- What is cell phone elbow, and what should we tell our patients?
- How to Treat Cellphone Elbow
- Cell phone elbow isn’t always due to cell phone use
- Cell Phone Elbow
What is cell phone elbow, and what should we tell our patients?
With prolonged cellular telephone use, people may note the onset of aching, burning, numbness, or tingling in the ulnar forearm and hand. This constellation of symptoms, termed “cell phone elbow” by the lay press, is known medically as cubital tunnel syndrome—the second most common nerve compression syndrome in the upper extremities after carpal tunnel syndrome.
In most cases, treatment consists simply of modifying the activity and avoiding activities that aggravate the symptoms. Switching hands frequently while talking on the phone or using a hands-free headset can help. Other daily activities that produce cubital tunnel syndrome include leaning on an elbow while driving or working, and sitting at a computer workstation that requires elbow flexion greater than 90 degrees. Making ergonomic adjustments to these activities is beneficial.
For patients who have nocturnal symptoms, a simple elbow pad worn anteriorly or a towel wrapped around the elbow to prevent flexion while sleeping can be very efficacious. Occasionally, anti-inflammatory injections can be given to quiet an inflamed ulnar nerve and reduce symptoms.1 Surgical interventions, discussed below, are available for patients with severe, persistent symptoms.
WHAT IS CUBITAL TUNNEL SYNDROME?
Cellular telephone use has increased exponentially, with 3.3 billion service contracts active worldwide—or about one for every two people on the planet. The exact incidence of cell phone elbow is not known, but anecdotal reports and our own clinical experience indicate that its incidence parallels the rise in the use of cell phones and computer workstations.
Cubital tunnel syndrome is caused by compression of the ulnar nerve as it traverses the posterior elbow, wrapping around the medial condyle of the humerus. When people hold their elbow flexed for a prolonged period, such as when speaking on the phone or sleeping at night, the ulnar nerve is placed in tension; the nerve itself can elongate 4.5 to 8 mm with elbow flexion.2 Additionally, flexion of the elbow narrows the space available for the nerve2 and can cause a sevenfold to 20-fold increase in the pressure within the cubital tunnel, depending on muscle contraction.3 This can be compounded by compression on the nerve, either from various fascial bands surrounding the nerve or from extrinsic sources of compression, such as leaning on one’s elbow while driving or talking. This increased pressure on the nerve leads to decreased blood flow and nerve ischemia; this in turn causes increased permeability of the epineurial vessels and nerve edema, enlarging the nerve and continuing the cycle. Less frequently, cubital tunnel symptoms can be caused by the ulnar nerve subluxing in and out of its groove in the posterior elbow, leading to nerve inflammation and swelling from the repetitive friction.
THE CLINICAL PRESENTATION
The clinical picture of cubital tunnel syndrome consists of numbness or paresthesias in the small and ring fingers. Dorsal ulnar hand numbness, which is not present if the ulnar nerve is compressed at Guyon’s canal, helps the clinician differentiate cubital tunnel nerve compression from distal ulnar nerve compression.
If ulnar nerve compression persists, symptoms may progress to hand fatigue and weakness, including difficulty opening bottles or jars. Chronic and severe compression may lead to permanent motor deficits, including an inability to adduct the small finger (Wartenberg sign) and severe clawing of the ring and small fingers (a hand posture of metacarpophalangeal extension and flexion of the proximal and distal interphalangeal joints due to dysfunction of the ulnar-innervated intrinsic hand musculature). Patients may be unable to grasp things in a key-pinch grip, using a fingertip grip instead (Froment sign).
How to Treat Cellphone Elbow
Cellphone elbow can occur when you bend your elbow too long
Cellphone elbow, also known as cubital tunnel syndrome, is a painful condition caused by bending the elbow for long periods of time, thereby damaging nerves.
The most common symptoms of cellphone elbow are numbness on the inside of the hand as well as the ring and little finger, and pain and muscle weakness in the hand, forearm and elbow.
Repeatedly bending your elbow for long periods of time (such as when you are on the telephone, typing, leaning on your elbows, or pulling, reaching or lifting) can irritate the ulnar nerve, which over time can cause constant strain. In addition, the ulnar nerve runs through a groove in the bone near the inside of the elbow at the site where the muscles and ligaments of the forearm attach. These structures can constrict the irritated nerve.
To diagnose cubital tunnel syndrome, your doctor may (in addition to a physical examination) do a nerve conduction test to measure the speed at which the impulses travel along your nerves and an electromyogram (EMG) to evaluate nerve and muscle function.
Be aware of what you are doing that may be triggering the problem and focus on modifying your actions to minimize stress on your elbows.
Treatment for cubital tunnel syndrome will depend on its severity and may include:
- Reducing or eliminating the activity causing the irritation – for cellphone users this may include a recommendation to switch to a hands-free earpiece.
