Conservative treatment of cubital tunnel syndrome: A systematic review

Abstract

Cubital tunnel syndrome (CuTS) is one of the most common compression neuropathies of the upper extremity. Conservative management of cubital tunnel syndrome is often considered first line therapy for mild or moderate symptoms; however, there is little evidence-based literature to guide physicians in this regard. As such, the objective of this study is to complete a comprehensive literature search of the conservative therapies available for treatment of CuTS. Additionally, we hope to assess the evidence for each therapy so that we can make evidence-based recommendations regarding the type and duration of optimal treatment. The databases MEDLINE, EMBASE, and CINAHL were search using a sensitive search strategy. Eligibility for studies included any studies or conference abstracts in which patients were treated conservatively for primary CuTS. Any form of non-operative treatment was acceptable. A data extraction form was developed to collect all information and outcomes of interest, including study design, level of evidence, number of patients, treatment modalities, follow-up time, patient reported outcomes, and electrophysiological markers. Qualitative and quantitative analysis was then completed based on the data extraction form. Given the heterogeneity of the included studies, results were summarized as best evidence available. Our sensitive literature search produced 6484 studies. Initial screening based on title and abstract resulted in the selection of 40 studies that underwent full text review. From these 19 studies were included for analysis in our systematic review. There were 3 level I studies, 4 level II studies, 3 level III studies, and 9 level IV studies. In total this included 844 patients. The most commonly reported outcomes included subjective patient reported outcomes and nerve conduction studies. The most common treatment modalities, from most to least common, included education and activity modification, splinting, steroid/lidocaine injection, nerve mobilization/gliding, pulsed ultrasound, laser therapy, non-steroidal anti-inflammatory drugs, and physiotherapy. The most common duration of therapy was 3 months with a median follow-up time of 3 months. There was moderate strength evidence to recommend the use of education/activity modification or splinting in mild or moderate CuTS. There is a paucity of literature and high-quality studies regarding the conservative management of CuTS. Regardless, there appears to be a role for non-operative management in CuTS, although further studies are needed to delineate this role further. In the cases of mild or moderate CuTS it is reasonable to trial education/activity modification or splinting as both appear to be equally effective.

Safety and Outcomes of Different Surgical Techniques for Cubital Tunnel Decompression

“…Second, a set of core outcome measures is needed to complement work on the minimal clinical important differences in ulnar neuropathy. 82 Thereafter, we echo calls 13 , 83 for comparative studies of operative vs nonoperative treatments. There is a paucity of data on nonoperative management, 84 and we have a responsibility to inform patients about the evidence for and against all management options.…”

The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review

“…With prolonged compression, demyelination and axonal loss follow, as well as nerve fascicles swelling leading to epineural fibrosis. Many treatment options are available to counter the effect of entrapment, conservative measures include splinting, tendon and nerve gliding exercise, physical modalities, and corticosteroids injection ( Huisstede et al, 2010 ; Kooner et al, 2019 ). Patients who respond poorly to those measures become candidates for surgical decompression or reconstruction ( Lauder et al, 2019 ).…”

Ultrasound‐Assisted Precise In Situ Decompression for Cubital Tunnel Syndrome

“…The cubital tunnel syndrome mainly forms because of long‐term and repeated elbow flexion that moves the ulnar nerve, thus increasing the internal tension of the cubital canal, which in turn affects the microcirculation in the nerve and ischemia and hypoxia cause nerve damage 2 . The early lesions of cubital tunnel syndrome can be treated with splinting at night time, thus keeping the elbows straight, medication, partial closure, and electro‐acupuncture 3 . Patients with severe signs and symptoms such as atrophy of interossei and weakness of handgrip strength might not improve with conservative management.…”