From the Research
Chronic ulnar neuropathy is a condition characterized by damage to the ulnar nerve, typically causing numbness, tingling, and weakness in the hand, particularly affecting the ring and little fingers, and is often caused by compression of the nerve as it passes through the cubital tunnel at the elbow. The symptoms of chronic ulnar neuropathy can vary, but common symptoms include:
- Numbness or tingling in the ring and little fingers
- Weakness in the hand, particularly in the muscles controlled by the ulnar nerve
- Pain or discomfort in the elbow or hand
- Difficulty with fine motor activities, such as writing or using small objects
The causes of chronic ulnar neuropathy can include:
- Compression of the ulnar nerve as it passes through the cubital tunnel at the elbow
- Repeated pressure or stretching of the nerve, such as from leaning on the elbow or repetitive activities
- Trauma or injury to the elbow or hand
- Certain medical conditions, such as diabetes or rheumatoid arthritis
Treatment for chronic ulnar neuropathy typically begins with conservative measures, including:
- Activity modification to avoid pressure on the nerve, especially at the elbow
- Night splinting to keep the elbow in a neutral position
- Physical therapy focusing on nerve gliding exercises and strengthening to help maintain function
- Pain management with NSAIDs, such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) 1
If symptoms persist beyond 3-6 months despite conservative treatment, surgical options should be considered, including ulnar nerve decompression or transposition, as moderate-quality evidence indicates that simple decompression and decompression with transposition are equally effective in idiopathic ulnar neuropathy at the elbow 2. Surgery aims to relieve pressure on the nerve by either removing constricting tissue or relocating the nerve to prevent compression. Recovery from ulnar neuropathy can take months, and some patients may experience residual symptoms.
It is worth noting that the available comparative treatment evidence is not sufficient to support a multiple treatment meta-analysis to identify the best treatment for idiopathic ulnar neuropathy at the elbow on the basis of clinical, neurophysiological, and imaging characteristics 2. However, conservative management seems to be effective, with both lidocaine/steroid injections and splint devices giving a statistically significant improvement of symptoms, and splinting is preferred over injections, as it shows a higher rate of improvement 1.