A Cochrane review included 6 studies with a total of 430 subjects. There was no difference between simple decompression and transposition of the ulnar nerve (subcutaneous or submuscular) for either clinical improvement (RR 0.93, 95% CI 0.80 to 1.08; 3 studies, n=261) or neurophysiological improvement (RR 1.47, 95% CI –0.94 to 3.87; 2 studies, n=101). In the simple decompression group 91 out 131 patients clinically improved; in the transposition group 97 out 130 patients improved. Transposition showed a higher number of wound infections (RR 0.32, 95% CI 0.12 to 0.85). In one trial (n=47) there was no difference between medial epicondylectomy and anterior transposition in clinical or neurophysiological outcomes.
One RCT (n=51) compared different conservative approaches to treat clinically mild or moderate ulnar neuropathy. Provision of information on avoiding prolonged movements or positions was effective in improving subjective discomfort. Night splinting and nerve gliding exercises in addition to the information did not produce further improvement.
Comment: The quality of evidence is downgraded by indirectness (no comparison between surgical and conservative treatments).