasting of small muscles of hand.
- May be clawing of little and ring fingers.
- If Nerve Conduction Studies are Positive; refer to Surgeon via Interface team.
If Serious pathology suspected or rapidly increasing neurological symptoms refer directly to Surgeon via Interface.
If serious pathology not suspected:
- Avoid direct pressure and sustained elbow flexion.
- Limit elbow flexion to less than 45° at night using towel or pad.
- Avoid Heavy Lifting.
- Ergonomic and sport related advice/ Ice.
- Graduated exercise programme including stretching.
- Local steroid injection into cubital tunnel should not be undertaken.
Refer to Physiotherapist/ Occupational Therapist if:
- There are no neurological changes.
- Diagnosis not ascertained.
- The patient require more specialist advice and would consider nocturnal splinting.
- The patient does not want surgery.
Consider Nerve Conduction Studies.