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A 26 year old student presented clinically with a right ulnar sensory neuropathy, thought to have resulted from compression at the elbow during late night studying. There was no previous history, nor family history, of compression neuropathy; serum glucose and inflammatory markers were not elevated. Nerve conduction studies confirmed marked slowing across the elbow on the right, compared with the left side. Plain x ray of the right elbow revealed no bony abnormality.
Despite resting the arm, hand weakness progressed over the next 6 weeks, with evidence of hand clawing. At this time the student confessed that, in an attempt to stimulate recovery himself, he had fashioned an “elbow warmer” from an electric blanket (fig), which had been worn continuously over the previous weeks. He was instructed not to use it any more, and referred immediately for surgical intervention following which his weakness resolved.
Ulnar neuropathy at the elbow (UNE) remains a controversial entity, both in terms of neurophysiological diagnosis and subsequent management.1 UNE often improves with conservative management and simple elbow rest, but surgical referral is advised where there is progression of motor symptoms. Although it is not possible to be certain that the use of the “elbow warmer” worsened this patient’s neuropathy, neurophysiology is influenced by temperature.2 Heat induced conduction block has been described in the setting of carpal tunnel syndrome,3 and cooling has been successfully used to aid recovery in common peroneal nerve compressive neuropathy.4 It is therefore conceivable that this home-made device prevented spontaneous recovery in this patient, necessitating surgical referral.
Competing interests: none declared
Patient consent has been obtained for publication of figure 1