- Limiting the amount of time you’re doing activities such as pulling, talking on the phone, typing, etc.
- Taking regular breaks to stretch your arms
- Wearing an athletic elbow brace or splint to limit movement of your elbow
- Wearing an elbow pad when leaning on hard surfaces
- OTC anti-inflammatory medications or acetaminophen.
If elbow pain persists, talk to your doctor. Treatment options can include manual therapy, prescription medications or even surgery.
Originally published in Wellness Matters, Canada Wide Media’s quarterly newsletter on health and wellness.
Cell phone elbow isn’t always due to cell phone use
Recent media activity has called attention to a repetitive use syndrome called ‘cell phone elbow,’ which can cause pain, numbness or tingling in the forearm and hand. But cubital tunnel syndrome, as it’s known medically, isn’t only caused by excessive cell phone use. In fact, it can be caused by any repetitive activity in which the elbow is bent at a greater than 90 degree angle. This could include holding any kind of phone to the ear for long periods of time. It just happens that because cell phone use has increased exponentially and because people can now use their phones while walking, while driving, literally anywhere, some people are spending much more time on the phone than they did previously. And some of them are paying the price with painful hands and arms.
Cubital tunnel syndrome is similar in many respects to the more widely known and more common carpal tunnel syndrome. In the latter, repetitive use injury causes the median nerve to become compressed as it passes from the forearm to the hand through the wrist. In the former, cubital tunnel syndrome, which is the second most common nerve compression syndrome of the arm, it’s another nerve, this time the ulnar nerve, which becomes compressed as it passes around the elbow, giving the condition its nicknames of cell phone elbow and even “cellbow.” Everyone has experienced banging their elbow and the resulting sharp pain and tingling that occurs immediately thereafter. We call it hitting our funny bone but it’s not a bone at all but rather the ulnar nerve that’s being hit and causing the pain. You can see the ulnar nerve, shown below in yellow, as it passes around the inner aspect of the elbow right along the bone.
Whenever we bend the elbow more than 90 degrees it both stretches the ulnar nerve and compresses the tunnel through which it passes. Normally we don’t hold this position for long periods of time, which allows the nerve to regain its normal length and relieves the pressure. But if you keep your elbow bent for hours at a time on a daily basis, it can cause reduced blood flow to the ulnar nerve, resulting in localized tissue swelling and eventually the symptoms of pain and neurologic issues like numbness and tingling.
You can actually develop cubital tunnel syndrome while you sleep! Some people sleep on their side with their elbows bent sharply and their hands tucked under their head and some remain in that position for many hours each night. Some people sleep on their side and then hold a phone to their ears all day, further compounding the problem. You can also cause problems by leaning heavily on your elbow while driving or working. Some folks keep their arms bent while keyboarding. It’s even known to occur in people who play the guitar for hours at a time because the action of working the fretboard not only keeps the arm bent but also puts pressure on the thumb and forefingers at the same time – a perfect setup for cubital tunnel syndrome.
As mentioned, the symptoms are typically pain and/or numbness and tingling along the inner arm and hand (the pinky and ring fingers). Some people also develop fatigue and weakness of the affected hand leading to difficulty opening jars. Long term or severe problems can lead to permanent muscle problems including the inability to straighten out the pinky and ring fingers.
In the early stages or in non severe cases, treatment consists simply of avoiding the offending movement or position, which allows the nerve to heal. If it’s due to cell phone use, cutting back, switching hands and/or using a headset are usually effective. Becoming aware of all your activities that cause long term elbow bending, whatever they are, is key to modifying those behaviors. If elbow bending occurs during sleep, wearing an elbow brace that prevents or limits bending can be effective. Another nocturnal trick is to wrap a towel around the elbow (use a safety pin to keep it in place) to provide a bulky obstacle to bending.
People with more severe symptoms may require treatment with anti-inflammatory drugs, which might be taken orally or injected locally depending on the individual circumstances. In rare cases surgery is required either to decompress the nerve tunnel at the elbow or in some cases actually to reposition it. Early identification and treatment is the best way to prevent long term complications. Awareness of one’s behaviors is most important because many of these activities are done without conscious thought. You might not even realize you’re bending your elbow for hours on end until pain and other symptoms cause you to stop and take a good look at exactly what’s going on.
Have you had problems with cell phone elbow or with other causes of cubital tunnel syndrome? What did you do to get relief? Please leave a comment below so that others can learn from your experience. We look forward to hearing from you.
You’re constantly grabbing your smartphone to check the weather, watch videos, read the news, check in with family, text friends, play games and look things up.
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But you may not realize that staying connected involves repetitive motions that can take a toll on several parts of your body. In fact, repetitive strain injuries associated with talking, texting and swiping on mobile devices are on the rise.
Orthopedic surgeon Peter J. Evans, MD, PhD, often sees these injuries in his practice. We asked him what you should know about the risks of cell phone overuse. Breaking injuries into three main types, he offers tips on prevention and treatment.
