Conservative treatment suggested for cubital tunnel syndrome

Dear Dr. Roach: My left elbow has been bothering me for eight years. When I bump it, there is a terrible pain, like an electric shock. The pain only lasts for about 10 seconds; however, it happens all the time. Even if I am wearing a heavy winter coat, the slightest bump disables me for 10 seconds or so.

A couple of years ago, I noticed a bump at the end of my elbow, while the other elbow seems to have none. Is it possibly a bone spur? Is surgery an option for me? — V.C.M.

Dear V.C.M.: The bottom part of the humerus, the bone of your upper arm, has two rounded ends called condyles, which form the top part of the elbow joint. Running in between those condyles is one of the major nerves to the hand, the ulnar nerve. Hitting that exact spot will cause the kind of sensation you are describing (sometimes people call it the “funny bone”).

If you pay careful attention, you can feel the electric shock and numbness sensation go all the way down into the hand, specifically the little finger and the outside half of the ring finger. Your doctor can confirm this by tapping gently on the spot, causing a milder shock/pain sensation.

The nerve can be compressed in a structure near there called the cubital tunnel, where a sheet of connective tissue covers the nerve just over the condyle of the humerus. Cubital tunnel syndrome is much less common than carpal tunnel syndrome, but both of these syndromes involve the compression of a nerve, causing symptoms of a damaged nerve (neuropathy).

The surgery for cubital tunnel syndrome is substantially more complicated and has a lower success rate than surgery for carpal tunnel, so I do not recommend this surgery lightly. Your symptoms have been going on for a long time, but unless there is evidence of nerve damage by exam (sometimes including electrical testing of the muscles and nerves), then I recommend conservative treatment (avoiding excess stress to the elbow, padding to avoid trauma and keeping the elbow wrapped at night).

Your regular doctor is the right person to start with, but a hand surgeon is the expert for management.

Dear Dr. Roach: Iama 72-year-old woman who has tricuspid regurgitation that is mild to moderate. What does mild to moderate mean? Does it mean that it is in between mild and moderate? Is it possible for this to stay the same, or is it going to get more severe? — H.C.B.

Dear H.C.B.: The four valves of the heart normally last more than a lifetime. Sometimes a person gets an echocardiogram to look for the cause of a heart murmur, or for some other reason, and they are found to have mild valve abnormalities, such as a leaking valve. (“Regurgitation” and “insufficiency” mean leaking, whereas “stenosis” means the valve is too tight.)

In most cases, these never become problems. A person with mild regurgitation of the tricuspid valve and an otherwise normal heart does not need any intervention or further testing unless they develop symptoms.

A person with moderate regurgitation should probably have a follow-up echocardiogram in one to two years, to make sure the valve is not getting worse. When the echocardiogram report reads “mild to moderate,” they are unable to characterize the degree of regurgitation perfectly, and it’s probably prudent to get another echocardiogram just to be sure.

My experience is that the tricuspid valve rarely causes problems by itself, but can sometimes get leaky if the heart is enlarged overall, such as in someone with longstanding high blood pressure or with heart failure.