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Pain and Arthritis Newsletter
June 8, 2009


In This Issue
• 'Cell Phone Elbow' -- A New Ill for the Wired Age
• When It Comes to Lifting, the Pros Have Your Back
• Rheumatoid Arthritis Drug Might Fight Swine Flu
 

'Cell Phone Elbow' -- A New Ill for the Wired Age


TUESDAY, June 2 (HealthDay News) -- First came Nintendo thumb. Then, Guitar Hero wrist. Now, for the latest affliction of the wired age, it's cell phone elbow.

Medically known as cubital tunnel syndrome, cell phone elbow is numbness, tingling and pain in the forearm and hand caused by compression of the ulnar nerve, which passes along the bony bump on the inside of the elbow.

One of the causes of pressure on the ulnar nerve? Too much gabbing, often brought on by those cell phone plans with unlimited minutes, experts say.

Prolonged flexing of the elbow, such as when you hold a cell phone to your ear while closing sales, talking to your mother or keeping tabs on your teens while you're at work, puts tension on the ulnar nerve. In susceptible people, holding the bent-elbow position for extended periods can lead to decreased blood flow, inflammation and compression of the nerve.

"Repetitive, sustained stretching of the nerve is like stepping on a garden hose," said Dr. Peter J. Evans, director of the Cleveland Clinic's Hand and Upper Extremity Center. "With the hose, you're blocking the flow of water. With the elbow, you're blocking the blood flow to the nerve, which causes it to misfire and short circuit."

The first symptoms patients often notice include numbness, tingling or aching in the forearm and hand, a pain similar to hitting your "funny bone." (The unpleasant sensation of hitting your "funny bone" is actually your ulnar nerve.)

As symptoms progress, they can include a loss of muscle strength, coordination and mobility that can make writing and typing difficult. In chronic, untreated cases, the ring finger and pinky can become clawed, Evans and colleagues note in a report in the May issue of the Cleveland Clinic Journal of Medicine.

Though there are no solid figures on how many people have cell phone elbow, hand specialists say the incidence is increasing along with the 3.3 billion cell phone service contracts active worldwide, Evans said.

Still, the disorder is less common than carpal tunnel syndrome, a related condition that causes pain in the hand and wrist. Carpal tunnel syndrome is caused by compression of the median nerve that runs from the forearm into the hand.

"Cubital tunnel is the second most common compression syndrome we see," said Heather Turkopp, an occupational therapist and certified hand specialist at William Beaumont Hospital in Royal Oak, Mich.

Most people who get cubital tunnel syndrome are middle-aged or older. Women get cubital tunnel syndrome more often than men -- and it's probably not because they talk more.

Although the precise reasons are unknown, women may be more susceptible due to hormonal fluctuations or their anatomy, Evans said.

And too much yakking isn't the only cause of cubital tunnel syndrome. Other causes may include sleeping with the elbows bent and tucked up into the chest, sitting at a desk with the elbows flexed at an angle greater than 90 degrees and driving with your elbow propped on the window for extended periods, he said.

In most cases, minor lifestyle changes can help alleviate symptoms, including using a hands-free headset for your cell phone. If sleep position is the problem, an elbow pad to keep the arm straighter at night can help.

More serious cases are referred to an occupational therapist, who may use ultrasound to loosen scar tissue that can form around the nerve as a result of the inflammation, as well as stretching, deep massage and "nerve-gliding" exercises to reduce pressure on the nerve, Turkopp said.

Doctors may also use anti-inflammatory injections or surgery.

Seeing your doctor soon if you're experiencing any numbness or tingling in your hand or forearm can prevent the problem from progressing to that point, Evans said.

More information

The University of Virginia has more on cubital tunnel syndrome  External Links Disclaimer Logo.


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When It Comes to Lifting, the Pros Have Your Back


SATURDAY, May 30 (HealthDay News) -- Following the example of professional movers can help you reduce the risk of injury the next time you move, says a new study that included 20 men who carried a load on a treadmill so that researchers could assess the effects on the shoulders, neck, back, abdomen and forearms.

The study found that carrying loads on your back rather than against the abdomen may reduce effort and lower the risk of injury. It also found that using assistive load carriage devices can improve grip and lessen the strain on the back and forearms.

"We found that professional movers often carry loads against their backs, mainly because they found it to be more practical and less painful. However, more research is needed with professional movers or warehouse workers to see if the back carry technique reduces the risk of back injury without increasing the risks of other injuries," study co-author Joan M. Stevenson, said in an American College of Sports Medicine (ACSM) news release. The study was presented this week at the ACSM annual meeting in Seattle.

