Main idea: This study suggests that in situ decompression for mild ulnar neuropathy at the elbow results in faster relief of symptoms when compared to conservative treatment, but at long-term follow-up, no differences were observed.
Abstract: The best treatment strategy for mild ulnar neuropathy at the elbow (UNE) is not known, due to the lack of trials comparing surgery vs conservative treatment. We recruited patients with clinical symptoms and signs of mild UNE and an electrophysiologically or sonographically confirmed diagnosis. Patients were randomly allocated to either in situ decompression or conservative treatment. The primary outcome was the proportion of patients with subjective symptom improvement at short-term (3 months) and long-term (6-12 months) follow-up. n situ decompression for mild UNE may result in faster relief of symptoms when compared with conservative treatment, but at long-term follow-up, no differences were observed. Because of the aforementioned difficulties of our study, further research seems warranted to confirm these results. Future studies may need to adjust their design to take patient preferences for treatment options into account, include the whole clinical spectrum of patients with ulnar neuropathy at the elbow, use a combination of validated subjective and objective outcome measures, and adopt a standardized electrodiagnostic and sonographic evaluation to identify subgroups based on exact localization, presumed etiology and prognostic factors.