ESPORTS INJURIES: HITTING A FUNNY BONE!!! The Cubital Tunnel Syndrome

As the adrenaline rush intensifies along with a burst of excitement, video gamers often hit their elbows against their game chairs at such a high impact, but this doesn’t seem to bother them as long as they’re beating their opponents hard. They just couldn’t get off of their hold on the game. But the harder they could get their opponent down, the harder they hit their elbows against their chairs. And after long hours of continuously playing the game, one would notice how many times they would shake their hands and rub their fingers with each other, while almost losing their grip on the controller. They’re beginning to feel a numb hand, or starting to unfeel a hand, most especially on the inside of the hand. They hit a nerve and developed Cubital Tunnel Syndrome.

The ulnar nerve is the second most commonly injured nerve in the upper limb after Carpal Tunnel Syndrome(insert link), which involves the median nerve. Although injury to the ulnar nerve may occur at different parts along its course in the arm, it is commonly entrapped at the elbow, within the cubital tunnel.

Relevant Anatomy of the Elbow:The Cubital Tunnel

At your elbow, the ulnar nerve runs through the structures that make up the cubital tunnel, namely the medial epicondyle, the bony bump on the inner side of the elbow, and olecranon process, the bony projection at the back of the elbow, on either side of the tunnel, Osborne's ligament as the roof, and the medial collateral ligament (MCL) and elbow joint capsule as the tunnel floor. After crossing the cubital tunnel, the ulnar nerve enters the forearm between the two heads of flexor carpi ulnaris muscle. This is where the most common site of ulnar nerve compression occurs, although reports showed that the ulnar nerve can be maximally compressed between Osborne's ligaments and the MCL in this tunnel at 135 degrees of elbow flexion. The muscles that are supplied by the ulnar nerve and their corresponding functions are as follows:

• Flexor Carpi Ulnaris – flexion and ulnar deviation of the wrist
• Flexor Digitorum Profundus (medial half) – flexion of the distal joint (distal interphalangeal joint) of the ring and little fingers
• Hypothenar muscles – a group of muscles that form the base of the little finger at the palm. Functions include flexion, abduction, lateral rotation, and opposition of the little finger:
  • Abductor Digiti Minimi
  • Flexor Digiti Minimi Brevis
  • Opponens Digiti Minimi
  • Palmaris Brevis
• Adductor Pollicis – thumb adduction at the carpometacarpal joint
• Palmar and Dorsal Interossei – palmar interossei abduct the fingers (open up away from the midline), dorsal interossei adduct the fingers (fingers toward the midline)
• Lumbricals(medial two) – flexion of the metacarpophalangeal joints and extension of the interphalangeal joints

Sensory Functions:The ulnar nerve supplies sensation to the inner half of the palm and the back of the hand, including the whole of the little finger and inner half of the ring finger.

How Would a Gamer Get Cubital Tunnel Syndrome?

At the inside of your elbow, the ulnar nerve passes in between the two bony humps beneath the Osborne’s ligament. When the ulnar nerve is hit here by a direct impact on the elbow, one would feel pain, numbness, and electric-shock sensation that radiates down to the forearm on the inside to the little finger and inner side of the ring finger. This is the area where the widely known “hitting the funny bone” is located.

When Gamers lean their elbows on their game chairs or desks for long periods, the ulnar nerve may be compressed as it passes through the cubital tunnel, such as the term cubital tunnel syndrome or ulnar neuritis. Also, when a gamer repeatedly bends his elbow or held his elbow in a bent position for an extended time, the nerve can be entrapped or compressed between the two heads of the flexor carpi ulnaris muscle.

In some people, the nerve may slide out from behind the medial epicondyle when the elbow is bent, which may irritate the nerve.

Signs and Symptoms of Cubital Tunnel Syndrome

Unlike carpal tunnel syndrome, which is a well-known nerve compression condition, cubital tunnel syndrome is less common, although it occurs at a moderate frequency. Symptoms of cubital tunnel syndrome include:

• Point tenderness and pain at the inside of the elbow due to inflammation.
• Pain, pins-and-needles sensation, and numbness on the inside of the palm, including the little finger and half of the ring finger, especially when the elbow is bent. (numbness and tingling at night)
• Muscle weakness about the hand because of paralysis of the muscles supplied by the ulnar nerve:
  • Inability to spread out the fingers due to paralysis of the interossei muscles.
  • Impaired movement of the 4th and 5th digits due to paralysis of the medial two lumbricals and hypothenar muscles.
  • Inability to pinch, grip, and hold objects between the thumb and fingers due to impaired adductor pollicis muscle.
  • A weakness of wrist flexion due to paralysis of flexor carpi ulnaris and medial half of flexor digitorum profundus.
• Handgrip weakness and clumsiness.
• Thinning or muscle wasting (atrophy) of the muscles on the inside of the palm — “hypothenar eminence.”

Cubital Tunnel Syndrome Preventive Measures for Gamers

Both PC and console gamers can do things to help prevent, relieve, or minimize symptoms of cubital tunnel syndrome:

• Perform warm-up exercises for your elbows, wrists, and hands before training or game.
• Avoid keeping your elbows bent for long periods. Take breaks and alternately bend and straighten your elbows to relax your elbow muscles.
• Do not rest (the inside of) your elbows on to the armrests, desk, or on your thighs for a very long time. If you can’t avoid doing so, use an elbow pad or rest on the bony bump at the back of your elbow to minimize pressure on the nerve (although for some, this can be painful).
• Make sure that your game chair is not too low because your elbows will be too far bent. Adjust your seat accordingly.
• Perform proper stretching exercises to mobilize your ulnar nerve and associated muscles.

Ulnar Gliding Exercise:These exercises mobilize the ulnar nerve and encourage movement through the cubital tunnel.

1. Sit or stand upright and make an OK sign between your thumb and index finger using your affected arm.
2. While keeping your head in a neutral position and maintaining the OK sign, bring your arm out to the side at a shoulder level with elbow straight, palm facing up, and wrist extended.
3. Bend your elbow, bringing your hand up towards your eyes and rotate the palm outward and bend your wrist so that the fingers are pointing towards you.
4. Further rotate your wrist, placing the OK sign against your eye, palm side facing you, and pinky towards the ceiling. Hold for 3 seconds.
5. Gently tilt your head to the opposite shoulder while simultaneously bringing back your elbow to the side.
6. Return your head to midline while bringing your elbow back up towards your head. Continue to alternate between these two positions.

Hit It WithRecovapro!

The focus of treatment for cubital tunnel syndrome is relieving the pressure on the ulnar nerve through mobilization. Working up the flexor carpi ulnaris muscle and other wrist flexors can also decrease tension in this area.

• Muscle tension can contribute to compression or restriction. With the round head attachment, apply sweeping cross‑fiber stroking to the wrist flexors, working the entire length of the forearm from the wrist to the elbow. Use a lower intensity.
• Tissue elasticity is enhanced and muscle tension is reduced in the flexor carpi ulnaris with deep stripping techniques. You may continue with the ball head, but the bullet tip is more appropriate for stripping.
• Stretching for the wrist flexor muscles should be incorporated along with soft-tissue treatment.

Precaution:Observe caution with the use of a massage gun when performing the treatment in this region where pressure is applied near the cubital tunnel. You might put additional pressure on the nerve, which may exacerbate the condition.