Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Nov 15;11(11):CD006839.
doi: 10.1002/14651858.CD006839.pub4.

Treatment for ulnar neuropathy at the elbow

Pietro Caliandro  1 , Giuseppe La Torre, Roberto Padua, Fabio Giannini, Luca Padua
Affiliations
Meta-Analysis

Treatment for ulnar neuropathy at the elbow

Pietro Caliandro et al. Cochrane Database Syst Rev. .

Update in

  • Treatment for ulnar neuropathy at the elbow.
    Caliandro P, La Torre G, Padua R, Giannini F, Reale G, Padua L. Caliandro P, et al. Cochrane Database Syst Rev. 2025 Apr 29;4(4):CD006839. doi: 10.1002/14651858.CD006839.pub5. Cochrane Database Syst Rev. 2025. PMID: 40298125

Abstract

Background: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome. Treatment may be conservative or surgical, but optimal management remains controversial. This is an update of a review first published in 2010 and previously updated in 2012.

Objectives: To determine the effectiveness and safety of conservative and surgical treatment in ulnar neuropathy at the elbow (UNE). We intended to test whether:- surgical treatment is effective in reducing symptoms and signs and in increasing nerve function;- conservative treatment is effective in reducing symptoms and signs and in increasing nerve function;- it is possible to identify the best treatment on the basis of clinical, neurophysiological, or nerve imaging assessment.

Search methods: On 31 May 2016 we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, AMED, CINAHL Plus, and LILACS. We also searched PEDro (14 October 2016), and the papers cited in relevant reviews. On 4 July 2016 we searched trials registries for ongoing or unpublished trials.

Selection criteria: The review included only randomised controlled clinical trials (RCTs) or quasi-RCTs evaluating people with clinical symptoms suggesting the presence of UNE. We included trials evaluating all forms of surgical and conservative treatments. We considered studies regarding therapy of UNE with or without neurophysiological evidence of entrapment.

Data collection and analysis: Two review authors independently reviewed titles and abstracts of references retrieved from the searches and selected all potentially relevant studies. The review authors independently extracted data from included trials and assessed trial quality. We contacted trial investigators for any missing information.

Main results: We identified nine RCTs (587 participants) for inclusion in the review, of which three studies were found at this update. The sequence generation was inadequate in one study and not described in three studies. We performed two meta-analyses to evaluate the clinical (3 trials, 261 participants) and neurophysiological (2 trials, 101 participants) outcomes of simple decompression versus decompression with submuscular or subcutaneous transposition; four trials in total examined this comparison.We found no difference between simple decompression and transposition of the ulnar nerve for both clinical improvement (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08; moderate-quality evidence) and neurophysiological improvement (mean difference (in m/s) 1.47, 95% CI -0.94 to 3.87). The number of participants to clinically improve was 91 out of 131 in the simple decompression group and 97 out of 130 in the transposition group. Transposition showed a higher number of wound infections (RR 0.32, 95% CI 0.12 to 0.85; moderate-quality evidence).In one trial (47 participants), the authors compared medial epicondylectomy with anterior transposition and found no difference in clinical and neurophysiological outcomes.In one trial (48 participants), the investigators compared subcutaneous transposition with submuscular transposition and found no difference in clinical outcomes.In one trial (54 participants for 56 nerves treated), the authors found no difference between endoscopic and open decompression in improving clinical function.One trial (51 participants) assessed conservative treatment in clinically mild or moderate UNE. Based on low-quality evidence, the trial authors found that information on avoiding prolonged movements or positions was effective in improving subjective discomfort. Night splinting and nerve gliding exercises in addition to information provision did not result in further improvement.One trial (55 participants) assessed the effectiveness of corticosteroid injection and found no difference versus placebo in improving symptoms at three months' follow-up.

Authors' conclusions: We found only two studies of treatment of ulnar neuropathy using conservative treatment as the comparator. The available comparative treatment evidence is not sufficient to support a multiple treatment meta-analysis to identify the best treatment for idiopathic UNE on the basis of clinical, neurophysiological, and imaging characteristics. We do not know when to treat a person with this condition conservatively or surgically. Moderate-quality evidence indicates that simple decompression and decompression with transposition are equally effective in idiopathic UNE, including when the nerve impairment is severe. Decompression with transposition is associated with more deep and superficial wound infections than simple decompression, also based on moderate-quality evidence. People undergoing endoscopic surgery were more likely to have a haematoma. Evidence from one small RCT of conservative treatment showed that in mild cases, information on movements or positions to avoid may reduce subjective discomfort.

