Waking up with a numb ring and little finger is one of the most common complaints I hear — and most of the time, the cause is embarrassingly simple. You slept with your elbow bent, compressed the ulnar nerve, and your hand is temporarily registering the protest. Straighten your arm, move around, give it a few minutes. If sensation returns and stays normal, that is a textbook no big deal. The nerve just needed breathing room.

What I want you to watch for is persistence and progression. If the numbness returns night after night regardless of sleep position, or if you start noticing it during the day — typing, driving, gripping a steering wheel — the nerve is telling you something different. You may be dealing with cubital tunnel syndrome, compression of the ulnar nerve at the elbow. Left untreated long enough, this travels from numbness to weakness in your grip, and eventually to permanent changes in the small muscles of the hand. That window matters, and it closes quietly.

Ulnar nerve problems are very treatable early and considerably harder to fully reverse late. If you're in the red flag column, a clinical exam — not a Google search — is the right next step.

Steroid injections have become almost reflexive in orthopedic care. Pain in the elbow — injection. Shoulder hurts — injection. And I understand the appeal: they work fast, they're straightforward to administer, and patients walk out feeling relief. But twenty-seven years of watching outcomes unfold over time has made me considerably more selective about when I reach for cortisone, and I think you deserve to understand the reasoning.

The scenario where I'm most cautious is tendinopathy — conditions like lateral epicondylitis (tennis elbow) or rotator cuff tendinosis. The tissue is degenerated, not inflamed. A cortisone injection may quiet the pain signal for six to eight weeks, but in that window the tendon is also mechanically weaker and you're less likely to do the eccentric loading work that actually rebuilds it. Multiple injections in the same tendon compound this problem. The evidence is clear that repeated cortisone into the same structure raises rupture risk in a meaningful way.

When are injections genuinely the right call? Acute inflammatory conditions — a flare of inflammatory arthritis, an acutely inflamed bursa, carpal tunnel with significant swelling — are exactly the right indications. The injection suppresses a real inflammatory process, buys time for other treatments to take hold, and doesn't carry the same structural risk. The principle I follow: inject what's inflamed, load what's degenerated. Those are two different problems requiring two very different solutions.

My family calls me Safety Officer Ben. It started as a joke — the surgeon who narrates every hiking trail, every wet dock, every icy parking lot with a running commentary on what could go wrong and how to prevent it. But the nickname stuck because the instinct behind it is real. When you spend nearly three decades operating on injuries that were preventable, you stop seeing gear and environment choices as personal preferences. You start seeing them as clinical decisions made outside the hospital.

The injuries I treat most often are not freak accidents. They are predictable failures — the wrong footwear on an unstable surface, inadequate thermal protection in cold water, poor visibility in low light, fatigue compounded by the wrong equipment for the conditions. The patterns repeat with remarkable consistency across patients who have nothing else in common. A competitive athlete and a weekend fisherman and a grandfather on a glacier tour can arrive in my operating room via essentially the same chain of avoidable decisions. That repeatability is the point. Predictable means preventable.

This spring I'm taking my family — four people across four decades of age — into a demanding environment in Alaska. Cold water, variable weather, remote terrain, physically challenging activities across multiple days. Planning that trip through a clinical lens is exactly what this column is going to be about. Not brand recommendations. Not sponsored checklists. The underlying reasoning: what categories of risk exist in a given environment, what physiological and biomechanical principles govern those risks, and what properties in a piece of gear actually address them. Evidence over ego applies here the same way it does in the clinic. I'll show you how I think through it — and you can apply that framework wherever your next adventure takes you.