Treatment for ulnar neuropathy at the elbow

Ulnar neuropathy at the elbow is the second most common form of nerve irritation from a trapped or compressed nerve, after carpal tunnel syndrome. People with the condition normally have tingling of the fourth and fifth finger at night, pain at the elbow, and altered sensation on prolonged bending of the elbow. In severe cases the condition causes weakness in the muscles of the hand, which is innervated by the ulnar nerve. Diagnosis is based on signs, symptoms, and nerve conduction studies. The treatment of ulnar neuropathy at the elbow can be conservative (splint devices, physical therapy, rehabilitation) or surgical. We found one randomised controlled trial of conservative treatment involving 51 participants, which supports the opinion that conservative treatment is effective in clinically mild or moderate ulnar neuropathy. In this study, provision of written information on avoiding movements or positions provoking the symptoms, either alone, combined with night splinting for three months, or combined with nerve gliding exercises, was equally effective in improving occupational activities and reducing pain at night. None of the conservative treatments improved muscle strength. In three randomised controlled trials, a total of 131 participants were treated by the surgical technique of simple decompression and 130 participants were treated by transposition of the nerve (submuscular or subcutaneous transposition). Meta-analysis found no significant difference between simple decompression and transposition of the ulnar nerve (subcutaneous or submuscular) in postoperative clinical and neurophysiological improvement. In another trial the authors compared medial epicondylectomy with anterior transposition and found no difference in clinical and neurophysiological outcomes. The available evidence is not sufficient to identify the best treatment of ulnar neuropathy at the elbow, on the basis of clinical, neurophysiological and imaging characteristics. However, in mild cases information on movements and positions to avoid may reduce subjective discomfort. Moreover, the results of our meta-analysis suggest that simple decompression surgery and decompression with transposition are equally effective. Decompression with transposition results in a higher number of deep and superficial wound infections.