She and her colleagues found that movers who use the back carry technique feel they lift more safely, reduce their risk of tripping, and are less likely to suffer back pain.

"This technique may be very important when it comes to injury prevention, whether it is on a professional mover or just a college student moving to an apartment. We know that some people do not have the shoulder flexibility or grip strength to perform this technique, so an assistive lifting device can be valuable," Stevenson said.

Before moving, you should gently warm up your body with low-intensity muscle stretching for about 10 to 15 minutes, the ACSM said. It also recommends regular stretching sessions two to three times a week to improve flexibility and other aspects of health.

More information

The U.S. National Institutes of Health have more about avoiding back pain.


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Rheumatoid Arthritis Drug Might Fight Swine Flu


FRIDAY, May 29 (HealthDay News) -- Scientists are exploring the possibility that drugs that affect the immune system might one day serve as potent weapons to fight the flu, even the swine flu that's currently circulating around the globe.

The concept has worked with a group of lab mice that were treated with the rheumatoid arthritis drug abatacept (Orencia) after being given a lethal dose of influenza A virus, researchers report.

The mice were also loaded up with "memory" T-cells -- white blood cells that were programmed to react to this strain of flu.

Eighty percent of the treated mice lived, compared to only 50 percent of those left untreated, said Donna Farber, senior author of a paper published in the June 1 issue of The Journal of Immunology.

Basically, the drug enabled infection-fighting "memory" T cells to fight off the initial infection, but prevented them from overactivating the immune system, a process that can cause worse illness and even death.

The findings could have implications not only for the seasonal flu, which reappears with regularity each year, but for surprise outbreaks such as the swine flu.

"For the swine flu, there really are indications that you do get this sort of hyperimmune reaction," said Farber, who is a professor of surgery and microbiology and immunology at the University of Maryland School of Medicine in Baltimore. "Currently there is no treatment for people who are really ill from the flu, and there is already an indication that the immune system is too revved up [in these severe cases]. This could be a potential treatment for the flu."

The study was sponsored by Bristol-Myers Squibb, which makes Orencia, and the U.S. National Institutes of Health.

Orencia was approved for use in the United States in 2005 and introduced to the market in early 2006 to treat rheumatoid arthritis, an autoimmune disorder. It prevents activation of T lymphocytes, or white blood cells, whose function is to fight off infection.

"Memory" T-cells are a subset of T lymphocytes. They are "good" in that they can fight off an invading virus, but "bad" because they can also contribute to a hyperactive immune system that can lead to more illness and even death.

When a person becomes infected with a flu virus, the immune system dispatches these white blood cells to the lungs to get rid of the virus. But, if the cells don't know when to stop, they can cause tissue damage in the lungs, pneumonia and even death, Farber said.

"About half of your T-cells are memory T-cells. They persist and remember that you've seen a pathogen," she explained. "A response [to infection with the influenza virus] is likely to include some contribution of memory T-cells."

"With a lot of influenza, especially these pandemic strains, what really makes you sick and causes pneumonia is your immune response," Farber added.

The researchers injected mice with memory T-cells that had been programmed to react to an H1N1 strain of influenza A virus (the same "subtype" as the currently circulating swine flu) and then infected them with either a sub-lethal or lethal dose of the actual virus. In addition, at the start of infection, before the mice actually fell ill, half were given Orencia while the remaining half were left untreated.

In both sets of mice, those that had received Orencia cleared the virus quicker, got less sick and recovered faster than mice in the control group. The drug also tempered the immune response of the memory T-cells, the researchers found.

"It didn't dampen the immune response so much that it wasn't able to get rid of the virus but it tempered down the immune response," Farber said. "The mice didn't get as sick, they recovered a lot better and the lungs looked a lot healthier."

Orencia and similar drugs would have the added advantage of being effective against different strains of the flu virus because they're targeting the immune system, not the virus. The annual vaccine, on the other hand, is only effective against specific viral strains, the researchers said.

Robert Alaniz is an assistant professor of microbial and molecular pathogenesis at Texas A&M Health Science Center College of Medicine. He said, "Although the paper is a mouse study, the drug used is currently approved for human use and effective in humans. As far as I know, the use of abatacept has not been tested for its effects in humans infected with the flu, which is what makes this study novel and interesting.

"Although the results from this study are intriguing, much more work is warranted to ensure safety in humans infected with seasonal flu. However, the promise of the approach used in this study is that it maintains protective immunity against the virus while reducing disease pathology -- a very important point because overwhelming disease pathology is often a major contributing factor in flu-related deaths," he added.

More information

The U.S. Centers for Disease Control and Prevention has more on influenza.


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