I am a 56 year old healthy dental hygienist. I have been prcaticing my profession for 33 years. Considering the type of repetitive motion, strange positions and vibrating machinary I use, could this have caused my cubital tunnel syndrome.
Hi, “occupational activities may aggravate cubital tunnel syndrome secondary to repetitive elbow flexion and extension. Certain occupations are associated with the development of cubital tunnel syndrome; however, a definite relationship with occupational activities is not well defined.
As the elbow moves from extension to flexion, the distance between the medial epicondyle and the olecranon increases 5 mm for every 45° of elbow flexion. Elbow flexion places stress on the medial collateral ligament (MCL) and the overlying retinaculum. The shape of the cubital tunnel changes from a round to an oval tunnel, with a 2.5-mm loss of height, because the cubital tunnel rises during elbow flexion and the retrocondylar groove on the inferior aspect of the medial epicondyle is not as deep as the groove is posteriorly. The cubital tunnel's loss in height with flexion results in a 55% volume decrease in the canal, which further results in the mean ulnar intraneural pressure increasing from 7 mm Hg to 14 mm Hg. A combination of shoulder abduction, elbow flexion, and wrist extension results in the greatest increase in cubital tunnel pressure, with ulnar intraneural pressure increasing to about 6 times normal.
Traction and excursion of the ulnar nerve also occur during elbow flexion, as the ulnar nerve passes behind the axis of rotation of the elbow. With full range of motion (ROM) of the elbow, the ulnar nerve undergoes 9-10 mm of longitudinal excursion proximal to the medial epicondyle and 3-6 mm of excursion distal to the epicondyle. In addition, the ulnar nerve elongates 5-8 mm with elbow flexion.
Within the cubital tunnel, the measured mean intraneural pressure is significantly greater than the mean extraneural pressure at elbow flexion of 90° or more. With the elbow flexed 130°, the mean intraneural pressure is 45% higher than the mean extraneural pressure. At this amount of flexion, significant flattening of the ulnar nerve occurs; however, with full elbow flexion, no evidence exists of direct focal compression, suggesting that traction on the nerve in association with elbow flexion is responsible for the increased intraneural pressure. In addition, studies have shown that the intraneural and extraneural pressures within the cubital tunnel are lowest at 45° of flexion. As a result of these studies, 45° of flexion is considered to be the optimum position for immobilization of the elbow to decrease pressure on the ulnar nerve”.
Taken from http://www.emedicine.com/orthoped/TOPIC479.HTM
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