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.