Clinical outcomes of ulnar nerve gliding exercise in the nonoperative treatment of cubital tunnel syndrome

Background

In cubital tunnel syndrome, inflammation and edema around the ulnar nerve inhibit physiologic nerve gliding, causing pain, paresthesia, and muscle weakness. The objective of this study was to investigate the clinical outcomes of our developed ulnar nerve gliding exercise for cubital tunnel syndrome.

Methods

Seventeen patients with cubital tunnel syndrome underwent ulnar nerve gliding exercise. All patients had numbness and paresthesia of the ulnar aspect of the forearm and hand and tenderness over the cubital tunnel. Before treatment, 15 patients had McGowan grade 2 (moderate) abnormality, and 2 patients had grade 3 (severe). For our nonsurgical ulnar nerve release, an occupational therapist applied repetitive passive wrist movement at maximal elbow flexion position to improve ulnar nerve gliding twice weekly for 20 minutes each session (average treatment period: 5.8 months). Data regarding the visual analog scale of paresthesia, rate of positive elbow flexion tests, Semmes–Weinstein monofilament test, grip strength, pulp pinch strength, and motor and sensory nerve conduction velocities (6 accepted patients) before ulnar nerve gliding exercise were compared with the values at the final follow-up (average follow-up period: 64 months).

Results

Ulnar nerve gliding exercise significantly decreased the severity of paresthesia overall (P < .0001). In addition, the elbow flexion test (P = .0002) and Semmes–Weinstein monofilament test (P < .0001) improved and grip strength (P < .0001) and pulp pinch strength (P < .0001) increased comparable to those on the contralateral side. Motor and sensory nerve conduction velocities after ulnar nerve gliding exercise improved in 5 of 6 patients (83%) and 4 of 6 patients (67%), respectively. One patient with McGowan grade 3 abnormality failed ulnar nerve gliding exercise and underwent anterior subcutaneous transposition of the ulnar nerve.

Conclusion

The ulnar nerve gliding exercise by using repetitive passive wrist movement at the maximal elbow flexion can be a useful option for moderate cubital tunnel syndrome.