From the Research
Surgery for chronic ulnar neuropathy is typically recommended when conservative treatments have failed after 3-6 months, or when there is progressive neurological deficit, muscle atrophy, or severe symptoms affecting daily function. Conservative management should be attempted first, including activity modification, splinting, anti-inflammatory medications, and physical therapy 1. The choice of procedure depends on the specific anatomical cause of compression, severity of symptoms, and surgeon preference.
Key Considerations
- Surgical options include decompression (releasing the cubital tunnel), transposition (moving the nerve to a new position), or medial epicondylectomy (removing part of the medial epicondyle) 2.
- Simple decompression and decompression with transposition are equally effective in idiopathic ulnar neuropathy, including when the nerve impairment is severe 1.
- Patients with mild symptoms, intermittent numbness, or those who respond well to conservative measures may not need surgery 3.
- The decision should be individualized based on symptom severity, functional impairment, electrodiagnostic findings, and patient preferences after discussing potential benefits and risks with a specialist 4.
Recent Findings
- A recent study found that anterior subcutaneous transposition had the lowest recurrence rate with an excellent effectiveness and safety profile 5.
- Young age and good pre-operative neurological status were predictive of favorable outcome both at univariate and at multivariate analysis 5.
- Nerve transfers, such as the supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer, may be considered for severe ulnar neuropathies as a means of facilitating recovery 3.