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Cubital Tunnel From Gaming

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Cubital Tunnel From Gaming

Cubital Tunnel Syndrome

Cubital Tunnel From Gaming
  • Cubital tunnel is one of the of the most common conditions of the upper extremity, but also one that gets overshadowed by carpal tunnel syndrome
  • Cubital Tunnel Syndrome is compression of the ulnar nerve which innervates (supplies) specific muscles in the hand and fingers
  • Nerves are responsible for providing muscles with necessary strength, coordination, sensation, and ultimately function which is hugely important in gaming

Cubital Tunnel Syndrome is a condition that affects the ulnar nerve at your elbow. The ulnar nerve runs through the “cubital tunnel” (a narrow passageway on the inside of the elbow) which can become irritated and compressed through prolonged or excessive elbow flexion (bending). The ulnar nerve controls sensation and movement in the small finger and ulnar (picky) side of the ring finger of your hand. The ulnar nerve is most recognized in the everyday person for those who hit their “funny bone.” Interestingly, this is not a bone at all that is being hit but the ulnar nerve which is susceptible to trauma as the elbow bends and loses its protection. 

 

“An analogy that can be used to think of nerves is like a water hose. When a water hose has a kink in the line there may be a little water sputtering out which can be like the tingling often first experienced with some prolonged bending at the elbow. With a large bend in the line this results in no water coming out, similar to when an individual sleeps with their elbow extremely bent and wakes up with a numb hand. Similarly, this can also occur with pressure being placed on the nerve or hose. If someone comes along and steps on the hose then water may stop or sputter out just as if external pressure from resting the elbow directly on the hard table/armrest. If there is no water coming from the hose to feed the plants then the plants will begin to die after months, similar to how our muscles can start to atrophy (die/weaken) if they are not getting proper innervation (supply) from the nerve.”

 

Repetitive elbow bending and straightening can lead to irritation and inflammation at the cubital tunnel. This can compress the ulnar nerve, resulting in symptoms like numbness, tingling, and pain in the small finger and ulnar (picky) side of the ring finger of your hand. 

Posture and ergonomics are hugely important for the prevention of cubital tunnel syndrome. When an individual rests on the elbow for prolonged periods of time they are essentially compressing the nerve. This also commonly occurs when individuals sleep in a position of extreme elbow flexion (bending) where they will then wake up with the hand feeling numb. 

Anatomical variations may also be present in some who will experience a subluxing ulnar nerve which may feel like a “popping” or “snapping” feeling at the inner elbow (medial epicondyle). This snapping sensation over time will continuously irritate the nerve further where individuals may need to learn what movements or activities to avoid. Individuals who experience extreme discomfort and decreased quality of life will likely require surgical intervention as this is a more structural/anatomical issue and is less likely to be resolved with therapy.

Now this is no surprise how it is common in gamers or office workers because of the positioning they find themselves in for hours on end. Though common, tendinopathies appear to be much more common and pain that is reported at the hand/wrist. This means one should first identify and differentiate between a tendinous injury or nerve injury. 

Additionally, certain factors such as genetics, obesity, age, and underlying health conditions can increase the risk of developing this condition. The name “Cubital Tunnel Syndrome” is derived from the anatomical structure involved, where the ulnar nerve passes through the cubital tunnel in the elbow.

Gamers are likely to begin experiencing tingling or numbness in the *ulnar nerve distribution. Gamers may report feeling “slow” or weakness gripping the mouse. Finger dexterity is likely to be reduced which is likely to decrease performance and alter the gameplay of the individual. Specifically, this condition will slow the functioning of the small and ring finger which may be used in PC gamers to hit the shift or control key. Individuals may also experience a burning sensation, but when pain is reported without numbness/tingling suspicion should then be placed on a tendon injury. Again, tendon injuries or tendinopathies are much more common in gaming and it is important to understand this as treatment differs. 