1. Cell phone elbow
If you spend a lot of time chatting on your phone, you may develop cell phone elbow, called cubital tunnel syndrome.
This repetitive strain injury stems from holding your elbow at an extreme angle for long periods of time, as you do when holding your phone to your ear. This compresses the ulnar nerve, which travels from your neck to your hand.
Signs of cubital tunnel syndrome include tingling, numbness, burning or aching in the forearm, and the small and ring fingers of the hand.
Dr. Evans recommends using a headset instead of holding your phone to your ear when talking on the phone, or switching hands frequently.
2. Texting thumb
Although texting on most smartphones is faster with your thumbs, our thumbs aren’t really very limber. Heavy texting with your thumbs can cause fine tears in your muscles and tendons, creating inflammation that causes swelling and stiffness.
Try varying your texting style, Dr. Evans suggests. Using your index fingers might slow you down, but it will give your thumbs a break.
Or consider using voice-to-text instead of your fingers. You can also try an external keyboard for extended text conversations if you’re not communicating on the go.
3. Neck, back and shoulder pain
All that time spent looking downward at your cell phone or tablet can cause problems with your neck and upper back. Keeping your head bent for hours each day can lead to pain, muscle spasms and stiffness in your neck, upper back and shoulders.
Some studies even suggest it may lead to early arthritis in the neck.
Dr. Evans advises keeping your mobile devices as close to eye level as you can to help relieve neck strain.
Pay attention to your body
If you notice tingling, numbness or pain in your hands, arms or neck, pay attention to how you hold your phone and how you’re bending your neck to view it.
The first step in preventing repetitive strain injuries is simple, says Dr. Evans. Once you pinpoint the problem, stop whatever it is you’re doing to cause the injury. Or if you can’t stop, at least reduce how often you do it. Taking physical and mental breaks from talking, texting and browsing online will do you good.
If you suspect your pain is related to mobile device use, you can start treating it with RICE (rest, ice, compression and elevation). This first-aid strategy involves:
- Resting the part of your body that’s hurting.
- Applying an ice pack to reduce inflammation.
- Compression, such as using a brace, for support.
- Elevating the injured area above heart level, when possible, to help decrease swelling.
If your pain persists beyond a week or two, talk to your doctor. He or she may prescribe medication or physical therapy to help relieve pain and repair the damage.
Cell Phone Elbow
Cases of “cell phone elbow,” where patients experience tingling or numbness in their ring and pinkie fingers, is not a new condition. Actually, it’s a condition that can be dated back to 1958.
Cubital tunnel syndrome, or cell phone elbow, is similar to carpal tunnel syndrome in that the pinching of nerves results in tingling or numbness within the hand. However, in cubital tunnel syndrome, the nerve pinched is the ulnar nerve and the pinching occurs behind the elbow.
Bending the elbow for long periods of time like when using a cell phone, sleeping with your elbows bent, or holding your arms bent and by your head can cause cubital tunnel syndrome.
“Although symptoms may not be immediate, using these positions can aggravate the problem and progressively irritate the nerve,” says Dr. David Ernst at Orthopedic Associates of Port Huron.
Nonconservative treatments should be used first and include anti-inflammatory medications, splints, and avoidance of problem positions. If nerve damage has occurred, the following surgical treatment is offered by Orthopedic Associates of Port Huron, and could be considered:
Cubital Tunnel Release: A surgical procedure that involves moving the nerve from the back of the “bump” to the front to avoid pressure and allow the elbow to bend more smoothly and efficiently.
To consult with one of our doctors at Orthopedic Associates of Port Huron, please call (810) 985-4900 or click on the Appointment Request button.
Most people who get cubital tunnel syndrome are middle-aged or older. Women get cubital tunnel syndrome more often than men — and it’s probably not because they talk more.
Although the precise reasons are unknown, women may be more susceptible due to hormonal fluctuations or their anatomy, Evans said.
And too much yakking isn’t the only cause of cubital tunnel syndrome. Other causes may include sleeping with the elbows bent and tucked up into the chest, sitting at a desk with the elbows flexed at an angle greater than 90 degrees and driving with your elbow propped on the window for extended periods, he said.
In most cases, minor lifestyle changes can help alleviate symptoms, including using a hands-free headset for your cell phone. If sleep position is the problem, an elbow pad to keep the arm straighter at night can help.
More serious cases are referred to an occupational therapist, who may use ultrasound to loosen scar tissue that can form around the nerve as a result of the inflammation, as well as stretching, deep massage and “nerve-gliding” exercises to reduce pressure on the nerve, Turkopp said.
Doctors may also use anti-inflammatory injections or surgery.
Seeing your doctor soon if you’re experiencing any numbness or tingling in your hand or forearm can prevent the problem from progressing to that point, Evans said.