Immediate Versus Delayed Mobilization After Cubital Tunnel Release Surgery: A Systematic Review and Meta-analysis

Abstract

Purpose: It is unknown whether early mobilization after cubital tunnel decompression improves functional outcomes without increasing complication risks. This systematic review aims to evaluate the effectiveness of early mobilization compared to delayed mobilization of the elbow after ulnar nerve decompression. Methods: Randomized controlled trials (RCTs) and observational studies comparing adults who received early mobilization or late mobilization were included. Embase, MEDLINE, CENTRAL, PEDro, clinicaltrials.gov, and the World Health Organization database were systematically searched from inception to January 2023. Results: Of the 2183 studies identified and screened, five studies (two RCT and three observational) totaling 224 patients (232 elbows) were included in this review. Evidence from two RCTs (100 patients) suggests that early mobilization may result in a large reduction in the amount of time needed to return to work (mean difference 40.1 days, 95% confidence interval [CI] 16-64 days earlier, I 2 = 85%, low-certainty evidence) and little to no difference in grip strength (0 kg, 95% CI = −0.17 to 0.17, I 2 = 0%, low-certainty evidence). There was little to no difference in adverse events or range of motion (low to very-low certainty evidence). Pooled results from the three observational studies showed similar findings (very low-certainty evidence). There were no studies that evaluated upper extremity related quality of life. Conclusion: Immobilizing patients for periods longer than 3 days appears to delay patient's return to work with no appreciable clinical benefit.