UNE Treatment

Background: Ulnar neuropathy at the elbow (UNE) is primarily caused by entrapment in the cubital tunnel (CTE) or by external compression in the retrocondylar groove (RGC). This study examines the utility of surgery in UNE due to entrapment and external compression in a randomized controlled trial. Methods: Consecutive UNE patients referred to a single referral centre were categorized into CTE and RGC groups. Each group was randomly assigned to either surgery or conservative treatment by throwing the dice. After a one-year follow-up, their clinical, electrodiagnostic (EDx), and ultrasonographic (US) outcomes were compared. The primary outcome measure was the percentage of patients with markedly improved symptoms. Examiners were blinded to group assignment. We anticipated better results in surgically treated CTE patients, but expected no differences among the RGC groups. Findings: There were 32 CTE–surgery, 33 CTE–conservative, 33 RGC–surgery, and 32 RGC–conservative UNE patients analysed. The proportion of patients reporting markedly improved symptoms did not differ significantly across the four groups. However, among the CTE surgery patients, the percentage of individuals with decreased clinical severity, improved small finger abduction strength, increased motor nerve conduction velocity, and reduced maximal nerve cross-sectional area significantly improved compared to the CTE conservative group. In the RGC groups, no consistent difference in improvement was found. Interpretation: Although the primary outcome measure did not achieve statistical significance, several positive secondary outcomes in the CTE surgery arm support the preference for surgical intervention over conservative treatment for UNE patients with CTE. In contrast, the findings do not favour surgery for RGC patients.