Cubital tunnel syndrome is the second most common nerve compression in the arm and is likely more well known as your “funny bone” as the ulnar nerve is what is being hit and sending that sharp pain or zing throughout your arm. This can be caused due to prolonged elbow flexion such as talking on the phone, sleeping with your elbows bent, etc. It can also be caused by repetitive bending and straightening of the elbow, a traumatic injury, or even by putting pressure or resting the elbow on a desk, table, armrest, etc. In more severe or untreated cases some may develop an “ulnar claw hand deformity” which is due in part from weakened muscles (third and fourth lumbricals) being overpowered by other muscles of the fingers.

Data suggest tendinopathies as being a far more prevalent condition than Cubital tunnel syndrome (Hwu, 2021). When it occurs, Cubital tunnel syndrome is brought on by a variety of factors, including sleep positioning, lack of rest breaks, overweight/obesity (Descatha et al, 2004), repetitive elbow flexion/extension, as well as anthropometric measures. Gamers in particular should be aware of resting for prolonged periods of time on the elbow, setting rest breaks every 30 minutes, and monitoring their sleeping position to avoid being in a position of extreme elbow bending.


The following information is provided for general educational purposes only and should not be considered medical advice. It is not intended to replace consultation with a qualified healthcare professional. If you have specific concerns or questions about your health or medical condition, please seek the guidance of a licensed physician or another qualified medical practitioner. Any reliance you place on the information provided is solely at your own risk. In no event will the author or 1HP be liable for any loss or damage arising from using this information. Always consult with a healthcare professional before starting or changing any medical treatment or regimen.

 

Perform this quick test* shown here to screen for this diagnosis. If there is numbness/tingling (paresthesia) experienced in the area highlighted then this may indicate a you have this condition.

 Instructions: Position the elbows in maximal flexion and hold for 60 seconds

Gamers use their hands and fingers a lot! Gamers are at risk for injury because of the long durations we play, but this does not always indicate carpal tunnel syndrome. Instead, pain is more often reported which tends to be a result of tendinopathies, NOT carpal tunnel syndrome which will present as numbness/tingling. In regards to cubital tunnel syndrome, numbness/tingling will be present, but will differ from the location felt from carpal tunnel syndrome. Carpal tunnel syndrome is irritation and compression of the median nerve represented in the BLUE, while cubital tunnel is irritation and compression of the ulnar nerve represented in the GREEN. 



Gamers oftentimes take minimal rest breaks because they are so engaged and locked in and don’t always think to put their body first. Pain and discomfort is something that can be reduced from distractions and gaming is a good distractor which makes it hard for gamers to know when to stop due to pain/discomfort. Gamers are at risk however because of the positions they find themselves in when playing and the excessive use required of the hands/fingers. 

 

  • Gamers who sit with poor posture are more susceptible to this diagnosis as they may find themselves resting and leaning on their elbows more resulting in compression at the elbow. 
  • Gamers who sit for prolonged periods of time without moving and the elbow in a bent position. This is often in part due to improper ergonomics/positioning and failing to plan out rest breaks.
  • Gamers who sleep with their elbow bent are more likely to experience daytime symptoms of numbness/tingling.
Check out the video linked here for a video showing what treatment may look like for this condition

Returning from this injury takes a concerted effort, but can be done without much time away from the game. Below are a few steps that individuals need to understand and take when discomfort in this area occurs. 

 