PubMed Disclaimer

Conflict of interest statement

PC: none known

GLT: none known

RP: none known

FG: none known

LP: none known

Figures

1
1
A flow diagram illustrating the study selection process.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Forest plot of comparison: 1 Clinical and neurophysiological effect of simple decompression versus transposition, outcome: 1.1 Proportion of participants with clinical improvement in function compared to baseline.
4
4
Forest plot of comparison: 1 Clinical and neurophysiological effect of simple decompression versus transposition, outcome: 1.2 Postoperative motor nerve conduction velocity.
1.1
1.1. Analysis
Comparison 1 Clinical and neurophysiological effect of simple decompression versus transposition, Outcome 1 Proportion of participants with clinical improvement in function compared to baseline.
1.2
1.2. Analysis
Comparison 1 Clinical and neurophysiological effect of simple decompression versus transposition, Outcome 2 Postoperative motor nerve conduction velocity.
1.3
1.3. Analysis
Comparison 1 Clinical and neurophysiological effect of simple decompression versus transposition, Outcome 3 Proportion of participants with deep/superficial wound infections.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bartels 2005 {published data only}
    1. Bartels RH, Verhagen WI, Wilt GJ, Meulstee J, Rossum LG, Grotenhuis JA. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery 2005;56(3):522‐30. [PUBMED: 15730578] - PubMed
Biggs 2006 {published data only}
    1. Biggs M, Curtis JA. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery 2006;58(2):296‐304. [PUBMED: 16462483] - PubMed
Gervasio 2005 {published data only}
    1. Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. [Erratum appears in Neurosurgery. 2005 Feb;56(2):409]. Neurosurgery 2005;56(1):108‐17. [PUBMED: 15617592] - PubMed
Geutjens 1996 {published data only}
    1. Geutjens GG, Langstaff RJ, Smith NJ, Jefferson D, Howell CJ, Barton NJ. Medial epicondylectomy or ulnar‐nerve transposition for ulnar neuropathy at the elbow?. Journal of Bone and Joint Surgery. British Volume 1996;78(5):777‐9. [PUBMED: 8836069] - PubMed
Nabhan 2005 {published data only}
    1. Nabhan A, Ahlhelm F, Kelm J, Reith W, Schwerdtfeger K, Steudel WI. Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. Journal of Hand Surgery. British Volume 2005;30(5):521‐4. [PUBMED: 16061314] - PubMed
Schmidt 2014 {published data only}
    1. Schmidt S, Kleist Welch‐Guerra W, Matthes M, Baldauf J, Schminke U, Schroeder HW. Endoscopic vs open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized double‐blind study. Neurosurgery 2015;77(6):960‐70. [PUBMED: 26595347] - PubMed
Svernlov 2009 {published data only}
    1. Svernlöv B, Larsson M, Rehn K, Adolfsson L. Conservative treatment of the cubital tunnel syndrome. Journal of Hand Surgery. European Volume 2009;34(2):201–7. [PUBMED: 19282413] - PubMed
vanVeen 2015 {published data only}
    1. vanVeen KE, Alblas KC, Alons IM, Kerklaan JP, Siegersma MC, Wesstein M, et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: a randomized, double‐blind, placebo‐controlled trial. Muscle & Nerve 2015;52(3):380‐5. [PUBMED: 25522919] - PubMed
Zarezadeh 2012 {published data only}
    1. Zarezadeh A, Shemshaki H, Nourbakhsh M, Etemadifar MR, Moeini M, Mazoochian F. Comparison of anterior subcutaneous and submuscular transposition of ulnar nerve in treatment of cubital tunnel syndrome: a prospective randomized trial. Journal of Research in Medical Sciences 2012;17(8):745‐9. - PMC - PubMed

References to studies excluded from this review

Chen 2006 {published data only}
    1. Chen Y, Hong G, Wang F. Therapeutic effect evaluation of ulnar neurolysis and nerve anterior transposition with an immediate range of motion in the aged. Zhongguo Xiu Fu Chong Jian Ke Za Zhi 2006;20(8):809‐11. - PubMed
Zhong 2011 {published data only}
    1. Zhong W, Zhang W, Zheng X, Li S, Shi J. Comparative study of different surgical transposition methods for ulnar nerve entrapment at the elbow. Journal of International Medical Research 2011;39(5):1766‐72. - PubMed

