Host: There is a condition that usually is called cubital tunnel, what does that mean? There is nothing about playing pool is it that?
Guest: No, cubital comes from cubitus. Cubitus is the elbow and in the elbow just as you have a carpal tunnel, there is a cubital tunnel behind the funny bone; and the funny bone when you touch it hard sometimes you touch the nerve and people get shock feeling in the fourth and the fifth fingers.
Host: How common is this?
Guest: For every 100 carpal tunnels that exist may be this is one cubital tunnel.
Host: So it is pretty rare?
Guest: Yeah.
Host: Is there any particular type of profession we are able to see it and then some other types of professions?
Guest: I see more in drivers who lean on their elbows. I see in people who sit on chairs and lean on their elbow. Any profession where people lean on their elbows, they will get cubical tunnel --
Host: If a truck driver who is driving a lot of hours, are they more prone to get it than somebody who does travels in a truck?
Guest: Truck drivers who drive with their elbow on the padding or on the central padding between the two seats he will put his elbow there that is when they get it because, of course, they are driving for long periods of time, yes.
Host: So in other words, the approach there would be immobilization initially?
Guest: The nerve is at the maximum stretch in the flexion of the elbow because it has to travel around. When you extend the elbow the stretch is less. So the way to immobilize the elbow is to immobilize it in a straight position. For example, when you sleep at night, you always sleep with the elbow bent. So if you immobilize the elbow in a straight splint, they will not bend it at night and it to relieve the pressure on the cubital tunnel.
Host: Do anti-inflammatory help this in any degree?
Guest: Anti-inflammatory medications are of no value in any peripheral neuropathy.
Host: And after resting it, keeping it in the position you have mentioned, sometimes you have to do surgery?
Guest: Yes, if the splint doesn't help and the patients continue to have numbness and tingling in the fourth and the fifth fingers and they are losing the sensation in the hand or losing the strength, the grip.
Host: What nerve is involved when you are talking about this numbness?
Guest: It is the ulnar nerve.
Host: Ulnar nerve, so it is an ulnar nerve that is being affected by it.
Guest: So, we call it ulnar nerve neuropathy.
Host: Okay and if it does not relieve the pressure against the nerve symptoms, you are going to lose the sensation permanently?
Guest: You lose two things. You lose the sensation and then you lose the muscles that are supplied by this nerve. These are the muscles within the hand and so people lose the grip strength.
Host: So probably this ends up the surgery a lot quicker than some other conditions, is that true?
Guest: Yes, because they complain weakness of the hand, they can't do the hammering.
Host: In general rule, if you have to do surgery what is usually the success rate and what do you say?
Guest: The success rate in the cubital tunnel is not as good as carpal tunnel, but if you don't do it you have got nothing and if you do it, maybe you get -- 80% the people will get better.
Host: Are the other condition or how can the diabetic or some of the conditions more prone to it?
Guest: The diabetics are not more prone to it but this is what happens. In diabetics because the insulin is not working properly and there is excessive blood sugar, the blood sugar sensitizes the nerves, so the nerve is not functioning properly in the first place, for example people get diabetic neuropathy. Therefore, these nerves, for example, if you take a normal person, you require 100 grams of pressure to cause a nerve problem. In diabetes, you need just 50 grams of pressure to get the symptoms. So they get the symptoms earlier, but diabetics are not any more prone to cubital tunnel than normal people, but their symptoms would be earlier.
Host: Thank you very much.
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