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Dirsek Düzeyindeki Ulnar Sinir Tuzak Nöropatisinde Konservatif Tedavinin Yeri

Year 2025, Volume: 6 Issue: 3, 334 - 344, 28.09.2025
https://doi.org/10.47482/acmr.1643139

Abstract

Dirsek ulnar nöropatisi (DUN), ulnar sinirin dirsek bölgesinde sıkışması sonucu ortaya çıkan bir tuzak nöropatidir. Genellikle ağrı, uyuşma ve güçsüzlük gibi semptomlarla kendini gösterir. Konservatif tedavi yöntemleri arasında hasta eğitimi, aktivite modifikasyonu, egzersiz, fizik tedavi modaliteleri, splintleme, enjeksiyonlar ve oral tedaviler programları yer almaktadır. Konservatif tedaviler hastaların sinir fonksiyonlarını iyileştirmeyi ve ağrılarını azaltmayı amaçlamaktadır. Literatürde en fazla öne çıkanlardan biri olan splintleme, dirsek üzerindeki mekanik basıncı azaltarak semptomların hafifletilmesine yardımcı olurken, diğer ön plandaki fizik tedavi modaliteleri ise ağrı ve enflamasyonu kontrol ederek hastanın fonksiyonelliğine katkıda bulunur. Konservatif tedavilerin, cerrahi müdahale gereksinimini azaltarak hastaların yaşam kalitesini artırma potansiyeli önemlidir. Sonuç olarak, DUN’da konservatif tedavi yöntemleri, hastaların semptomlarını yönetme ve genel fonksiyonlarını iyileştirme açısından değerli bir seçenek sunmaktadır. Bu derleme, dirsek ulnar nöropatisinin tedavisinde konservatif yaklaşımların rolü, etkinliği ve uygulama stratejileri incelenmesi amaçlanmıştır

