Conservative Cubital Tunnel Syndrome Interventions: A Scoping Review

Eric Johnson, OST Student; Steven Kolb, OST Student; Rebecca Roerig, OST Student; Drew Smiley, OST Student
Jeanine Beasley, EdD, OTR, CHT, FAOTA; Carla Floyd-Slabaugh, DrOT, OTRL, CBIS; & Betsy Williams, MSLIS

Grand Valley State University: Grand Rapids, Michigan

BACKGROUND & SIGNIFICANCE SEARCH STRATEGY RESULTS

Summary of Results for High and Fair Level Studies
Cubital Tunnel Syndrome (CuTS) is the second most prevalent nerve Databases: Intervention Outcome
Level IB Studies (2)- Highest Level of Evidence
PEDRO Score

entrapment syndrome secondary to carpal tunnel syndrome. There is very PubMed, CINAHL, Continuous Ultrasound
(5 min 1 MHz 1.5 w/cm2)
Statistically significant improvement in pain 9/11- High

little high-level research that demonstrates the effectiveness of conservative OTseeker, and Web of Science Elbow Extension Orthosis Statistically significant improvement in COPM and nighttime pain 5/11- Fair

Nerve Gliding Statistically significant improvement in COPM, VAS, and nighttime pain 5/11-Fair
treatment methods for CuTS.
Key search terms and subject headings Patient Education and Activity Modification Statistically significant improvement in COPM, VAS, and nighttime pain 5/11-Fair

Level 2A Study
Symptoms include: Cubital Tunnel syndrome Night Orthoses to Avoid Flexion, and Ultrasound Systematic Literature Review-Consensus Recommendations N/A
Conservative treatment/treatments
o Pain, sensory changes, and motor deficits (Lund & Amadio, 2006), Conservative management
Night Orthosis and Activity Modification
Level 2B and 2C Studies (3)
Improved nerve conduction study, Tinel’s, and Symptom self-assessment 7/11-High
Conservative therapy or therapies
weakened hand strength, Rehabilitation
o Decreased precision, and pinching abilities (Oskay et al., 2010)
Rigid Night Orthosis and Activity Modification Statistically significant results were demonstrated on the QuickDash 6/11-High
Ulnar neuropathy or neuropathies
66% Excellent outcomes on the Modified Akahori’s Classification System

o Can include loss of grip and pinch strengths, and clumsiness (Nakamichi,
Patient Education and Activity Modification 5/11-Fair
Ulnar neuritis
Ulnar nerve Level 4 Studies (2) – Case Series
Tachibana, Ida, & Yamamoto, 2009) Nerve Compression Patient Education, Nerve Mobilization, Ultrasound, Icing, Stretching Statistically significant results found for DASH-T scores N/A

Elbow Injuries
Dry Needling Clinically significant results for NPRS, pain-free grip strength, PSFS, and GROC N/A
scores

PURPOSE OF THE STUDY Inclusion Criteria

Cubital tunnel syndrome diagnosis Orthosis
Level 5 Studies (30) Expert Opinions

23

Receiving conservative treatment Behavior/activity modifications 19

Elbow/hand pads 17

To identify the most effective conservative rehabilitative Exclusion Criteria

Education 16

Conservative Interventions
Nerve gliding 7

interventions for CuTS through a scoping review. Surgical Exercise 5

Steroid injection Stretching 5

Medication-based solutions Icing 3

Person
Environment
CONNECTION TO OCCUPATIONAL Continuous ultrasound

Massage 2
3

Occupation

THERAPY Rest

Pulsed ultrasound
2

Ice massage 1

Biomechanical: Non-invasive approach for treating moderate CuTS Heat based thermal agents 1

DATA ANALYSIS
Electrical Stimulation 1
symptoms 0 5 10 15 20 25
Frequency of Interventions Used in Studies

Person-Environment-Occupation (PEO): Interventions grouped into how

they related to the Person, Environment, and Occupation (see results)

Rating and CONCLUSIONS

RESEARCH DESIGN Level of
Evidence Occupational Therapy Cubital Tunnel Interventions:

• Scoping review to identify and assess the current literature as it pertains to conservative treatment 1. There is some evidence of high quality to support: a night orthoses that prevents
options for cubital tunnel syndrome.
elbow flexion, activity modifications, and continuous ultrasound.
• A scoping review is an effective process of summarizing a range of existing evidence and
evaluating the need for continued research. 2. There is some evidence of fair quality to support the above with the addition of
• Scoping research questions are broad and focus on describing the breadth of evidence. patient education and nerve gliding.
• Followed the Arksey and O’Malley five stage methodological framework described for conducting a 3. There is some evidence of poor quality to support all of the above with the
scoping review. addition of dry needling, icing, and stretching.
4. There is consensus support with expert opinion for the interventions listed above
42 Articles Selected and also: elbow pads, massage, heat, pulsed ultrasound, and electrical
6 high level studies (Pedro: 5-9, Sacket level <3) stimulation.
5. Future research needed to evaluate each of these interventions individually and in
36 were considered poor quality (Pedro: 0-3, Sacket >3)
combination to determine the best conservative management of CuTS.
2 were case series
4 were single client case reports
30 were expert opinion
References available upon request: johnseri@mail.gvsu.edu