Abstract:
BACKGROUND:Ulnar neuropathy at the elbow is the second most common entrapment neuropathy after carpal tunnel syndrome. Treatment may be conservative or surgical but optimal management remains controversial. This is an update of a review first published in 2010. OBJECTIVES:To determine the effectiveness and safety of conservative and surgical treatments in ulnar neuropathy at the elbow. SEARCH METHODS:We searched the Cochrane Neuromuscular Disease Group Specialized Register (20 February 2012), CENTRAL (2012, Issue 2), MEDLINE (January 1966 to February 2012), EMBASE (January 1980 to February 2012), AMED (January 1985 to February 2012), CINAHL Plus (January 1937 to February 2012), LILACS (January 1982 to Feburary 2012), PEDro (January 1980 to February 2012), and the papers cited in relevant reviews. SELECTION CRITERIA:The review included only randomised controlled clinical trials (RCTs) or quasi-RCTs evaluating people with clinical symptoms suggesting the presence of ulnar neuropathy at the elbow. We included trials evaluating all forms of surgical and conservative treatments. We considered studies regarding therapy of ulnar neuropathy at the elbow with or without neurophysiological evidence of entrapment. DATA COLLECTION AND ANALYSIS:Two authors independently reviewed titles and abstracts of references retrieved from the searches and selected all potentially relevant studies. The authors extracted data from included trials and assessed trial quality independently. They contacted trial investigators for missing information. MAIN RESULTS:We identified six RCTs (430 participants), with moderate quality evidence, for inclusion in the review. When the searches were updated in 2012 we found no further studies. The sequence generation was not adequate in one study and not described in two studies. We performed two meta-analyses to evaluate the clinical (three trials, 261 participants included) and neurophysiological (two trials, 101 participants included) outcomes of simple decompression versus decompression with submuscular or subcutaneous transposition.We found no difference between simple decompression and transposition of the ulnar nerve for both clinical improvement (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08) and neurophysiological improvement (mean difference (in m/s) 1.47, 95% CI -0.94 to 3.87). 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 (47 participants) the authors compared medial epicondylectomy with anterior transposition and found no difference in the clinical and neurophysiological outcomes.One trial (51 participants) assessed conservative treatment in clinically mild or moderate ulnar neuropathy at the elbow. The authors found that 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. AUTHORS' CONCLUSIONS:The available evidence is not sufficient to identify the best treatment for idiopathic ulnar neuropathy at the elbow on the basis of clinical, neurophysiological and imaging characteristics. We do not know when to treat a patient conservatively or surgically. However, the results of our meta-analysis suggest that simple decompression and decompression with transposition are equally effective in idiopathic ulnar neuropathy at the elbow, including when the nerve impairment is severe. In mild cases, evidence from one small RCT of conservative treatment showed that information on movements or positions to avoid may reduce subjective discomfort.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Caliandro P,La Torre G,Padua R,Giannini F,Padua Ldoi
10.1002/14651858.CD006839.pub3subject
Has Abstractpub_date
2012-07-11 00:00:00pages
CD006839issue
7issn
1469-493Xpub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) causes progressive or relapsing weakness and numbness of the limbs, developing over at least two months. Uncontrolled studies suggest that intravenous immunoglobulin (IVIg) helps. OBJECTIVES:To review systematically the evidence from randomise...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD001797.pub2
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abstract:BACKGROUND:Nedocromil sodium and sodium cromoglycate inhaled shortly before exercise appear to reduce the severity of exercise-induced bronchoconstriction. There is some debate over which drug may be more effective. OBJECTIVES:The objective of this review was to compare the effects on post-exercise lung function betwe...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002731
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abstract:OBJECTIVES:To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. SEARCH STRATEGY:We used Medline, Popline, and EMBASE computer searches, supplemented by review articles and contacts with investigators. SELECTION CRITERIA:We sought all randomized controlled trials that h...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD001777
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Epileptic seizures occur in only a minority of patients with multiple sclerosis (MS), but can have serious consequences. The available literature suggests an association of seizures in MS with cortical and subcortical demyelinating lesions, which suggest that seizures in MS are probably most often symptomati...
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abstract:BACKGROUND:When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. While there are risks and benefits for both planned elective repeat caesarean birth and planned vaginal birth after caesarean, current sou...
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abstract:BACKGROUND:Inflammation and oedema of the facial nerve due to viral infection by the herpes zoster virus are implicated in the aetiology and clinical manifestation of Ramsay Hunt syndrome (herpes zoster oticus with facial palsy). Corticosteroids, with their powerful anti-inflammatory effect, have a potential role to pl...
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doi:10.1002/14651858.CD006852.pub2
更新日期:2008-07-16 00:00:00
abstract:BACKGROUND:Meningococcal disease begins suddenly and death can follow within hours. Pre-admission antibiotic therapy aims to prevent delay in starting therapy that occurs if bacterial confirmation is sought before instituting therapy. OBJECTIVES:To study the effectiveness and safety of pre-admission antibiotics versus...
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doi:10.1002/14651858.CD005437.pub2
更新日期:2008-01-23 00:00:00
abstract:BACKGROUND:Prostaglandins have mainly been used for postpartum haemorrhage (PPH) when other measures fail. Misoprostol, a new and inexpensive prostaglandin E1 analogue, has been suggested as an alternative for routine management of the third stage of labour. OBJECTIVES:To assess the effects of prophylactic prostagland...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD000494.pub3
更新日期:2007-07-18 00:00:00
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pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD005041.pub2
更新日期:2014-09-18 00:00:00
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD007533.pub2
更新日期:2012-04-18 00:00:00
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doi:10.1002/14651858.CD001298.pub4
更新日期:2014-07-09 00:00:00
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pub_type: 杂志文章
doi:10.1002/14651858.CD012764.pub2
更新日期:2019-07-19 00:00:00
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pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003664.pub3
更新日期:2006-10-18 00:00:00
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更新日期:2015-09-17 00:00:00
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journal_title:The Cochrane database of systematic reviews
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更新日期:2014-06-05 00:00:00
abstract:BACKGROUND:Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that can develop in pregnancy. It occurs when there is a build-up of bile acids in the maternal blood. It has been linked to adverse maternal and fetal/neonatal outcomes. As the pathophysiology is poorly understood, therapies have been largely e...
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更新日期:2020-07-27 00:00:00
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更新日期:2004-01-01 00:00:00
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doi:10.1002/14651858.CD003718.pub3
更新日期:2007-07-18 00:00:00
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更新日期:2010-12-08 00:00:00
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更新日期:2014-10-16 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2009-04-15 00:00:00