Ulnar neuropathy at the elbow: from diagnosis to rehabilitation

Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy of the upper limb, involving physical medicine and rehabilitation, neurology, orthopedics, and plastic surgery. It results from static or dynamic ulnar nerve instability, cubital tunnel syndrome, or space-occupying lesions. Accurate diagnosis requires thorough history, clinical examination, and selection of appropriate diagnostic tests.

PubMed/MEDLINE, Scopus and Web of Science were searched (January 2000-August 2026) using combinations of "ulnar neuropathy", "cubital tunnel syndrome", "elbow", "ultrasound", "electrodiagnosis", "conservative treatment", "rehabilitation" and "surgery". English-language original studies, systematic reviews and meta-analyses were eligible; case reports were included only where no higher-level evidence existed. Approximately 220 records were screened; 58 were retained, following SANRA recommendations for narrative reviews.

High-resolution ultrasound provides dynamic, non-invasive, cost-effective evaluation of the ulnar nerve and real-time assessment of compression or instability, and guides minimally invasive procedures such as perineural injections, although the only randomized placebo-controlled trial did not show superiority of corticosteroid injection over placebo. Conservative treatment is usually first-line, although surgery may be required in advanced or refractory cases; comparative evidence shows no clear superiority among surgical techniques, while endoscopic decompression carries a higher complication rate than open approaches.

This narrative review summarizes current evidence on diagnostic pathways and therapeutic options for UNE, highlighting the role of ultrasound as both a diagnostic and interventional tool, and outlines gaps in the literature regarding standardized conservative and surgical protocols.