Everyone now knows about carpal tunnel syndrome. The term has become a mainstream name. Carpal tunnel syndrome is the most commonly occurring nerve compression of the upper extremity. It can cause numbness in the thumb, index finger, middle finger, and partially in the ring finger. It can cause weakness in the muscles at the base of the thumb and cause pain that radiates up the arm into the shoulder and neck. Like the older sibling who gets blamed for all wrong-doing, carpal tunnel syndrome has become synonymous with all hand pain.

Lurking in the shadow of carpal tunnel syndrome's fame is its counterpart, cubital tunnel syndrome. Cubital tunnel syndrome is the second most commonly occurring nerve compression of the upper extremity. It is caused by the ulnar nerve becoming pinched at the elbow. When you hit your "funny bone", you are actually hitting this nerve. The ulnar nerve is responsible for sensation in the small finger and partially in the ring finger. Trauma to the ulnar nerve can cause pain in the small finger side of the hand that radiates into the forearm towards the inside of the elbow. It can cause weakness to the small muscles in the hand and, if severe, loss of coordination.

It is time to bring cubital tunnel syndrome out from behind carpal tunnel syndrome's shadow and into the light. If diagnosed correctly, there are simple modifications that can be made to help relieve the symptoms of this frequently overlooked nerve compression.

• Avoid bending the elbow for any length of time. This stretches the nerve tautly through the cubital tunnel. Activities that can irritate the nerve include:
  
  • sleeping with the elbow bent - use pillows for support; wrap an ace wrap or towel loosely around the elbow to keep it from bending; avoid sleeping on the arm or sleeping with the hands positioned up behind the head.
    
  • holding a phone to the ear - use a head-set.
    
  • blow-drying hair.
    
  • driving - adjust the seat position so that the elbows are open and relaxed; avoid resting the arms on the elbow supports or window sill.
    
  • computer work - position the height of the keyboard and mouse so that the elbows are open a bit more than 90 degrees.
    
  • playing the guitar (because of the positioning of the fretting hand) - warm-up prior to playing, take frequent breaks, stretch often.
    
• Don't lean on the elbow.
  
• Don't lean on the forearm, especially if it is placed over the hard edge of a desk or table. Place a soft support or cushioning under the forearm.
  
• Position the mouse and the keyboard in front of you so that you do not need to reach forward or out to activate them.
  
• The mouse and keyboard should be low enough that the shoulders are relaxed.
  
• Activate the mouse by keeping the wrist solid and using shoulder movement for positioning.
  
• Keep the wrists neutral. The wrists should be flat over the keyboard, not bent forward or back. The wrists should not be angled towards the small finger while typing. Using a split keyboard or a vertical mouse may help position the wrists correctly and relieve tension in the forearms.
  
• Avoid repetitive elbow bending and straightening.
  
• Avoid over-developing the triceps during gym and sports activities.
  

The ulnar nerve runs from the side of the neck, into the armpit, down the arm, through a groove on the inside aspect of the elbow, into the forearm, and into the hand through a small tunnel adjacent to the carpal tunnel (Guyon's canal). In addition to being vulnerable to forces at the elbow, the nerve is vulnerable at the level of the wrist. The following activities can cause an irritation of the ulnar nerve at the wrist:

• heavy gripping
  
• repetitive wrist and hand movements
  
• performing activity with the hand bent down and angled toward the small finger
  
• compression on the small finger side of the wrist (for example, cyclists who lean onto the handlebars, heavy machine operators and use of jack-hammers, weight-lifters, use of crutches, typists who rest the wrists on a hard surface)
  

Here are a few more tips to protect the nerve at the wrist.

• Avoid leaning on or placing pressure against the wrist.
  
• Do not use the base of the hand as a "hammer" (as when snapping a hubcap into place or freeing up the last remnants of smoothie from the blender).
  
• Use vibration-reducing, gel-lined gloves when performing sports or work activities that can compress the nerve
  

As with other injuries, it is important to:

• take frequent breaks when performing repetitive work.
  
• gently stretch the forearm muscles.
  
• warm-up prior to performing strenuous activity.
  
• avoid or modify activities that cause pain.
  
• use cold packs to control post-activity pain when necessary.
  

For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

RECOMMENDED ERGONOMIC PRODUCTS

The Microsoft Natural Ergo Keyboard positions the wrist in a neutral position. An added bonus - it has a detachable support that allows you to angle the keyboard in a negative tilt (or reverse slope) which can ease strain in the wrists and forearms.
Microsoft Natural Ergo Keyboard 4000

The Evoluent Vertical Mouse fits comfortable in the hand and reduces forearm stress by placing the arm in a more neutral rotation.
Evoluent VerticalMouse 2 - Optical Computer Mouse

These Fox cycling gloves have gel padding in the palm and fingers for protection and comfort.
2006 Fox Reflex Gel Cycling Glove