Treatment for ulnar neuropathy at the elbow

Area of Science:

• Neurology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Ulnar neuropathy at the elbow (UNE) is a common entrapment neuropathy.
• Optimal treatment strategies for UNE remain a subject of ongoing debate.
• This review is an update of previous analyses from 2011, 2012, and 2016.

Purpose of the Study:

• To evaluate the effectiveness and safety of conservative and surgical interventions for UNE.
• To determine if surgical treatments improve symptoms, signs, and nerve function.
• To assess if conservative treatments yield similar benefits and to identify predictors for optimal treatment selection.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Searched multiple databases up to July 2022 for relevant studies on UNE treatments.
• Extracted data on clinical, neurophysiological, and imaging outcomes, assessing risk of bias and certainty of evidence using GRADE.

Main Results:

• No significant difference in functional improvement or complications between simple decompression and transposition surgeries (submuscular/subcutaneous).
• Endoscopic decompression showed comparable clinical outcomes and complication rates to open decompression.
• Limited evidence suggests potential benefits of dextrose injections for pain and conservative advice for mild cases.

Conclusions:

• Low-to-moderate certainty evidence indicates comparable outcomes for different surgical decompression techniques in UNE.
• Moderate certainty evidence suggests no significant difference between endoscopic and open decompression.
• The efficacy of conservative treatments like steroid injections and patient education requires further investigation.