From the Research
The best approach to manage a patient with symptoms of ulnar nerve compression or neuropathy, presenting with tingling and numbness in the 4th and 5th digits, is to start with conservative treatment for mild to moderate symptoms, including avoiding activities that aggravate symptoms, nighttime elbow padding or splinting, and anti-inflammatory medications, rather than immediately proceeding with a steroid injection. This approach is supported by the fact that ulnar nerve compression can be managed conservatively in many cases, and surgical or injectable treatments are typically reserved for patients with persistent symptoms or significant nerve damage 1.
Some key considerations in managing ulnar nerve compression include:
- Avoiding activities that aggravate symptoms, particularly those involving elbow flexion or direct pressure on the nerve
- Using nighttime elbow padding or splinting in a neutral position to prevent further irritation during sleep
- Prescribing anti-inflammatory medications like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to help reduce inflammation and pain
- Recommending physical therapy focusing on nerve gliding exercises and strengthening of surrounding muscles to improve symptoms and prevent recurrence
For patients with persistent symptoms despite 6-8 weeks of conservative management, or those with muscle weakness or atrophy, surgical decompression should be considered, with options including in-situ decompression or anterior transposition 1. It's also important to note that other conditions, such as trigger points in the teres minor muscle, can mimic the symptoms of ulnar nerve compression, and a thorough diagnosis should be made before initiating treatment 2.
In terms of the use of steroid injections, while some studies have suggested potential benefits, a randomized, double-blind, placebo-controlled trial found no significant difference in outcomes between patients receiving ultrasound-guided corticosteroid injection and those receiving a placebo injection 1. Therefore, steroid injections should not be the first line of treatment for ulnar nerve compression, and conservative management should be attempted first.