Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Conservative Treatment of Ulnar Nerve Compression at the Elbow: A Systematic Review and Meta-Analysis

  • Tinatin Natroshvili (Department of Plastic and Reconstructive Surgery) ;
  • Milly S. van de Warenburg (Department of Plastic and Reconstructive Surgery) ;
  • Erwin P. Heine (Department of Plastic and Reconstructive Surgery) ;
  • Nicholas J. Slater (Department of Plastic and Reconstructive Surgery) ;
  • Erik T. Walbeehm (Department of Plastic and Reconstructive Surgery, Radboud University Medical Center) ;
  • Ronald H.M.A. Bartels (Department of Neurosurgery, Radboud University Medical Center)
  • Received : 2022.01.27
  • Accepted : 2022.05.26
  • Published : 2023.01.15
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Abstract

Background The clinical results of conservative treatment options for ulnar compression at the elbow have not been clearly determined. The aim of this review was to evaluate available conservative treatment options and their effectiveness for ulnar nerve compression at the elbow. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. Literature search was performed using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Results Of the 1,079 retrieved studies, 20 were eligible for analysis and included 687 cases of ulnar neuropathy at the elbow. Improvement of symptoms was reported in 54% of the cases receiving a steroid/lidocaine injection (95% confidence interval [CI], 41-67) and in 89% of the cases using a splint device (95% CI, 69-99). Conclusions Conservative management seems to be effective. Both lidocaine/steroid injections and splint devices gave a statistically significant improvement of symptoms and are suitable options for patients who refuse an operative procedure or need a bridge to their surgery. Splinting is preferred over injections, as it shows a higher rate of improvement.

Keywords

Acknowledgement

We thank Alice Tillema for her assistance with database searches.

References

  1. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev 2016;11:CD006839
  2. Jacobson L, Dengler J, Moore AM. Nerve entrapments. Clin Plast Surg 2020;47(02):267-278 https://doi.org/10.1016/j.cps.2019.12.006
  3. Boone S, Gelberman RH, Calfee RP. The management of cubital tunnel syndrome. J Hand Surg Am 2015;40(09):1897-1904, quiz 1904 https://doi.org/10.1016/j.jhsa.2015.03.011
  4. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372(71):n71
  5. Moola S, Munn Z, Tufanaru C, et al. , Systematic reviews of etiology and risk. In: Aromataris E, Munn Z, eds. Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute; 2017
  6. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-560 https://doi.org/10.1136/bmj.327.7414.557
  7. Ostend, Belgium: MedCalc Software Ltd; 2020
  8. Alblas CL, van Kasteel V, Jellema K. Injection with corticosteroids (ultrasound guided) in patients with an ulnar neuropathy at the elbow, feasibility study. Eur J Neurol 2012;19(12):1582-1584 https://doi.org/10.1111/j.1468-1331.2012.03676.x
  9. Choi CK, Lee HS, Kwon JY, Lee WJ. Clinical implications of real-time visualized ultrasound-guided injection for the treatment of ulnar neuropathy at the elbow: a pilot study. Ann Rehabil Med 2015;39(02):176-182 https://doi.org/10.5535/arm.2015.39.2.176
  10. Gronbeck C, Wolf J, Rodner CM. Ultrasound-guided cubital tunnel injection: a review and exploration of utility as a diagnostic aid in mild or nonclassic cubital tunnel patients. Tech Orthop 2021;36(03):301-306 https://doi.org/10.1097/BTO.0000000000000450
  11. Pechan J, Kredba J. Treatment of cubital tunnel syndrome by means of local administration of cortisonoids. II. Long-term follow-up. Acta Univ Carol [Med] (Praha) 1980;26(3-4):135-140
  12. Rampen AJ, Wirtz PW, Tavy DL. Ultrasound-guided steroid injection to treat mild ulnar neuropathy at the elbow. Muscle Nerve 2011;44(01):128-130 https://doi.org/10.1002/mus.22091
  13. Oskay D, Meric A, Kirdi N, Firat T, Ayhan C, Leblebicioglu G. Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases. J Manipulative Physiol Ther 2010;33(02):156-163 https://doi.org/10.1016/j.jmpt.2009.12.001
  14. Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology 1993;43(09):1673-1677 https://doi.org/10.1212/WNL.43.9.1673
  15. Michell AW, Sesath HGR. Feasibility trial of treatment of ulnar neuropathy at the elbow using a specifically designed splint. J Clin Rheumatol 2020;26(01):37-39
  16. Seror P. Treatment of ulnar nerve palsy at the elbow with a night splint. J Bone Joint Surg Br 1993;75(02):322-327 https://doi.org/10.1302/0301-620X.75B2.8444959
  17. Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. J Hand Surg Am 2013;38(06):1125--1130.e1 https://doi.org/10.1016/j.jhsa.2013.02.039
  18. Nakamichi K, Tachibana S, Ida M, Yamamoto S. Patient education for the treatment of ulnar neuropathy at the elbow. Arch Phys Med Rehabil 2009;90(11):1839-1845 https://doi.org/10.1016/j.apmr.2009.06.010
  19. Padua L, Aprile I, Caliandro P, Foschini M, Mazza S, Tonali P. Natural history of ulnar entrapment at elbow. Clin Neurophysiol 2002;113(12):1980-1984 https://doi.org/10.1016/S1388-2457(02)00295-X
  20. Chen LC, Ho TY, Shen YP, et al. Perineural dextrose and corticosteroid injections for ulnar neuropathy at the elbow: a randomized double-blind trial. Arch Phys Med Rehabil 2020;101(08):1296-1303 https://doi.org/10.1016/j.apmr.2020.03.016
  21. vanVeen KE, Alblas KC, Alons IM, et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: a randomized, double-blind, placebo-controlled trial. Muscle Nerve 2015;52(03):380-385 https://doi.org/10.1002/mus.24551
  22. Ozkan FU, Saygi EK, Senol S, et al. New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy. Acta Neurol Belg 2015;115(03):355-360 https://doi.org/10.1007/s13760-014-0377-9
  23. Hong CZ, Long HA, Kanakamedala RV, Chang YM, Yates L. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil 1996;77(06):573-577 https://doi.org/10.1016/S0003-9993(96)90297-X
  24. Svernlov B, Larsson M, Rehn K, Adolfsson L. Conservative treatment of the cubital tunnel syndrome. J Hand Surg Eur Vol 2009;34(02):201-207 https://doi.org/10.1177/1753193408098480
  25. Beekman R, Wokke JH, Schoemaker MC, Lee ML, Visser LH. Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology 2004;63(09):1675-1680 https://doi.org/10.1212/01.WNL.0000142535.24626.90
  26. Omejec G, Podnar S. Long-term outcomes in patients with ulnar neuropathy at the elbow treated according to the presumed aetiology. Clin Neurophysiol 2018;129(08):1763-1769 https://doi.org/10.1016/j.clinph.2018.04.753