References

  • Landau ME, Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am. 2013;24(1):49-66.
  • Rubin G, Orbach H, Bor N, Rozen N. Tardy Ulnar Nerve Palsy. J Am Acad Orthop Surg. 2019;27(19):717-725.
  • Feindel W, Stratford J. Cubital tunnel compression in tardy ulnar palsy. Can Med Assoc J. 1958;78(5):351-353.
  • Posner MA. Compressive Ulnar Neuropathies at the Elbow: I. Etiology and Diagnosis. J Am Acad Orthop Surg. 1998;6(5):282-288.
  • Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234(1–2):5-10.
  • Ashworth NL, Huang C, Chan KM. Laterality and risk factors for ulnar neuropathy at the elbow. Muscle Nerve. 2020;61(1):101-104.
  • Andrews K, Rowland A, Pranjal A, Ebraheim N. Cubital tunnel syndrome: Anatomy, clinical presentation, and management. J Orthop. 2018;15(3):832-836.
  • David CP, Barbara S. Electromyography and Neuromuscular Disorders: Clinical Electrophysiologic Correlations. 3rd ed. London: Elsevier Saunders; 2013. p.385-398.
  • Ozcete ZA. Ulnar Nerve Entrapment Neuropathies. Türk Fiz Tıp Rehab Derg. 2010;56(4):190-195.
  • Abuzinadah AR, Addas BMJ. Ulnar Neuropathy at the Elbow Associated With Focal Demyelination in the Proximal Forearm and Intraoperative Imaging Correlation. Front Neurol. 2019;27(10):292.
  • Natroshvili T, van de Warenburg MS, Heine EP, Slater NJ, Walbeehm ET, Bartels RHMA. Conservative Treatment of Ulnar Nerve Compression at the Elbow: A Systematic Review and Meta-Analysis. Arch Plast Surg. 2023;50(1):70-81.
  • Nakamichi K, Tachibana S, Ida M, Yamamoto S. Patient Education for the Treatment of Ulnar Neuropathy at the Elbow. Arch Phys Med Rehabil. 2009;90(11):1839–1845.
  • Anderson D, Woods B, Abubakar T, et al. A Comprehensive Review of Cubital Tunnel Syndrome. Orthop Rev (Pavia). 2022;14(3):38239.
  • Beekman R, Wokke JH, Schoemaker MC, Lee ML, Visser LH. Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology. 2004;63(9):1675-1680.
  • Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther. 2005;28(5):345.
  • Hong CZ, Long HA, Kanakamedala RV, et al. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil. 1996;77(6):573–577.
  • Sailer SM. The role of splinting and rehabilitation in the treatment of carpal and cubital tunnel syndromes. Hand Clin. 1996;12(2):223-241.
  • Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology. 1993;43(9):1673-1677.
  • Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. J Hand Surg. 2013;38(6):1125-1130.
  • Svernlöv B, Larsson M, Rehn K, Adolfsson L. Conservative Treatment of the Cubital Tunnel Syndrome. J Hand Surg Eur Vol. 2009;34(2):201-207.
  • Carlson H, Colbert A, Frydl J, Arnall E, Elliot M, Carlson N. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol. 2010;5(1):129-142.
  • Lund AT, Amadio PC. Treatment of cubital tunnel syndrome: perspectives for the therapist. J Hand Ther. 2006;19(2):170-178.
  • Coppieters MW, Bartholomeeusen KE, Stappaerts KH. Incorporating nerve-gliding techniques in the conservative treatment of cubital tunnel syndrome. J Manipulative Physiol Ther. 2004;27(9):560-568.
  • Coppieters MW, Van De Velde M, Stappaerts KH. Positioning in anesthesiology: toward a better understanding of stretch-induced perioperative neuropathies. Anesthesiology. 2002;97(1):75-81.
  • Paik NJ, Cho SH, Han TR. Ultrasound therapy facilitates the recovery of acute pressure-induced conduction block of the median nerve in rabbits. Muscle Nerve. 2002;26(3):356-361.
  • Ozkan FU, Saygı EK, Senol S, et al. New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy. Acta Neurol Belg. 2015;115(3):355-360.
  • Oskay D, Meriç A, Kirdi N, Firat T, Ayhan C, Leblebicioğlu G. Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases. J Manipulative Physiol Ther. 2010;33(2):156-163.
  • Hong CZ, Liu HH, Yu J. Ultrasound thermotherapy effect on the recovery of nerve conduction in experimental compression neuropathy. Arch Phys Med Rehabil. 1988;69(6):410-414.
  • Sener Ö, Hizmetli S, Karadaǧ A, Hayta E. Investigation of Shortwave Diathermy Genotoxic Effect in Patients with Knee Osteoarthritis. Turk Osteoporoz Dergisi. 2019;25(2):53-57.
  • Fu T, Lineaweaver WC, Zhang F, Zhang J. Role of shortwave and microwave diathermy in peripheral neuropathy. J Int Med Res. 2019;47(8):3569-3579.
  • Bilgin Badur N, Unlu Ozkan F, Aktas I. Efficacy of shortwave diathermy in ulnar nerve entrapment at the elbow: a double-blind randomized controlled clinical trial. Clin Rehabil. 2020;34(8):1048-1055.
  • Naeser MA, Hahn KAK, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. Arch Phys Med Rehabil. 2002;83(7):978-988.
  • Sakurai Y, Yamaguchi M, Abiko Y. Inhibitory effect of low-level laser irradiation on LPS stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts. Eur J Oral Sci. 2000;108(1):29–34.
  • Çelik G, Doğan ŞK, Filiz MB. Evaluation of the efficacy of low-level laser therapy in the treatment of ulnar neuropathy at the elbow in terms of symptoms and clinical and electrophysiological findings: a randomized, prospective, double-blind clinical trial. Lasers Med Sci. 2024;39(1):243.
  • Suganthirababu P, Prathap L, Alagesan J, Kumaresan A, Srinivasan V, Ganesan D. Neurophysiological effect of low level laser therapy on ulnar nerve. Biomedicine (India). 2021;41(3):543-546.
  • vanVeen KE, Alblas KC, Alons IM, et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: A randomized, double-blind, placebo-controlled trial. Muscle Nerve. 2015;52(3):380-385.
  • Abdelrahman KM, Hackshaw KV. Nutritional Supplements for the Treatment of Neuropathic Pain. Biomedicines. 2021;9(6):674.
  • Bacle G, Marteau E, Freslon M, et al. Cubital tunnel syndrome: Comparative results of a multicenter study of 4 surgical techniques with a mean follow-up of 92 months. Orthop Traumatol Surg Res. 2014;100(4S):S205-S208.
  • Terlemez R, Yılmaz F. Ulnar sinir tuzak nöropatileri. Üst Ekstremite Tuzak Nöropatileri. Ed: Sarıdoğan M. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.22-30.
  • Gasco J. Surgical options for ulnar nerve entrapment: An example of individualized decision analysis. Hand. 2009;4(4):350-356.

