What is Cubital Tunnel Syndrome?

Everyone has now heard of carpal tunnel syndrome. The term is seen in everyday magazines, is used commonly in texts and tweets, and is even the name of a musical group. Carpal tunnel syndrome is the most commonly occurring nerve compression of the upper extremity. It is caused by the median nerve becoming pinched at the wrist causing 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 when the ulnar nerve, running parallel to the median nerve in the forearm, becomes 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. 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 and simple solutions 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.

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.

Need more information?  Or want to share your experiences or ask questions of our community?  Visit us online at HandHealthResources.com or via our Facebook or Twitter accounts.

Let’s put some caring back into healthcare!  Marji



mHealth – Using Mobile Devices to Improve Healthcare

What an amazing time we are living in! With an internet search and the click of a button, we have more access than ever before to even the most obscure information. With the current rapid changes in technology, we are seeing a trend towards people seeking answers to their healthcare questions online as well as through mobile devices. These emerging tools are allowing us to take charge of our healthcare in ways never before possible.

In fact, I just came across a new term that I think we will be hearing much of in the near future: mHealth. mHealth was defined by a National Institutes of Health Consensus group as the use of mobile and wireless devices to improve health outcomes, healthcare services and health research.

My goal, as an Occupational Therapist and a Certified Hand Therapist, is to provide you with reliable and helpful tips that will ease your recovery from a hand or upper extremity injury. Social Media is making this much easier than ever before. Here is how I will attempt to organize my information using mHealth:

  • Through this weekly blog (handtherapy.wordpress.com)
  • Through daily Tweets @handhajic. As a loose guideline, the tweets will be organized as follows ( but I’m sure we will throw in some random, off topic tweets as well!):
    • Medical Monday – information relating to specific hand injuries
    • Open Topic Tuesday -answers to questions generated by our followers
    • Workday Wednesday – ergonomic suggestions to help make your work activities more comfortable and less stressful
    • Therapy Thursday – tips, tricks, and advice from the clinic
    • Fun Fact Friday – interesting facts about our hands and arms; or just fun facts in general!
    • Weekend Warriors – tips to help you protect your hands from sports, gardening, home projects and leisure activities
  • Through our Facebook page – another way for you to keep in touch with the clinic. I will post my own commentary; provide injury and recovery information; give you behind-the-scenes glimpses into an active, outpatient occupational therapy clinic specializing in upper extremity rehab;; and throw in some general information about the profession of occupational therapy. Look for our logo and “Like” us at the Hand Therapy & Occupational Fitness Center.
  • HandHealthResources.com – our website is currently in the process of being updated for content and ease of use. However, it is still full of information on upper extremity injuries, recovery/therapy, ergonomics and prevention tips. Feel free to browse.

What will make this endeavor successful are the questions and feedback that will come from our followers. Please don’t be shy. My clinical experience leads me to believe that the healing process is fostered with a sense of community as people relate their experiences, frustrations and triumphs with each other as they travel on the road to recovery. So, share your journey. Ask your questions. Seek and/or provide support.

And, as always, let’s put some caring back into healthcare! Marji


I did not expect my second blog to head off in this direction.  Recent news events have deterred me from my clinical course.  But stick with me as I provide a behind the scenes glimpse into the community of our clinic.  This is a story of marathon runners, of injury and of inspiration.

As an Occupational Therapist and a Certified Hand Therapist, it is often my job to motivate and to educate.  It is my goal to give those with an injury, illness or disability the support and knowledge they need to achieve their best recovery possible.  The relationships that we develop with our clients may seem pretty cut and dried.  We are the professionals offering a service; our clients receive the service; and insurance pays for the service (if we are lucky).

The amazing thing about my job, though, is that I don’t believe this therapeutic relationship to be a one-way street.  Although the time we spend with our clients may be brief, we come into their lives in a time of pain, uncertainty and need.    We may not become BFFs, go out to happy hour, or spend the day shopping (although these things have happened!), but for a short while, we share life events, concerns and dreams with those who we are treating.  We can get to know each other well in our brief time together, and we, as therapists, are more inspired by and amazed with the people we are helping than they may ever know.

