Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: Clinical and electrophysiological evaluation

Abstract

Objective: To compare the effects of splinting alone in the treatment of ulnar nerve lesion at the elbow with the effects of applying a local steroid injection in addition to splinting. Design: Twelve nerves of 10 patients were randomly assigned into two groups: 5 nerves in Group A were treated with elbow splinting only; 7 nerves in Group B were treated with local steroid injection in addition to splinting. Therapeutic effects were assessed 1 and 6 months after treatment. Setting: Patients were selected from an outpatient clinic of a VA Medical Center. Patients: Ten patients (12 nerves) with ulnar neuropathy at the elbow confirmed by electrodiagnostic tests. Interventions: Elbow splint was given to patients of both Groups A and B. A single dose of 40mg triamcinolone plus 1 mL of 1% lidocaine was injected around the ulnar nerve at the elbow of Group A patients. Main Outcome Measures: Clinical evaluation of symptoms and signs, and ulnar motor and sensory nerve conduction studies were performed before, 1 month after, and 6 months after treatment. Results: There was significant improvement in symptoms in both groups at 1 and 6 months after treatment. Ulnar motor nerve conduction velocity across the elbow improved at 1 month in Group A only, but showed improvement at 6 months in both groups. There was no significant change in the other parameters either at 1 or 6 months in both groups. In comparing the differences between Groups A and B regarding the changes at 1 or 6 months after treatment, there was no significant difference between the two groups in all parameters. Conclusions: Splint application alone is adequate to improve the symptoms and ulnar nerve conduction across the elbow. The addition of a steroid injection did not provide further benefit in the treatment of cubital tunnel syndrome.