JAVS Fall 1989

29

something about this nerve and to practice preventive measures regarding it. The ulnar nerve leaves the spinal column in the neck, travels through the armpit and down the inside of the upper arm to the elbow. There is a little hole in the elbow, called the cubital tunnel (remember the Biblical unit of measure, the cubit, from the elbow to the finger tip?), which is lined by a little sheath through which the ulnar nerve travels. The nerve continues along the lower part of the forearm, through the wrist and into the hand. The ulnar nerve is the path for nerve impulses from the ring and little finger to the-brain and from the brain to the ring and little finger. Every time you bend your arm past a right angle, you put a great deal of stress on the ulnar nerve as it goes through the cubital tunnel. In case you hadn't noticed, both arms are frequently bent to a greater degree than a right angle when we play. In this case, it is better to be a violist than a violinist, because even in first position, most violinists' left arms are bent smaller than ninety degrees, while many violists' arms remain wider than ninety degrees. If you ever have had any tingling or numbness in the ring or little fingers, you likely have had a little too much stress on the ulnar nerve. Things are complicated by the fact that when a nerve is injured it tends to expand a little. The cubital tunnel is normally large enough, but after an injury to the ulnar nerve, the tunnel can become too small. Two Effected Areas There are a number of things we can do to prevent ulnar problems. They fall into two areas: one around the cubital tunnel, and one around the shoulders. The most important way to prevent ulnar nerve problems is to keep our arms straight. It seems that it should be easy to change our habits and keep our arms straighter than a right angle, but it is surprisingly difficult to keep this in mind. The position we have when we rest the viola between movements or during long rests will often bend the elbow past the right angle. We should try to extend our arms at such times. Obviously, we must put

some stress on the ulnar nerve when we play, but we should try to keep the arms somewhat straighter when not playing. This also includes when we drive, eat, talk on the phone, jog, and so forth. The more time we spend thinking about keeping the arm straight, the better it is for the nerve. While sleeping, we can also put tension on the ulnar nerve. Therefore, we should try to change our sleeping habits to sleep with our arms extended, and not tucked under the pillow. This can be very difficult to accomplish, since we are not aware of our arms when we sleep. As you fall asleep, try to think of your arm positions, making sure they are straight enough. When you awaken during the night and in the morning, try to think at once of your arm positions in order to monitor them. It will take quite a long time to develop new sleeping patterns, but it is worth it to reduce stress on the ulnar nerve. If the ulnar nerve becomes stressed during sleep, you can force your arms to remain extended by putting them through a pillow sewn in the form of a cylinder. Medical supply houses have splints for arms which accomplish the same thing. Several Exercises Several exercises, designed for the shoulders, were recommended to me by my physical therapist. Since the ulnar nerve comes through the arm pit, one's posture may pull against the nerve, increasing the potential for a problem at the cubital tunnel. This is especially true if one has a posture that includes a sunken chest, with shoulders pulled forward. These exercises are intended to increase the strength of the upper back to help pull one more upright. They were shown to me while on a small table in a doctor's office. They can be done on a bed as you lie diagonally across on your back, your head in a corner, and the arms over the sides. First, with some small weights (two cans of soup are sufficient), extend your hands out to the side, arms straight, thumbs pointing up, while lifting several times. Second, with your arms bent at ninety degrees, hands near your head, thumbs pointing toward your head, lift your arms again several times, keeping the forearm level. Then, with your arms extended over your head, lift the weights again. Finally,