The Role of Conservative Treatment in Ulnar Nerve Entrapment at the Elbow

Year 2025, Volume: 6 Issue: 3, 334 - 344, 28.09.2025
https://doi.org/10.47482/acmr.1643139

Abstract

Ulnar neuropathy at the elbow (UNE), is a condition characterized by the compression of the ulnar nerve in the elbow region. It typically presents with symptoms such as pain, numbness, and weakness. Conservative treatment methods include patient education, activity modification, exercise, physical therapy modalities, splinting, injections, and oral medications. These conservative treatments aim to improve nerve function and reduce pain. One of the most prominent approaches in the literature is splinting, which helps alleviate symptoms by reducing mechanical pressure on the elbow, while other physical therapy modalities contribute to pain control and inflammation management, enhancing the patient’s functionality. The potential of conservative treatments to decrease the need for surgical intervention and improve patients’ quality of life is significant. In conclusion, conservative treatment methods for cubital tunnel syndrome (CuTS) offer valuable options for managing symptoms and enhancing overall functionality. This review aims to examine the role, effectiveness, and application strategies of conservative approaches in the treatment of UNE.

Ethical Statement

Ethical committe approval is not required because of this article is a review article.

Supporting Institution

The author received no financial support for the research and/or authorship of this article.

References

  • Landau ME, Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am. 2013;24(1):49-66.
  • Rubin G, Orbach H, Bor N, Rozen N. Tardy Ulnar Nerve Palsy. J Am Acad Orthop Surg. 2019;27(19):717-725.
  • Feindel W, Stratford J. Cubital tunnel compression in tardy ulnar palsy. Can Med Assoc J. 1958;78(5):351-353.
  • Posner MA. Compressive Ulnar Neuropathies at the Elbow: I. Etiology and Diagnosis. J Am Acad Orthop Surg. 1998;6(5):282-288.
  • Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234(1–2):5-10.
  • Ashworth NL, Huang C, Chan KM. Laterality and risk factors for ulnar neuropathy at the elbow. Muscle Nerve. 2020;61(1):101-104.
  • Andrews K, Rowland A, Pranjal A, Ebraheim N. Cubital tunnel syndrome: Anatomy, clinical presentation, and management. J Orthop. 2018;15(3):832-836.
  • David CP, Barbara S. Electromyography and Neuromuscular Disorders: Clinical Electrophysiologic Correlations. 3rd ed. London: Elsevier Saunders; 2013. p.385-398.
  • Ozcete ZA. Ulnar Nerve Entrapment Neuropathies. Türk Fiz Tıp Rehab Derg. 2010;56(4):190-195.
  • Abuzinadah AR, Addas BMJ. Ulnar Neuropathy at the Elbow Associated With Focal Demyelination in the Proximal Forearm and Intraoperative Imaging Correlation. Front Neurol. 2019;27(10):292.
  • Natroshvili T, van de Warenburg MS, Heine EP, Slater NJ, Walbeehm ET, Bartels RHMA. Conservative Treatment of Ulnar Nerve Compression at the Elbow: A Systematic Review and Meta-Analysis. Arch Plast Surg. 2023;50(1):70-81.
  • Nakamichi K, Tachibana S, Ida M, Yamamoto S. Patient Education for the Treatment of Ulnar Neuropathy at the Elbow. Arch Phys Med Rehabil. 2009;90(11):1839–1845.
  • Anderson D, Woods B, Abubakar T, et al. A Comprehensive Review of Cubital Tunnel Syndrome. Orthop Rev (Pavia). 2022;14(3):38239.
  • Beekman R, Wokke JH, Schoemaker MC, Lee ML, Visser LH. Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology. 2004;63(9):1675-1680.
  • Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther. 2005;28(5):345.
  • Hong CZ, Long HA, Kanakamedala RV, et al. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil. 1996;77(6):573–577.
  • Sailer SM. The role of splinting and rehabilitation in the treatment of carpal and cubital tunnel syndromes. Hand Clin. 1996;12(2):223-241.
  • Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology. 1993;43(9):1673-1677.
  • Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. J Hand Surg. 2013;38(6):1125-1130.
  • Svernlöv B, Larsson M, Rehn K, Adolfsson L. Conservative Treatment of the Cubital Tunnel Syndrome. J Hand Surg Eur Vol. 2009;34(2):201-207.
