Entrapment Subtitles
Darci Carlton
Cubital tunnel syndrome, also called ulnar nerve entrapment is a condition caused by compression of the ulnar nerve in an area of the elbow called the cubital tunnel. The ulnar nerve travels down the back of the elbow behind the bony bump called the medial epicondyle & through a passageway called the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, & ligaments with the ulnar nerve passing through its centre. The roof of the cubital tunnel is covered with soft tissue called fascia. When the elbow is bent, the ulnar nerve can stretch & catch on the bony bump. When the ulnar nerve is compressed or entrapped, the nerve can tear & become inflamed leading to various symptoms
Signs & symptoms of cubital tunnel syndrome usually occur gradually, progressing to the point where the patient seeks medical attention. Left untreated, cubital tunnel syndrome can lead to permanent nerve damage in the hand. Commonly reported symptoms associated with cubital tunnel syndrome include intermittent numbness, tingling, & pain to the little finger, ring finger, & the inside of the hand. These symptoms occur more frequently at night, & with elbow bending or prolonged resting on the elbow.
Injury to the elbow such as fractures, dislocations, or a direct blow can cause tissue swelling which can compress the ulnar nerve within the cubital tunnel. Individuals who perform repetitive elbow flexion movements at work or play are believed to be at high risk for developing cubital tunnel syndrome. Repeatedly bending & straightening the elbow can irritate & inflame the ulnar nerve. Leaning on the elbow for extended periods of time such as when working at a desk can also cause ulnar nerve irritation. Bone spurs, ganglion cysts, or tumours can form in the cubital tunnel leading to pressure & irritation of the ulnar nerve.
Your physician will recommend conservative treatment options initially to treat the cubital tunnel syndrome symptoms unless muscle wasting or nerve damage is present. Conservative treatment options may include wearing a brace or splint at night while sleeping to keep the elbow in a straight position. You can also wrap the arm loosely with a towel & apply tape to hold it in place. If conservative treatment options fail to resolve the condition or if muscle wasting or severe nerve compression is present, your surgeon may recommend you undergo a surgical procedure to treat Cubital Tunnel Syndrome.
If your nerve compression is mild your surgeon may recommend a medial epicondylectomy. In this procedure your surgeon will make an incision over the medial epicondyle, the bony bump on the inside of the elbow. The cubital tunnel is cut open through the soft tissue roof exposing the ulnar nerve. The forearm muscles or flexor muscles are cut & detached from the epicondyle. Using special instruments, your surgeon will shave away the bump, freeing the ulnar nerve to glide smoothly within the cubital tunnel without pressure from the bump. The flexor muscles are then reattached to the area of shaved bone with special sutures. The incision is then closed with sutures & covered with a dressing.
More commonly, your surgeon may recommend an ulnar nerve transposition. Your surgeon will make an incision over the medial epicondyle. The cubital tunnel is cut open through the soft tissue roof exposing the ulnar nerve. The forearm muscles or flexor muscles are cut & detached from the epicondyle. The ulnar nerve is transposed or moved from behind the elbow to a new location in front of the elbow. The ulnar nerve may be placed above the flexor muscle, within the muscle, or under the muscle. Your surgeon will decide which option is best for you. The flexor muscles are then sutured back together & reattached with special sutures to the Epicondyle. The incision is then closed with sutures & covered with a dressing.
Grab your limited-edition pride shirt now until June 30th (or until they are gone). Limited quantities and sizes are available. A portion of the proceeds will support the 4 Corners Rainbow Youth Center and all t-shirt purchases include a free Alpacka Raft Pride sticker.
The Alpacka Raft warranty applies to the original owner and is not transferable. Will explains the process in this short video. Please refer to the warranty page on our website for additional information or contact us at [email protected] if you have additional questions.
We cannot stress enough how important cleaning your Cargo Fly zippers is on your packrafts. If you are not great at keeping your zippers clean and dry, you could run into Cargo Fly Zipper Rot. Make sure your zippers are clean and dry for the longevity of your packraft and so they do not rot.
We've been asked for years for a tutorial on how to install your DIY attachment points. It's finally here. We have the attachment points available on our website, and this tutorial will help you install them at home.
Replacing the inflation nozzle or inflation hose on Alpacka Raft accessories like seats, inflatable dry bags, and more is a pretty simple process. Will from our Service and Repair team takes you through that process in this video.
Just a quick entrapment hazards PSA from Will in our Service and Repair department. Will sees a lot of packrafts improperly rigged with entrapment hazards. Check out this quick clip from him asking you to properly rig your packrafts to avoid entrapment hazards.
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Safest techniques for removing an entrapped ring from a finger, toe, or penis are reviewed and outlined in this guideline taking into account the metal composition of the rings in question that need to be removed to avoid tissue ischaemia with potential permanent tissue necrosis.
The most common reason for ring removal is swelling. Swelling can be caused by multiple reasons like trauma, allergic reactions, pregnancy, cardiac/renal failure or venous thromboembolism. Although, uncommon, penile entrapment has been described after patients place various constriction devices around the penis or scrotum to maintain or enhance an erection.
For valuable rings not requiring emergency removal this approach is acceptable. In general, inexpensive soft metal or plastics rings should be cut off because this procedure can be carried out quickly without analgesia/nerve blocks. Warn the patient that the removal of the ring by the elasticated band wrap method is painful and provide analgesia as necessary.
Soft metal (gold, silver, copper or tin) or plastics rings can be cut in ED with a manual operated ring cutter or electric ring cutters. Become familiar in how to use the individual ring cutter utilised
Apply the saw blade wheel to the ring and turn it, the friction of the ring cutting process generates heat that in turn can cause discomfort and burn the patient skin. To reduce this risk, water should be used during this process to reduce the heat of the metal being cut.
With the electric ring cutters it is important that the blade wheel is running before it touches the ring to prevent damage to the blades. Do not place undue pressure to the running blades to fasten the process as it will cause damage to the blades themselves. Be patient. The friction of the ring cutting process generates heat that in turn can cause discomfort and burn the patient skin. To reduce this risk, water should be used during this process to reduce the heat of the metal being cut
Tungsten carbide or ceramic: These rings can be shattered in ED with a set of locking pliers. Prior to use, cover any open wounds to prevent metal particles from entering and causing contamination / damage.
Removal of a ring can cause soft tissue trauma, including bruising or small cuts. After ring removal, clean digit, toe or penis and dress it if necessary. Re-evaluate neurovascular status. If there is clinical suspicion for digital/toe fracture then xray accordingly. For digital/toe swelling, instruct patient to keep affected limb elevated and ice it for the next 3 days (for 20 minutes every 4 hours). Advice patient not to wear another ring on affected finger/toe until the pain and swelling has completely resolved. Verify tetanus status and give prophylaxis as required. Patients with penile rings should be able to void normally before discharge
Emergency urology consultation is indicated for patients with penile ring entrapment and signs of penile ischaemia or necrosis. Urgent urology consultation is also granted if post-removal of ring there is persistent ischaemia, difficulty voiding, or deep ulceration with potential involvement of the urethra or cutaneous urethral fistula.
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