DEAR DR. ROACH: I'm an active 76-year-old retired accountant who likely spent too many hours at a computer. Now I'm paying for it with a painful condition. My general physician says that I have a pinched or compressed ulnar nerve, which likely starts in the neck shoulder area but shoots pain down my right arm and elbow, all the way to my pinkie and ring fingers. These fingers tingle and, at times, prickle so intensely that it feels like my hands on fire. I use ice on my shoulder, neck and elbow.

I take 25 mg of pregabalin on a prolonged step-up process that I augment with Tylenol, and I see a physiotherapist. It's been two months.

-K.A.

Answer: Your doctor is correct that your fifth finger and one half of your fourth finger are innervated by the ulnar nerve, and I agree that your symptoms suggest a nerve compression. However, the location of where the nerve is compressed may affect your prognosis and treatment, so I think it's important to try to find out where this is occurring in your body.

The most common locations are in the neck and elbow. A physical exam can sometimes make one location nearly certain. In the neck, a maneuver (the Spurling sign) can identify if the nerve root's being compressed in the neck at the C8-Tl level. If this is the case, there could also be weakness in specific muscles and numbness up into your forearm.

If the problems in the elbow, tapping on the elbow in the bicipital groove can reproduce an electric-shock sensation with the tingling and prickling that you're describing. Sometimes it's just not possible to be sure through a physical exam, and nerve-conduction studies and electromyography's are necessary to make the diagnosis.

If the problems in the neck, then in addition to the medications that you're taking, your physical therapist can target this area. Injections may help. If the problems in the elbow, then an elbow brace at night, advice on elbow care, and elbow padding can help.

I'm cautious about referring patients to surgery too soon, since cubital tunnel syndrome surgery is more difficult and less successful compared to carpal tunnel syndrome surgery (where the median nerve is compressed in the wrist).

DEAR DR. ROACH: I had a routine echocardiogram in December 2024. They found a "small pericardia! effusion." While my primary doctor wasn't concerned, I asked to be retested again this year. The result was unchanged. I'm 69 years old and in otherwise good health; I don't take any meds. Surprisingly, I got turned down for a new life insurance policy. Any thoughts or comments?

-E.J.

Answer: The pericardium is a "bag" of tough connective tissue that surrounds the heart. In the pericardia! space (between the heart and pericardium), there's often a little bit of fluid (15-50 mL) that can be seen through an echocardiogram (a test that uses sound waves to take moving pictures of the heart).

Very large amounts can indicate a severe problem, but about 3% of healthy people have this fluid. "Trivial" and "small" pericardia! effusions are most likely normal, and for a person who doesn't have symptoms, they don't need to be further evaluated. A letter from the cardiologist reading your echo, stating that your effusion was in the normal range, may get them to change their minds. However, it's possible that you may have other factors that influenced their decision.

ToYourGoodHealth@med.cornell.edu.