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Treatment for ulnar neuropathy at the elbow
Pietro Caliandro1, Giuseppe La Torre, Roberto Padua
1Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
The Cochrane Database of Systematic Reviews
|November 16, 2016
Summary
Ulnar neuropathy at the elbow (UNE) treatments, both surgical and conservative, show similar effectiveness. Surgical decompression with transposition increases wound infection risk, while conservative care may help mild cases by modifying activities.
Area of Science:
- Neurology
- Orthopedic Surgery
- Physical Medicine and Rehabilitation
Background:
- Ulnar neuropathy at the elbow (UNE) is a common entrapment neuropathy.
- Optimal treatment strategies for UNE remain debated.
- This review is an update of previous analyses from 2010 and 2012.
Purpose of the Study:
- To evaluate the efficacy and safety of conservative and surgical interventions for UNE.
- To determine if surgical treatment improves symptoms, signs, and nerve function.
- To assess the effectiveness of conservative treatment on symptoms, signs, and nerve function.
- To identify optimal treatment selection based on clinical, neurophysiological, or imaging assessments.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
- Searched multiple databases including Cochrane, MEDLINE, Embase, AMED, CINAHL Plus, LILACS, and PEDro.
- Included studies evaluated surgical and conservative treatments for UNE, with or without neurophysiological confirmation.
Main Results:
- No significant difference in clinical or neurophysiological outcomes between simple decompression and transposition for UNE (moderate-quality evidence).
- Transposition surgery was associated with a higher incidence of wound infections compared to simple decompression (moderate-quality evidence).
- Endoscopic decompression did not show superior clinical function improvement compared to open decompression.
- Conservative treatment, including activity modification, showed benefit for subjective discomfort in mild UNE cases (low-quality evidence).
Conclusions:
- Current evidence suggests simple decompression and transposition are equally effective for UNE, irrespective of severity.
- Decompression with transposition carries a higher risk of wound infections.
- Evidence for conservative treatment is limited, but activity modification may benefit mild UNE.
- Further research is needed to establish clear guidelines for conservative versus surgical treatment selection.
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