Question
QUESTION: I AM 17 YEARS OLD. MALE. MY RIGHT ELBOW CLICKS AT AROUND 90 DEGREES. IT BEEN SAID THAT MY ULNAR NERVE SUBLUXATES FOR WHATEVER REASON. SOME SUSPECT ITS DUE TO MCL LAXITY OR BROKEN BANDS OR SHALLOW CUBITAL TUNNEL. WHAT CAN WE DO?

ANSWER: Dear RJ,

I am a bit confused here...are you actually in pain?  Do you have any distal symptoms such as numbness, tingling, or loss of muscle control in the ring or pinky fingers?  Do you have a loss of sensation on the front or back of the hand?  The reason I ask is that if not there is likely not any problem with the ulnar nerve.

I am not sure who told you that the nerve could be subluxating, but this is not accurate.  The Ulnar nerve may be moving in and out of the cubital fossa due to a shallow tunnel, but this is not a subluxation.  The clicking you are hearing is probably the result of the joint space, the joint capsule, a tendon, or ulnar collateral ligament at the elbow.  A nerve is not going to make a clicking noise, the tissue is not fibrous or tight enough, and nerves are meant to have a freedom of movement in the tissue.  Even if the nerve were responsible for the clicking, it would be irritated and sending pain signals.

The first thing you need to figure out is what is the actual cause of the problem. You need to ask, what piece of anatomy is causing the clicking and why?  The best way to determine if you have a shallow cubital tunnel or torn ligament is with an MRI of the elbow.  If you truly want to see why the clicking occurs, it can be imaged with a DMX (dynamic motion x-ray) or a fluoroscope as these two imaging techniques allow movement while the image is being generated and the doctors can visualize th3e anatomy while the click is occurring.

Now, if the elbow clicks, but there is no dysfunction or pain, most physicians are going to be reluctant to order any additional diagnostic imaging for this problem unless you really press them to determine the cause.  You see if it is not creating a problem other than noise, you抮e likely to be told not to worry about it.

If there is a true dysfunction, and you are having nerve symptoms down the arm and into the hand, there are various braces you can utilize at night and during the day to keep the arm straight so that the nerve does not become irritated, and over time the inflammation and irritation to the ulnar nerve will be reduced.  There are also surgical resolutions such as the medial epicondylectomy (removal of the bump on the inside of the elbow) or an ulnar nerve transposition, where they move the nerve out of the cubital tunnel.  Both conservative and surgical measures are equally effective with a success rate of about 80% overall in solving the problem.

Hope this helped RJ.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net




---------- FOLLOW-UP ----------

QUESTION: I LIVE IN THE MALDIVES. THE MRI MACHINES BROKEN AND WE GOT 3 ORTHO DOCS IN THE NATION. I DONT HAVE ANY OF THE SYMPTONS U HAVE DESCRIBED. SOMETHING DOES MOVE. I CAN FEEL IT. I CAN EVEN PUSH IT BACK AFTER IT CLICKS OR POPS OR SNAPS WITH THE SIDE OF THE MEDIAL EPICONDLE. SIMPLY PUT THIS DOESNT HAPPEN IN THE OTHER HAND. WHAT COULD IT BE?

Answer
Dear RJ,

If you can actually move the band of tissue back and forth with your fingers, and you are having none of the symptoms I have described, then a tendon is the source of the clicking.  The ligaments are located deeper in the tissue than the tendons, and tendons are able to be felt at the surface through the skin.

If this is really bothersome to you, you can wear a brace to help alleviate the probelm when active.  A tennis elbow/golfer's elbow brace will help to place pressure on the tendon so that it is less likley to rub against the bone and snap or pop over the medical condyle, and you can find these at most drug stores.  If not, you can easily order one on the internet, see the link below.

http://www.painreliever.com/Tennis+Elbow+Straps.html

The braces are small and placed directly below the elbow.  They are very comfortable to wear on a daily basis and are not expensive.  You can get a decent brace for about 20 dollars, some are less, some are more.  Good Luck RJ.

By the way, wish I was there with you... I had to look up the islands on the internet, and you truely live in paradise...the Maldives are now on my travel list...absolutely beautiful.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net