  1. Identify the issue (One of the most important factors is early detection…do NOT push into or through the numbness/tingling discomfort)
  2. Night Splinting
    • Splinting: This may be one way for individuals to rest the irritated nerve. An elbow extension brace may be worn on the inner part of the elbow to prevent excessive elbow bending as a frequent complaint is waking up in the middle of the night or early in the morning with numbness/tingling. It is important for a gamer to know that this should be used as minimally as possible.
  3. Elbow Padding
    • Wearing or adding an elbow pad under where the elbows rest may be necessary for some depending on ergonomics and positioning. Some may rest on their elbow while gaming which then results in added pressure to the ulnar nerve
  4. Massage
    • Prioritize massaging the forearm as muscles can be tense and tight from overuse and result in increased pressure on the nerve
  5. Utilize heat/ice (Hot/cold packs, warm water soak)
    • Heat can be helpful before or during activity. Ice can be helpful during an acute flare of symptoms.
  6. Movement Breaks
    • Incorporate movement into gaming sessions to increase blood flow to the surrounding nerves, muscles, and tendons
  7. Nerve Glides
    •  To restore mobility between the nerve and the surrounding tissue. 
  8. Stretching
    • Helpful in decreasing tightness throughout the muscles of the arm resulting in less pressure of the nerve

 

Diagnosis specific tip: Pay attention to which fingers and when numbness and tingling occurs as this should give some indication to which activities may be provoking it as it is not always just gaming alone.

 

*Surgery is rarely required in order to effectively treat, but can be effective if indicated

 

**For a comprehensive guide on the exercises discussed, check out the videos on our Fix Wrist Pain link here

The diagnosis was explained in short above, but for those wanting to know and learn more this is for you. 

 

Specifically, this diagnosis is looking at one nerve, the ulnar nerve and the surrounding tendons and muscles. The ulnar nerve is a mixed (sensory and motor) nerve which runs down from the brachial plexus. As it travels down the arm it continues through the cubital tunnel which is where the nerve compression occurs. The nerve continues on down the arm through muscles and tissue where it then reaches the hand and fingers. 

Nerve Responsible: 

  • Ulnar Nerve: Supplies the small finger and pinky (ulnar) side of the ring finger and hand both on the front and back (volar and dorsal) side.

 

Muscles/Tendons responsible

  • Flexor Carpi Ulnaris (FCU): This muscle is located on the inner side (ulnar side) of the forearm and is responsible for flexing the wrist and bending the wrist to the pinky side. This is the muscle largely associated with compressing the nerve as it passes between the two muscle heads.
  • Several additional muscles are innervated by the ulnar nerve in the hand and forearm, but are not found to be responsible for the nerve compression

 

Other involved structures:

  • Osborne’s Ligament: This is a band of connective tissue that forms the roof of the cubital tunnel. This provides a protective covering for the ulnar nerve as it passes through the tunnel.
  • Arcade of Struthers: This is a fibrous band just above the inner elbow (medial epicondyle) extending from the triceps muscle which can be another spot for compression of the ulnar nerve as it passes through.
    • A more rare anatomical structure not found in everyone. 

 

It should also be known that gaming is not the only activity to bring on this condition and certainly other lifestyle factors play a role. School, work, hobbies, and sleep positioning can also further irritate this nerve and can be important to thoroughly evaluate as well.

  • Guyon’s Canal Syndrome:

Guyon’s Canal Syndrome is a condition where the ulnar nerve is compressed near the palm side (volar) wrist in the hypothenar eminence. This space is called Guyon’s Canal where compression may present with motor or sensory involvement or a combination of both depending on where the compression takes place on the nerve.

 

  • Medial Epicondylosis: 

Medial epicondylosis (Golfer’s elbow, Fighter Game Forearm) is a medical condition characterized by pain and inflammation in the tendons on the inner (flexor/volar) side of the elbow at the medial epicondyle. It is similar to lateral epicondylosis (Tennis elbow), which affects the outer (Extensors/dosal) side of the elbow. 

 

  • Thoracic Outlet Syndrome: 

Thoracic Outlet Syndrome (TOS) is another condition which should be assessed as the nerves discussed above all stem from something called the brachial plexus. The brachial plexus is a network of nerves that come off of the spinal cord and travel between the clavicle and the first rib down into the arm. The presentation can lead to confusion when interpreting pain or sensory disturbances throughout the arm, wrist, hand, fingers while it may be a result of entrapment further up the chain near the neck as opposed to the ulnar nerve.

There are several approaches to take in order to prevent injury from occurring. There are 3 main factors to first focus on and address, but it is also important to keep in mind other secondary factors which can be helpful to address.

