Treatment of Ulnar Nerve Impingement

Initial Diagnostic Workup

The American College of Radiology recommends obtaining plain radiographs first to exclude osseous abnormalities, fractures, or arthritis that may contribute to nerve compression 3
Electrodiagnostic studies, including nerve conduction studies and EMG, should be performed to confirm the diagnosis, localize the site of compression, differentiate demyelinating from axonal injury, and establish baseline severity 2, 4
MRI without IV contrast may be ordered if diagnosis remains unclear or to evaluate for space-occupying lesions, with T2-weighted neurography showing high signal intensity and nerve enlargement at the compression site 2, 4
Ultrasound may be considered as an alternative imaging modality with high diagnostic accuracy (sensitivity 77-79%, specificity 94-98%) for assessing nerve cross-sectional area and thickness 2, 4

The American College of Medicine recommends starting with paracetamol up to 4g daily as first-line oral analgesic due to its favorable efficacy and safety profile 1, 2, 4
Topical NSAIDs may be used for localized pain to minimize systemic side effects 1, 2, 4
Oral NSAIDs may be added at the lowest effective dose for the shortest duration only if paracetamol provides inadequate relief 1, 4
Range of motion and strengthening exercises should be prescribed to maintain elbow and wrist function 1, 2, 4
Local heat may be applied before exercise to enhance tissue flexibility and reduce discomfort 1, 4

Electrodiagnostic studies should be repeated if symptoms worsen to assess for progression from demyelinating to axonal injury 4