Additional references

AAEM 1999
    1. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Muscle & Nerve 1999;22(3):408‐11. [PUBMED: 10086904] - PubMed
Bartels 2005a
    1. Bartels RH, Verhagen WI, Wilt GJ, Meulstee J, Rossum LG, Grotenhuis JA. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery 2005;56(3):522‐30. - PubMed
Bartels 2005b
    1. Bartels RH, Termeer EH, Wilt GJ, Rossum LG, Meulstee J, Verhagen WI, et al. Simple decompression or anterior subcutaneous transportation for ulnar neuropathy at the elbow: a cost‐minimization analysis: Part 2. Neurosurgery 2005;56(3):531‐6. - PubMed
Beekman 2004
    1. Beekman R, Schoemaker MC, Plas JP, Berg LH, Franssen H, Wokke JH, et al. Diagnostic value of high‐resolution sonography in ulnar neuropathy at the elbow. Neurology 2004;62(5):767‐73. - PubMed
Beekman 2009
    1. Beekman R, Schreuder AH, Rozeman CA, Koehler PJ, Uitdehaag BM. The diagnostic value of provocative clinical tests in ulnar neuropathy at the elbow is marginal. Journal of Neurology, Neurosurgery and Psychiatry 2009;80(12):1369‐74. - PubMed
Bell‐Krotoski 1987
    1. Bell‐Krotoski J, Tomancik E. The repeatability of testing with Semmes‐Weinstein monofilaments. Journal of Hand Surgery. American Volume 1987;12(1):155‐61. - PubMed
BMRC 1976
    1. Medical Research Council (Great Britain). Aids to examination of the peripheral nervous system. Medical Research Council Memorandum No. 45. London: Her Majesty’s Stationery Office, 1976.
Bordalo 2004
    1. Bordalo‐Rodrigues M, Rosenberg ZS. MR imaging of entrapment neuropathies at the elbow. Magnetic Resonance Imaging Clinics of North America 2004;12(2):247‐63, vi. - PubMed
Dellon 1989
    1. Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. Journal of Hand Surgery. American Volume 1989;14(4):688‐700. - PubMed
Dellon 1993
    1. Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8‐year prospective study. Neurology 1993;43(9):1673‐7. - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7(3):177‐88. - PubMed
Eaton 1980
    1. Eaton RG, Crowe JF, Parkes JC 3rd. Anterior transposition of the ulnar nerve using a non‐compressing fasciodermal sling. Journal of Bone and Joint Surgery. American Volume 1980;62(5):820‐5. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hudak 1996
    1. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and hand). The Upper Extremity Collaborative Group (UECG). American Journal of Industrial Medicine 1996;29(6):602‐8. - PubMed
Kleinman 1989
    1. Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. Journal of Hand Surgery. American Volume 1989;14(6):972‐9. - PubMed
Kuschner 1996
    1. Kuschner SH. Cubital tunnel syndrome: treatment by medial epicondylectomy. Hand Clinics 1996;12(2):411‐9. - PubMed
Macadam 2008
    1. Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta‐analysis. Journal of Hand Surgery. American Volume 2008;33(8):1314.e1‐12. - PubMed
Mondelli 2005
    1. Mondelli M, Giannini F, Ballerini M, Gianneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). Journal of the Neurological Sciences 2005;234(1‐2):5‐10. - PubMed
Mondelli 2006
    1. Mondelli M, Padua L, Giannini F, Bibbò G, Aprile I, Rossi S. A self‐administered questionnaire of ulnar neuropathy at the elbow. Neurological Sciences 2006;27(6):402‐11. - PubMed
Padua 2001
    1. Padua L, Aprile I, Mazza O, Padua R, Pietracci E, Caliandro P, et al. Neurophysiological classification of ulnar entrapment across the elbow. Neurological Sciences 2001;22(1):11‐6. - PubMed
Palmer 2010
    1. Palmer AB, Hughes TB. Cubital tunnel syndrome. Journal of Hand Surgery. American Volume 2010;35(1):153‐63. - PubMed
RevMan 2014 [Computer program]
    1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Robertson 2005
    1. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. Journal of Manipulative and Physiological Therapeutics 2005;28(5):345. - PubMed
Schünemann 2011
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Song 2012
    1. Song JW, Chung KC, Prosser LA. Treatment of ulnar neuropathy at the elbow: cost‐utility analysis. Journal of Hand Surgery. American Volume 2012;37(8):1617‐29. - PMC - PubMed
Sriwatanakul 1983
    1. Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G. Studies with different types of visual analog scales for measurement of pain. Clinical Pharmacology and Therapeutics 1983;34(2):234‐9. - PubMed
Tsai 1999
    1. Tsai TM, Chen IC, Majd ME, Lim BH. Cubital tunnel release with endoscopic assistance: results of a new technique. Journal of Hand Surgery. American Volume 1999;24(1):21‐9. - PubMed
Ware 1992
    1. Ware JE Jr, Sherbourne CD. The MOS 36‐item short‐form health survey (SF‐36). I. Conceptual framework and item selection. Medical Care 1992;30(6):473‐83. - PubMed
Zlowodzki 2007
    1. Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta‐analysis of randomized, controlled trials. Journal of Bone and Joint Surgery. American Volume 2007;89(12):2591‐8. - PubMed

References to other published versions of this review

Caliandro 2011
    1. Caliandro P, Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database of Systematic Reviews 2011, Issue 2. [DOI: 10.1002/14651858.CD006839.pub2] - DOI - PubMed
Caliandro 2012
    1. Caliandro P, Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database of Systematic Reviews 2012, Issue 7. [DOI: 10.1002/14651858.CD006839.pub3] - DOI - PubMed

Publication types

LinkOut - more resources