How to treat ulnar neuritis?

Treatment of Ulnar Neuritis

The optimal treatment for ulnar neuritis involves a combination of conservative management with neutral forearm positioning, pain control, and physical therapy, with surgical intervention reserved for cases that fail to respond to conservative measures. 1

Diagnostic Evaluation

• Ultrasound is highly effective for diagnosing ulnar nerve entrapment with sensitivity of 77-79% and specificity of 94-98%, showing increased cross-sectional area and nerve thickness 1
• MRI without IV contrast is the reference standard, with T2-weighted MR neurography showing high signal intensity and nerve enlargement 1
• Electrodiagnostic studies (nerve conduction studies and EMG) help differentiate between demyelinating and axonal injury patterns 1, 2

Conservative Management

Positioning and Protection

• Maintain the forearm in neutral or supinated position to decrease pressure on the postcondylar groove of the humerus (ulnar groove) 3, 1
• Avoid flexion of the elbow beyond 90° as this increases risk of ulnar neuropathy 3, 1
• Periodic assessment of upper extremity position is essential to prevent complications 3

Pain Management

• Paracetamol (up to 4g/day) is the recommended first-line oral analgesic due to its efficacy and safety profile 3, 1
• Topical NSAIDs are preferred for localized pain with fewer systemic side effects 3, 1
• Oral NSAIDs should be used at the lowest effective dose and for the shortest duration in patients who respond inadequately to paracetamol 3, 1

Physical Therapy

• Range of motion and strengthening exercises are recommended to maintain function 3, 1
• Local application of heat (e.g., paraffin wax, hot pack) before exercise is beneficial 3
• Splints may be helpful to prevent further nerve compression, especially during sleep 3

Surgical Management

Indications for Surgery

• Failure to respond to conservative treatment after 2-3 months 4
• Presence of hand numbness on the ulnar side 4
• Ulnar nerve subluxation 4
• Concomitant ulnar collateral ligament injury 4
• Low Kerlan-Jobe Orthopaedic Clinic (KJOC) score (<45) 4

Surgical Options

• Simple decompression of the ulnar nerve at the elbow has shown good results with 87.5% of patients experiencing relief from symptoms 5
• Superficial anterior transposition of the ulnar nerve with epineural neurolysis and superficial stabilization has demonstrated 83% good or excellent results 6
• Surgical intervention allows patients to return to sports activities after approximately 2 months postoperatively 4

Prognosis

• Athletes with early treatment and minimal neurologic deficits have excellent prognosis for return to competitive play 7
• Patients with long-standing ulnar neuritis, severe lesions with intrinsic muscle dysfunction, and profound findings on EMG have less favorable outcomes 7
• Many cases of mild-moderate ulnar neuropathy at the elbow may remit spontaneously 2
• After successful surgical treatment, 92% of patients can return to sports with no limitation of activities 4

Monitoring and Follow-up

• Follow-up monitoring strategies should be determined by the location and severity of the lesion 1
• Periodic reassessment of symptoms and function is necessary to evaluate treatment response 1
• For athletes, gradual return to throwing or sport-specific activities should be implemented after symptoms resolve 4, 7