From the Guidelines
Ulnar nerve neuritis is best diagnosed and treated with a combination of conservative measures, including rest, avoiding pressure on the elbow, and anti-inflammatory medications, as well as physical therapy and potentially corticosteroid injections or surgical decompression for persistent symptoms. The diagnosis of ulnar nerve neuritis typically involves a clinical evaluation, including a physical examination and medical history, to identify symptoms such as pain, numbness, and tingling in the ring and little fingers 1.
Key Considerations
- The condition often results from compression at the elbow's cubital tunnel or repetitive elbow flexion, which stretches the nerve around the medial epicondyle 1.
- Conservative treatment measures include rest, avoiding pressure on the elbow, and anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks 1.
- Night splinting to keep the elbow straight can prevent further irritation, and physical therapy focusing on nerve gliding exercises and strengthening of surrounding muscles is beneficial 1.
- For persistent symptoms, a corticosteroid injection near (but not into) the nerve may provide relief, and in severe cases lasting more than 3-6 months despite conservative treatment, surgical decompression or transposition of the nerve may be necessary 1.
Diagnostic Approaches
- Imaging studies, such as radiographs, may be beneficial in assessing chronic elbow pain and can help identify intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, occult fractures, or osteoarthritis 1.
- Electromyography can assist in the workup related to nerve symptoms, and musculoskeletal ultrasound (US) can be used to identify synovitis, joint effusion, tenosynovitis, tendinopathy, and tendon injury, as well as to assess for entrapment of the median or ulnar nerves 1.
Prevention and Management
- Patients should avoid leaning on elbows, prolonged elbow flexion, and repetitive activities that aggravate symptoms to prevent recurrence 1.
- Optimize glucose control to prevent or delay the development of neuropathy in patients with diabetes, as diabetic neuropathy can be a contributing factor to ulnar nerve neuritis 1.
- Assess and treat patients to reduce pain related to neuropathy and improve quality of life, considering pharmacologic treatments such as pregabalin or duloxetine for neuropathic pain in diabetes 1.
From the Research
Diagnosis of Ulnar Nerve Neuritis
- The diagnosis of ulnar nerve neuritis is based on clinical symptoms, such as dysesthesia, weakness, and atrophy in the area of distribution of the nerve 2.
- Neurophysiological evidence of entrapment may also be used to support the diagnosis 3, 4, 5, 6.
Treatment of Ulnar Nerve Neuritis
- Initial treatment for acute and subacute neuropathy at the elbow is nonsurgical, and may include rest, avoiding pressure on the nerve, and splint immobilization of the elbow and wrist 3.
- Conservative treatment, such as information on avoiding prolonged movements or positions, may be effective in improving subjective discomfort in mild cases 4, 5, 6.
- Surgical treatment, such as simple decompression or decompression with transposition, may be necessary for chronic neuropathy or when conservative treatment is unsuccessful 3, 4, 5, 6.
- The choice of surgical procedure depends on the severity of the neuropathy and the individual patient's needs, with submuscular transposition being a commonly preferred procedure 3.
- Endoscopic decompression is also an option, but may be associated with a higher risk of haematoma 5.
- Corticosteroid injection has been shown to be no more effective than placebo in improving symptoms at three months' follow-up 5.
Comparison of Treatment Options
- Simple decompression and decompression with transposition have been shown to be equally effective in improving clinical and neurophysiological outcomes 4, 5, 6.
- Transposition may be associated with a higher risk of wound infections compared to simple decompression 4, 5, 6.
- Medial epicondylectomy and anterior transposition have been shown to be equally effective in improving clinical and neurophysiological outcomes 4, 6.