With the Boston Marathon bombings in the news yesterday, the clients and staff in the clinic huddled around a laptop computer in our gym to stay caught up with the latest information.  The sense of shock, disbelief, anger, sadness and a myriad of other emotions was mitigated by the sense of togetherness and support as we shared this tragic moment in time.  All of the staff in the clinic have at one time or another participated in a sponsored walk or run.  We cringed when we imagined how the runners felt when the moment of joy and elation of crossing the finish line turned to such tragedy and mayhem.

And then I started to think back to how I, a non-athlete, became inspired to become a (slow) runner by three people who came in to my life about 3 years ago. These are the stories of two of the three, clients with whom I worked.

One was a beautiful young lady who, while qualifying to run the Boston Marathon, tripped after crossing the finish line and severely broke two fingers.  Two surgeries and multiple sessions of therapy later, she has a fully functional hand.  During our sessions together, we shared life dreams.  In addition to qualifying for Boston, this intelligent, young lady wanted to find a nice guy, get married, and have children – but she was quite discouraged with her prospects.  She has since visited the clinic several times to say thank you, not only for the therapy, but for encouraging her to hold on to the hope that the right guy was out there for her.  Her last visit to the clinic was several months ago – when she brought in her bouncing baby boy for a visit!

Another client was a woman who ran “crazy races”, an ultra-marathoner who pushed herself to her limits physically.  She had a severely fractured wrist from a fall and also required multiple surgeries and extensive therapy for her return to work as a massage therapist.

Both these women are physically fit and fast runners.  And yet, there is no ego.  Three years ago they encouraged me, a non-runner, to pick up my tennis shoes and go for a jog.  They cheered me on as I slowly walked and jogged my way through my first miles.  As we experienced yesterday with the publicity of the aftermath of the Boston tragedy, runners have a strong sense of community.  It doesn’t matter if you are a Boston Qualifier, or, if like me, you cross the finish line at the back of the pack.  Runners are a generous, supportive and caring group of people.  I was proud yesterday to be a part of that community.  I wore a running shirt today in support of Boston.  And I thank my lucky stars that these two women came into my life, shared their hopes and their dreams with me, and inspired me to reach for more.  I don’t think I’ve told them just how influential they have been in my life, and I’m not sure they would believe me if I did.  So I have detoured off course to share how powerful the therapeutic relationship can be, not just to the one receiving therapy, but to the person providing therapy as well.  So I want to take this moment to officially send thanks out to my many patients over the years who have enriched my life.

With gratitude, Marji


We’re Back! And Social Media Can Make us Stronger!

After a several year hiatus as a new business owner establishing a thriving clinical practice, I am now ready to make my online presence known once again!  

In the clinic, we have an open gym forum that allows those recuperating from their hand and upper extremity injuries the opportunity to share their experiences with others who are on the same life journey.  This community experience has many positive effects.  Last week, we took an informal survey of our clients.  The request for using technology as a means of assisting in both the physical and emotional aspects of injury recovery was overwhelmingly positive.  

As I am personally not technologically savvy, I have found a team of family and friends willing to take this journey with me.  So, a big welcome to Steve, Annette, Kevin and Jon who will be my Social Media Support Team.  

  • We will begin by using Facebook, Twitter, and Blogs to provide tips, tidbits and information to help make injury recovery smoother and less overwhelming.  
  • Our website, HandHealthResources is cosmetically outdated but still filled with lots of great information.  We have just started the process of updating and reorganizing.  More information on that coming soon!  
  • And, with all of the opportunities that portable technology offers, we are hoping to have some interesting and helpful SmartPhone and Tablet applications farther down the line.

I believe that the community aspect to injury recovery and wellness promotion is going to become a critical component of care as our healthcare delivery system changes.  We are already noticing a trend towards higher deductibles, fewer appointments authorized or covered, and more difficulties in obtaining reimbursement for care provided.  Social Media may allow us new ways to offer the support of a caring community that is currently in danger of disappearing.  So, let us know what you think!  Share your own stories, triumphs and advice for recovery.  Let’s put the caring back in to healthcare!