Surgical and postoperative management of ulnar neuropathy at the elbow: a national survey among Dutch hand and neurosurgeons

Introduction Ulnar neuropathy at the elbow (UNE) is a condition for which multiple surgical techniques exist, yet no consensus has been reached on the optimal approach. Additionally, postoperative follow-up protocols are not standardized, resulting in considerable variability in clinical practice. Research question To better understand current practices, a nationwide survey was conducted among Dutch surgeons involved in the surgical management of UNE. Materials and methods An online questionnaire was sent to all plastic surgeons, neurosurgeons and orthopedic surgeons with expertise in hand surgery in the Netherlands. The survey assessed surgical preferences, postoperative follow-up routines, and rehabilitation practices for both primary and revision UNE cases. Results In total, 163 surgeons filled out the survey. Open decompression was the preferred surgical technique for primary UNE (92.6%), subcutaneous transposition was most commonly selected for revision procedures (37.9%). The initial postoperative consultation was typically scheduled 4-8 weeks after surgery (55.2%). In case of persistent and recurrent UNE, repeated physical appointments were the most frequently chosen follow-up strategy (82.6% and 63.4%, respectively). For recurrent UNE, 31.7% opted for immediate diagnostic testing, with 64.7% selecting both electromyography and ultrasound as the preferred diagnostic approach. Postoperative splinting was rarely advised (0.6%). Hand therapy was recommended by 66.3% of surgeons and usually initiated within the first four weeks postoperatively (54.6%). Discussion and conclusion While there is broad agreement on the use of open decompression for primary UNE, notable variation remains in revision procedures and follow-up strategies. These findings underscore the need for standardized, evidence-based protocols to support consistent and effective care for UNE patients.