April 16, 2014

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The nerve of it: Doctor talks about LeBron’s arm

Numbness in the elbow area, like Cavaliers small forward LeBron James has experienced occasionally over the past few weeks, is usually caused by an unstable ulnar nerve.

That’s the word from Dr. David H. Hildreth, a hand, wrist and elbow specialist at the Richmond Bone & Joint Clinic in Houston.

“It’s very possible the funny bone nerve, called the ulnar nerve, is unstable in the cubital tunnel,” Hildreth said Wednesday in a phone interview. “If you hold onto your elbow and feel the primary bone, the nerve is right under it. If the nerve flips out over the top of that bone, it’s irritated and it can cause that electric-shock syndrome as you flex and extend your elbow.

“If you assume he has an unstable ulnar nerve that is the cause of the symptoms, it will give you the tingling sensation like you’re hitting your funny bone.”

The right-handed James, who shot a free throw left-handed in the closing seconds of Game 5 Tuesday against Chicago, underwent an MRI on Monday that revealed nothing significant and downplayed his injury after the game.

CT photo by David Richard.

CT photo by David Richard.

“An MRI is not going to show the instability of the nerve,” Hildreth said. “It’s going to show whether he has a medial collateral (ligament) injury. The most likely cause of his symptoms is the ulnar nerve being unstable.”

Hildreth said the best long-term solution for such an injury is surgery, in which the nerve is taken from behind the bone and put in front of it. After such a procedure, it usually takes 10 to 12 days for the wound to heal and a maximum rehabilitation period of six weeks.

Hildreth said there are steps that can be taken, short of surgery, to possibly lessen the recurrence of the numbness, including placing the affected arm in a splint so it’s “more extended than flexed.”

“When you flex it is when the nerve pops out,” Hildreth said. “The way to cool it off is to have your arm straightened.”

Hildreth also said anti-inflammatory medications — “Advil and Aleve are the two classics” — can help, but “the short answer is, don’t do what’s causing it.”

The Cavaliers, who have kept quiet about James’ elbow problem, are slated to open an Eastern Conference semifinal series against the Boston Celtics on Saturday.

James, who averaged 31.8 points, 9.2 rebounds and 8.2 assists in a first-round win over Chicago, said after the Game 5 win over the Bulls that he didn’t plan on missing any action.

“I don’t know exactly when it happened; I can’t figure it out,” James said. “It’s been going on for a couple of weeks and hopefully it doesn’t continue to bother me as we continue to move on in the postseason.

“It bothers me more because I don’t actually know what it is. I don’t know what’s going on, but we will figure it out. We have the best docs in Cleveland and they will figure it out. We will be fine.”

The Cavaliers were off Wednesday and provided no update on James’ condition. They are expected to practice today at Cleveland Clinic Courts in Independence.

Hildreth said cubital tunnel syndrome could also be the cause of numbness in the elbow area, but added that is usually accompanied by tingling in the ring and small fingers.

When that is not present — James has not described that as one of his symptoms — Hildreth said the most likely culprit is an unstable ulnar nerve.

“It can get worse in that the nerve gets more irritated,” Hildreth said. “As it gets more irritated, the inflammation causes the nerve function to get worse. It’s possible to lose significant hand function if it progresses.”

Like James, however, center Shaquille O’Neal didn’t seem overly concerned with the small forward’s health following Game 5 against Chicago.

“He’s a tough kid, unanimous MVP,” O’Neal said. “He’ll be fine.”

Contact Rick Noland at (330) 721-4061 or rnoland@medina-gazette.com.