Cubital tunnel syndrome: reviewing our conservative options
Leaning on your elbows too much can mean bad news, such as the onset of cubital tunnel syndrome. This week, we look at the conservative options available that address this condition.
With no promise of returning back to the office anytime soon, The LAB is continuing to see more problems associated with working from home, including cubital tunnel syndrome. Considered the second most common neuropathy of the upper extremity (first being carpal tunnel syndrome), cubital tunnel syndrome is caused by compression and irritation of the ulnar nerve, due to direct pressure on the inner elbow (near the “funny bone” region) or repetitive, maximal stretching into elbow flexion. This includes resting the elbows on a hard surface for long hours at a time.
The study:
Kooner et al performed a systematic review that looked at all conservative options for treating cubital tunnel syndrome. Twenty studies were included for analysis, with the most common outcome measures being patient-reported outcomes and nerve conduction studies. The average treatment duration was 3-months, with most intervention methods including education/activity modification, splinting, steroid/lidocaine injection, nerve mobilization/gliding, ultrasound, laser therapy, NSAIDs administration and physical therapy.
The results:
Two studies showed that activity modification and patient education alone resolved symptoms of 44-66% of patients after one year.
One study, a randomized controlled trial, compared activity modification/patient education with splinting and nerve gliding techniques. There were no significant differences between both groups, yet 90% of all participants demonstrated clinical improvement at 6-months.
One prospective cohort study looked at the effects of patients receiving splinting and activity modification over a 3-month period. Participants demonstrated improved questionnaire scores (DASH) and grip strength; 82% of patients became symptoms-free over a 2-year period.
One study showed no significant difference between steroid injections and placebo, with only 30% success rate for treatment.
Due to lack of heterogeneity, the systematic review had difficulty grouping which specific interventions trumped the others. There was also a lack of quality studies, and sample sizes were too small.
What it means:
Based on the studies, the author suggests that activity modification, patient education and splinting all prove to be among the most effective conservative means of addressing cubital tunnel syndrome.
Below are examples of exercises that also address cubital tunnel syndrome.
REFERENCES:
Kooner S, Cinats D, Kwong C, Matthewson G, Dhaliwal G. Conservative treatment of cubital tunnel syndrome: A systematic review. Orthop Rev (Pavia). 2019 Jun 12;11(2):7955. doi: 10.4081/or.2019.7955. PMID: 31281598; PMCID: PMC6589621.