Preliminary experiences in diagnosing and treating neuralgic amyotrophy with ulnar nerve involvement often misdiagnosed as cubital tunnel syndrome.

BACKGROUND

Neuralgic amyotrophy (NA) involving the ulnar nerve is frequently misdiagnosed as cubital tunnel syndrome (CuTS), leading to delayed or inappropriate treatment. This study reports aims to share our initial experiences in diagnosing and managing this underrecognized condition, highlighting the key clinical insights to improve differential diagnosis and therapeutic strategies.

METHODS

A retrospective analysis was conducted on 25 participants (30 limbs) diagnosed with NA affecting the ulnar nerve between October 2016 and June 2022. Among these patients, 20 had unilateral involvement and 5 had bilateral involvement. Individualized treatment plans, including conservative management and surgical decompression, were tailored based on disease severity and patient response. Clinical outcomes were assessed using the visual analog scale (VAS), static two-point discrimination (2PD) test, and Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire scores over a follow-up period of 6 to 14 months.

RESULTS

All patients exhibited pain, numbness, or weakness in the region innervated by the ulnar nerve. Conservative treatment was successful in 5 participants (6 limbs) with early-stage mild disease, while 20 participants (24 limbs) underwent surgical decompression after conservative therapy failed. At final follow-up, 22 participants (26 limbs) demonstrated improvement in DASH scores. However, 3 limbs retained VAS scores above 3 points, with no significant recovery according to the static 2PD test. Additionally, 3 participants (4 limbs) exhibited poor postoperative functional recovery after 1 year.

CONCLUSIONS

NA involving the ulnar nerve is often misinterpreted as CuTS, complicating diagnosis and management. A thorough review of patient history, combined with electromyographic (EMG) and ultrasound evaluations, is crucial for accurate diagnosis. Patients with early-stage NA may respond well to conservative therapy, but advanced cases should be counseled on the potential limitations of surgical outcomes. Our findings emphasize the necessity of prompt, accurate diagnosis and personalized treatment to optimize patient recovery.