From the Guidelines
Conservative treatment for chronic ulnar neuropathy should focus on reducing pressure on the nerve and managing symptoms, with initial management including activity modification, anti-inflammatory medications, and physical therapy, as these measures can help reduce inflammation and pain, and prevent further compression. The goal of conservative treatment is to alleviate symptoms, prevent further nerve damage, and improve quality of life.
- Activity modification is essential to avoid elbow flexion and direct pressure on the ulnar nerve, and patients should avoid leaning on the elbow, use an elbow pad for protection, and maintain the elbow in a neutral or slightly extended position during sleep 1.
- Nighttime elbow splinting at 30-45 degrees of flexion can prevent prolonged compression and is typically recommended for 3-6 weeks.
- Anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) can help reduce inflammation and pain, and are commonly used in the treatment of neuropathic pain 1.
- Physical therapy incorporating nerve gliding exercises, strengthening of the intrinsic hand muscles, and ergonomic training is beneficial for maintaining function and preventing further compression.
- For persistent symptoms, a corticosteroid injection near (but not into) the nerve may provide temporary relief, although the evidence for this is limited 1. It is essential to note that while these conservative measures can be effective, the evidence for their use in chronic ulnar neuropathy is not as strong as it is for other types of neuropathic pain, such as diabetic neuropathy or postherpetic neuralgia 1. Most patients should try conservative management for at least 6-12 weeks before considering surgical options, though treatment should be escalated if motor weakness progresses or symptoms significantly impact daily function.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Conservative Treatment Options
The conservative treatment options for chronic ulnar neuropathy include:
- Patient education and activity modification, which has been shown to be effective in improving subjective discomfort 2, 3, 4
- Night splinting, which offers clinical and functional improvement 4
- Physiotherapy trials, including ultrasound, low-level laser therapy, diathermy, extracorporeal shock wave therapy, and dry cupping 4
- Neurodynamic mobilization, which may add value to therapeutic approaches 4
- Avoidance of inappropriate arm positioning, which is recommended for patients with extrinsic compression in the retrocondylar groove 5
- Corticosteroid injections, which may play a role in selected cases, but their utility remains to be validated 4
Comparison of Conservative and Surgical Treatment
Studies have compared the effectiveness of conservative and surgical treatment for ulnar neuropathy at the elbow, including:
- A study that found no difference between simple decompression and decompression with transposition for both clinical improvement and neurophysiological improvement 2, 3
- A study that found in situ decompression may result in faster relief of symptoms when compared with conservative treatment, but no differences were observed at long-term follow-up 6
- A study that found patients with ulnar neuropathy at the elbow improve following both surgical decompression and non-operative treatment, with similar proportions of patients reporting clinical improvement 5
Specific Conservative Treatment Approaches
Specific conservative treatment approaches that have been studied include: