Date Presented 04/05/19
Primary Author and Speaker: Eric Johnson
Additional Authors and Speakers: Drew Smiley
PURPOSE: This scoping review identified the most commonly used conservative interventions that occupational therapists can use in the treatment of cubital tunnel syndrome. There is a lack of research for the conservative treatment of CuTS and this study summarizes the current evidence and assists in identifying needs for future research.
DESIGN: Scoping review
METHODS: The five-stage methodological approach described by Arksey and O’Malley (2005) was used to identify the 42 articles for inclusion and guide the scoping process. This straightforward approach allows for increased reliability of findings and confirms that the methodological approach is exhaustive and replicable. The five stages are: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarizing, and reporting the results. The quality of each article was evaluated on the PEDro rating checklist and organized into levels of evidence according to Sackett. This hierarchy rating system of evidence based medicine (EBM) places randomized control trials (RCT) at the highest level and case series or expert opinions at the lowest.
RESULTS: Of the 42 articles included, 36 were considered poor quality (Pedro: 0-3, Sackett > 3) 30 expert opinion articles recommended: electrical stimulation, heat based thermal agents, ice massage, pulsed ultrasound, rest, massage, continuous ultrasound, icing, stretching, exercises, nerve gliding, patient education, elbow or hand pads, behavior and activity modification, and various orthosis and splints. Four single client case reports recommended: a comfort sling at 45° flexion for elbow protection, nerve gliding exercises, postural and strengthening exercises (wall push-ups), myofascial release of the tricep, wrist and elbow flexors, cubital tunnel and lumbricals, kinesio taping, and thrust manipulation to humeroulnar joint. Two case series recommended: dry needling, patient education, activity modification, neurodynamic mobilizations, nerve gliding exercises and tensioning techniques. Six higher level studies were found (Pedro: 5-9, Sackett level < 3). Two outcomes research recommended: activity modification, patient education, and rigid night splinting at 45° of elbow flexion. One comparative study used a night time polyform splint, fabricated in 30° to 35° elbow flexion, forearm slightly pronated (10° to 20°) and wrist/hand in neutral for 6 months. One systematic review recommended nocturnal elbow splinting preventing flexion and avoidance of hyperflexed (>90°) elbow postures at work or during avocational activities. Two randomized control studies recommended: continuous ultrasound, low level laser therapy, night time wear of a prefabricated Neoprene splint with aluminium that prevented flexion of more than 45°, and nerve gliding exercises.
CONCLUSION: This scoping review demonstrated the conservative treatment measures identified as being most beneficial supported by moderate to high level research (PEDro: 5-9, Sackett level < 3). This research included: night orthosis, activity modification, continuous ultrasound (US), low level laser therapy, and patient education. Lower quality evidence also supported nerve gliding, ultrasound, and pulsed ultrasound. There is a need for further research in specific treatment options for the conservative management of CuTS. Occupational therapy emphasizes interventions that directly treat the person and their environment. This scoping review identified a variety of conservative interventions that occupational therapists can use in the treatment of cubital tunnel syndrome. The strongest evidence is for the use of a night orthoses, activity modification, continuous ultrasound, low level laser therapy, and patient education.
References
Nakamichi, K., Tachibana, S., Ida, M., & Yamamoto, S. (2009). Patient education for the treatment of ulnar neuropathy at the elbow. Archives of Physical Medicine and Rehabilitation, 90(11), 1839–1845. doi:10.1016/j.apmr.2009.06.010
Ozturk, E., Sonmez, G., Çolak, A., Sildiroglu, H. O., Mutlu, H., Senol, M. G., Basekim, C. C. and Kizilkaya, E. (2008), Sonographic appearances of the normal ulnar nerve in the cubital tunnel. J. Clin. Ultrasound, 36: 325–329. doi:10.1002/jcu.20486
Shah, C. M., Calfee, R. P., Gelberman, R. H., & Goldfarb, C. A. (2013). Outcomes of Rigid Night Splinting and Activity Modification in the Treatment of Cubital Tunnel Syndrome. The Journal of Hand Surgery, 38(6), 1125-1130.e1. https://doi.org/10.1016/j.jhsa.2013.02.039
Svernlöv, B., Larsson, M., Rehn, K., & Adolfsson, L. (2009). Conservative treatment of the cubital tunnel syndrome. Journal of Hand Surgery (European Volume), 34(2), 201–207. doi:10.1177/1753193408098480