  • Carlson H, Colbert A, Frydl J, Arnall E, Elliot M, Carlson N. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol. 2010;5(1):129-142.
  • Lund AT, Amadio PC. Treatment of cubital tunnel syndrome: perspectives for the therapist. J Hand Ther. 2006;19(2):170-178.
  • Coppieters MW, Bartholomeeusen KE, Stappaerts KH. Incorporating nerve-gliding techniques in the conservative treatment of cubital tunnel syndrome. J Manipulative Physiol Ther. 2004;27(9):560-568.
  • Coppieters MW, Van De Velde M, Stappaerts KH. Positioning in anesthesiology: toward a better understanding of stretch-induced perioperative neuropathies. Anesthesiology. 2002;97(1):75-81.
  • Paik NJ, Cho SH, Han TR. Ultrasound therapy facilitates the recovery of acute pressure-induced conduction block of the median nerve in rabbits. Muscle Nerve. 2002;26(3):356-361.
  • Ozkan FU, Saygı EK, Senol S, et al. New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy. Acta Neurol Belg. 2015;115(3):355-360.
  • Oskay D, Meriç A, Kirdi N, Firat T, Ayhan C, Leblebicioğlu G. Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases. J Manipulative Physiol Ther. 2010;33(2):156-163.
  • Hong CZ, Liu HH, Yu J. Ultrasound thermotherapy effect on the recovery of nerve conduction in experimental compression neuropathy. Arch Phys Med Rehabil. 1988;69(6):410-414.
  • Sener Ö, Hizmetli S, Karadaǧ A, Hayta E. Investigation of Shortwave Diathermy Genotoxic Effect in Patients with Knee Osteoarthritis. Turk Osteoporoz Dergisi. 2019;25(2):53-57.
  • Fu T, Lineaweaver WC, Zhang F, Zhang J. Role of shortwave and microwave diathermy in peripheral neuropathy. J Int Med Res. 2019;47(8):3569-3579.
  • Bilgin Badur N, Unlu Ozkan F, Aktas I. Efficacy of shortwave diathermy in ulnar nerve entrapment at the elbow: a double-blind randomized controlled clinical trial. Clin Rehabil. 2020;34(8):1048-1055.
  • Naeser MA, Hahn KAK, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. Arch Phys Med Rehabil. 2002;83(7):978-988.
  • Sakurai Y, Yamaguchi M, Abiko Y. Inhibitory effect of low-level laser irradiation on LPS stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts. Eur J Oral Sci. 2000;108(1):29–34.
  • Çelik G, Doğan ŞK, Filiz MB. Evaluation of the efficacy of low-level laser therapy in the treatment of ulnar neuropathy at the elbow in terms of symptoms and clinical and electrophysiological findings: a randomized, prospective, double-blind clinical trial. Lasers Med Sci. 2024;39(1):243.
  • Suganthirababu P, Prathap L, Alagesan J, Kumaresan A, Srinivasan V, Ganesan D. Neurophysiological effect of low level laser therapy on ulnar nerve. Biomedicine (India). 2021;41(3):543-546.
  • vanVeen KE, Alblas KC, Alons IM, et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: A randomized, double-blind, placebo-controlled trial. Muscle Nerve. 2015;52(3):380-385.
  • Abdelrahman KM, Hackshaw KV. Nutritional Supplements for the Treatment of Neuropathic Pain. Biomedicines. 2021;9(6):674.
  • Bacle G, Marteau E, Freslon M, et al. Cubital tunnel syndrome: Comparative results of a multicenter study of 4 surgical techniques with a mean follow-up of 92 months. Orthop Traumatol Surg Res. 2014;100(4S):S205-S208.
  • Terlemez R, Yılmaz F. Ulnar sinir tuzak nöropatileri. Üst Ekstremite Tuzak Nöropatileri. Ed: Sarıdoğan M. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.22-30.
  • Gasco J. Surgical options for ulnar nerve entrapment: An example of individualized decision analysis. Hand. 2009;4(4):350-356.
There are 40 citations in total.

Details

Primary Language English
Subjects Pain
Journal Section REVIEW ARTICLE
Authors

Gülşah Çelik 0009-0002-1170-4110

Publication Date September 28, 2025
Submission Date February 19, 2025
Acceptance Date May 7, 2025
Published in Issue Year 2025 Volume: 6 Issue: 3

Cite

APA Çelik, G. (2025). The Role of Conservative Treatment in Ulnar Nerve Entrapment at the Elbow. Archives of Current Medical Research, 6(3), 334-344. https://doi.org/10.47482/acmr.1643139

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