From the Research
The initial management for ulnar neuritis should focus on conservative measures, including activity modification, nighttime elbow padding or splinting, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy, as these approaches have been shown to reduce symptoms and improve function in patients with ulnar neuropathy at the elbow (UNE) 1.
Key Components of Conservative Management
- Activity modification to avoid positions that compress the nerve, such as prolonged elbow flexion, leaning on the elbow, or repetitive movements that aggravate symptoms
- Nighttime elbow padding or splinting in a neutral position (approximately 30-45 degrees of flexion) to prevent further irritation during sleep
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain
- Physical therapy incorporating nerve gliding exercises, stretching, and strengthening of surrounding muscles to improve symptoms and prevent recurrence
- Ergonomic modifications at work or during daily activities to avoid positions that compress the nerve
Rationale for Conservative Approach
The conservative approach is supported by the most recent and highest quality evidence, which indicates that simple decompression and decompression with transposition are equally effective in idiopathic UNE, including when the nerve impairment is severe 1. Additionally, conservative measures have been shown to be effective in reducing symptoms and improving function in patients with mild to moderate UNE 2.
Considerations for Further Management
If conservative measures fail to improve symptoms after 6-12 weeks, further management options, including surgical intervention, may be considered. However, the decision to proceed with surgery should be made on a case-by-case basis, taking into account the individual patient's symptoms, functional impairment, and overall health status.