 

  1. Exercising
    • Strengthening 
      • Important for building up a foundational base to allow the tendon/muscle to keep up with the workload they are being asked of in a preventative approach for tendinopathies
    • Movement Breaks
      • Incorporate movement into gaming sessions to increase blood flow to the surrounding nerves, muscles, and tendons
    • Nerve Glides
      •  Restore and maintain mobility between the nerve and the surrounding tissue. 
  2. Intermittent stretching (During and after gaming sessions)
  3. Proper warm-up (Promotes blood flow to the muscles/tendons and lubricates stiff joints)



Additional 

  • Ergonomics/positioning 
    • Poor positioning could put the nerve in a compromised position causing excessive compression therefore making it more susceptible to injury. Oftentimes gamers may find themselves leaning on their elbow for prolonged periods of time.
  • Sleep
    • Regarding cubital tunnel syndrome, sleep is very important as the positioning one may find themselves in could be provoking symptoms
    • Sleeping with the elbow excessively bent for long periods of time may result in compression of the ulnar nerve. If this is the case an elbow extension splint may be indicated at night.
  • Rest breaks 
    • Pain/discomfort levels can be reduced through distractions. Gaming is a big distractor, meaning that individuals should take breaks every 45-60 minutes to assess how you are feeling.
    • Creating a schedule that works for you and your game is also recommended. For example, consider taking a 10 minute break after 2 ranked games (~60 minutes) or a short 5 minute break to stretch following 1 ranked game (~30 min). Certain games will vary in duration, but planning ahead and forming a routine will be beneficial in the long run. A general rule of thumb is, the longer you play, the longer the break should be to allow for some recovery.
  • Massage 
    • A great way do decrease muscle tightness and increase blood flow to the muscles, tendons, and nerves
  • Heat 
    • Prior to gaming sessions or stretches to increase blood flow
  • Mental health/nutrition
    • These underlie all of what is experienced in a day and cannot be ignored in injury prevention

Andrews K, Rowland A, Pranjal A, Ebraheim N. Cubital tunnel syndrome: Anatomy, clinical presentation, and management. J Orthop. 2018 Aug 16;15(3):832-836. doi: 10.1016/j.jor.2018.08.010. Erratum in: J Orthop. 2020 Dec 14;23:275. PMID: 30140129; PMCID: PMC6104141.

 

Cutts S. Cubital tunnel syndrome. Postgrad Med J. 2007 Jan;83(975):28-31. doi: 10.1136/pgmj.2006.047456. PMID: 17267675; PMCID: PMC2599973.

 

Descatha A, Leclerc A, Chastang JF, Roquelaure Y; Study Group on Repetitive Work. Incidence of ulnar nerve entrapment at the elbow in repetitive work. Scand J Work Environ Health. 2004 Jun;30(3):234-40. doi: 10.5271/sjweh.784. PMID: 15250652; PMCID: PMC2988822.

 

Kooner S, Cinats D, Kwong C, Matthewson G, Dhaliwal G. Conservative treatment of cubital tunnel syndrome: A systematic review. Orthop Rev (Pavia). 2019 Jun 12;11(2):7955. doi: 10.4081/or.2019.7955. PMID: 31281598; PMCID: PMC6589621.

 

Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. J Hand Surg Am. 2013 Jun;38(6):1125-1130.e1. doi: 10.1016/j.jhsa.2013.02.039. Epub 2013 May 3. PMID: 23647638; PMCID: PMC3989882.

 

Wolny T, Fernández-de-Las Peñas C, Buczek T, Domin M, Granek A, Linek P. The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review. J Clin Med. 2022 Jul 21;11(14):4247. doi: 10.3390/jcm11144247. PMID: 35888010; PMCID: PMC9318553.

Additional 1HP Articles on Cubital Tunnel Syndrome

Written By: Brett Becker, OTR/L, MS, ACE-CPT