From the Guidelines
The primary treatment for ulnar nerve radiculopathy should start with conservative measures, including rest, activity modification, NSAIDs, physical therapy, and night splinting, with surgical intervention considered only if symptoms persist or worsen despite these efforts. When considering treatment options, it's essential to prioritize approaches that minimize morbidity, mortality, and improve quality of life. For ulnar nerve radiculopathy, the initial steps should include:
- Rest and activity modification: Avoid activities that aggravate symptoms for 2-4 weeks.
- NSAIDs: Take ibuprofen 400-600mg every 6-8 hours or naproxen 250-500mg twice daily for pain and inflammation, as these are commonly recommended for chronic pain conditions, including neuropathic pain 1.
- Physical therapy: Engage in nerve gliding exercises and stretches 2-3 times daily for 4-6 weeks, which can help improve nerve mobility and reduce compression.
- Night splinting: Use an elbow brace to keep the arm slightly bent (10-20 degrees) while sleeping, to reduce pressure on the ulnar nerve.
- Ergonomic adjustments: Modify workstation and daily activities to reduce nerve compression, which is crucial for preventing further irritation and allowing the nerve to heal.
If symptoms persist after 6-8 weeks of conservative treatment, consider:
- Corticosteroid injections: A single injection of methylprednisolone 40mg with lidocaine near the affected nerve root, which can help reduce inflammation and alleviate pressure on the nerve.
- Surgical decompression: If symptoms are severe or persist for more than 3 months despite conservative measures, surgical intervention may be necessary to physically decompress the nerve.
These treatments aim to reduce inflammation, alleviate pressure on the ulnar nerve, and promote healing, with the goal of minimizing morbidity, mortality, and improving quality of life. It's crucial to consult a healthcare professional for a proper diagnosis and to develop a personalized treatment plan, as the effectiveness of these treatments can vary depending on the individual case and the severity of the condition, as noted in studies on chronic pain management 1.
From the Research
Treatments for Ulnar Nerve Radiculopathy
- Conservative treatment options include:
- Information on avoiding prolonged movements or positions to improve subjective discomfort 2, 3, 4
- Night splinting and nerve gliding exercises, although these may not produce further improvement 2, 3, 4
- Lidocaine/steroid injections, which showed a statistically significant improvement of symptoms 5
- Splint devices, which showed a higher rate of improvement compared to injections 5
- Surgical treatment options include:
- Simple decompression, which is equally effective as decompression with transposition for clinical and neurophysiological improvement 2, 3, 4
- Decompression with transposition, which may have a higher number of wound infections 2, 3, 4
- Medial epicondylectomy, which showed no difference in clinical and neurophysiological outcomes compared to anterior transposition 2, 3, 4
- In situ decompression, which may result in faster relief of symptoms compared to conservative treatment, but with no differences at long-term follow-up 6
- The available evidence is not sufficient to identify the best treatment for idiopathic ulnar neuropathy at the elbow on the basis of clinical, neurophysiological, and imaging characteristics 2, 3, 4
- The choice of treatment may depend on the severity of the condition, with conservative treatment being suitable for mild cases and surgical treatment being considered for more severe cases 2, 3, 4, 6