Comparison of Kinesio Taping Techniques in Ulnar Nerve Entrapment

Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy affecting the upper extremity. Clinically, it impairs the patient's quality of life by causing numbness and paresthesia in the fifth digit and ulnar half of the fourth digit, decreased hand grip strength, intrinsic muscle weakness, and loss of manual dexterity. Conservative treatment options include patient education, activity modification (avoiding provocative elbow flexion and long-term surface contact), nerve gliding exercises, and kinesio taping.

Although kinesio taping has demonstrated significant improvements in functionality, symptom severity, grip strength, and electrophysiological parameters in peripheral nerve entrapments such as carpal tunnel syndrome, comparative evidence evaluating the efficacy of specific kinesio taping techniques (e.g., space correction and neural technique) in ulnar nerve entrapment at the elbow remains insufficient.

The primary objective of this prospective, randomized controlled study is to compare the efficacy of space-correction kinesio taping and neural technique kinesio taping-when added to a structured home exercise program-versus placebo taping with exercise on clinical, functional, and electrophysiological outcomes in patients with ulnar nerve entrapment at the elbow.

Intervention Protocol: Eligible participants meeting the inclusion criteria will be randomly allocated into three intervention groups:

Space-Correction Kinesio Taping + Exercise Group: Participants will receive space-correction kinesio taping. It will be applied over the cubital tunnel region with approximately 25-50% tension while the elbow is in flexion.

Neural Technique Kinesio Taping + Exercise Group: Participants will receive neural technique kinesio taping. It will be applied along the anatomical course of the ulnar nerve with 50% tension.

Placebo Kinesio Taping + Exercise Group: Participants will receive tape applied to the upper-lateral arm (unrelated to the ulnar nerve course) without any tension.

Application Schedule: Taping will be applied for a total of 3 weeks (1 session per week; tape remains in place for 3 days followed by a 4-day tape-free period). All three groups will receive activity modification instructions and perform a standardized home exercise program (ulnar nerve gliding exercises, 10 repetitions per session, 2 times daily for 3 weeks).

Outcome Evaluations: Evaluations-encompassing symptom severity, clinical parameters, hand grip strength, and electrophysiological (EDX) findings-will be conducted at three different time points:

Baseline (pre-treatment) Week 3 (at the end of intervention, to evaluate acute therapeutic effects) Month 3 (at the 3-month follow-up, to evaluate the long-term sustainability of treatment effects)

• Kinesio Taping with Space-Correction Technique (Other): Space-correction Kinesio taping technique applied around the cubital tunnel combined with a home exercise program.
• Kinesio Taping with Neural Technique (Other): Neural technique Kinesio taping along the path of the ulnar nerve combined with a home exercise program.
• Sham/Placebo Taping (Other): Non-tension sham taping applied near the cubital tunnel combined with a home exercise program.
• Home Exercise Program (Other): A structured home exercise program including ulnar nerve gliding exercises

Primary outcomes

• Visual Analog Scale (VAS) for Daytime Pain [Baseline, 3 weeks (post-treatment), and 3 months (follow-up)]: Evaluates daytime pain intensity using a 10-cm scale ranging from 0 (no pain) to 10 (worst possible pain). Higher scores indicate more severe pain.

Secondary outcomes

• Visual Analog Scale (VAS) for Nighttime Pain and Associated Symptoms [Baseline, 3 weeks (post-treatment), and 3 months (follow-up)]: Evaluates nighttime pain, numbness/paresthesia, weakness, and clumsiness using separate 10-cm visual analog scales (0 to 10 for each symptom). Each symptom is evaluated independently, where higher scores represent greater symptom severity.
• Tinel's Sign Positivity Rate [Baseline, 3 weeks (post-treatment), and 3 months (follow-up)]: Percentage of participants with a positive Tinel's sign evaluated at the cubital tunnel.
• Elbow Flexion Test Positivity Rate [Baseline, 3 weeks, and 3 months]: Percentage of participants with a positive result for the Elbow Flexion Test.
• Ulnar Nerve Compression Test Positivity Rate [Baseline, 3 weeks, and 3 months]: Percentage of participants with a positive result for the Ulnar Nerve Compression Test.
• Hand Grip Strength [Baseline, 3 weeks (post-treatment), and 3 months (follow-up)]: Evaluates the mean hand grip strength of three consecutive trials measured in kilograms (kg) using a standard hand dynamometer
• Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) Score [Baseline, 3 weeks (post-treatment), and 3 months (follow-up)]: Evaluates physical disability and symptoms in upper limb disorders using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire. Scores range from 0 (no disability) to 100 (most severe disability).
• Short Form-36 (SF-36) Subscale Scores [Baseline, 3 weeks (post-treatment), and 3 months (follow-up)]: Assesses health-related quality of life across 8 individual domains (Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health). Each domain is scored separately from 0 to 100, where higher scores indicate better health status.
• Ulnar Motor Nerve Conduction Velocity Across the Elbow [Baseline, 3 weeks (post-treatment), and 3 months (follow-up)]: Assesses the motor nerve conduction velocity of the ulnar nerve across the elbow segment (in meters per second, m/s).
• Ulnar Nerve Distal Motor Latency [Baseline, 3 weeks, and 3 months]: Assesses the distal motor latency difference between entrapment sites for the ulnar nerve (in milliseconds, ms).
• Ulnar Sensory Nerve Conduction Velocity [Baseline, 3 weeks, and 3 months]: Assesses the sensory nerve conduction velocity of the ulnar nerve (in meters per second, m/s).
• Ulnar Sensory Distal Latency [Baseline, 3 weeks, and 3 months]: Assesses the sensory distal latency of the ulnar nerve (in milliseconds, ms).

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Patients aged 18 years and older who provide written informed consent
* Electrophysiologically confirmed ulnar neuropathy entrapped between 4 cm below and 6 cm above the elbow
* Duration of symptoms for at least 1 month (presence of one or more symptoms such as paresthesia in the 4th and 5th digits corresponding to the ulnar nerve distribution, hand weakness during gross grip movements, elbow pain, or nighttime complaints)

Exclusion Criteria:

* Ulnar nerve transection or trauma (e.g., fracture, subluxation)
* Presence of thenar, hypothenar, or intrinsic muscle atrophy
* Electrophysiologically confirmed diagnosis of carpal tunnel syndrome, cervical radiculopathy, brachial plexopathy, or thoracic outlet syndrome
* Conditions causing chronic inflammatory polyradiculoneuropathy: diabetes mellitus, autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus)
* Vascular lesions causing local vasospasm: Raynaud's syndrome, reflex sympathetic dystrophy syndrome (CRPS)
* Conditions causing generalized peripheral neuropathy: uremia, diabetes mellitus, toxic causes, malnutrition, etc.
* Malignancy
* Pregnancy
* Having received treatment for distal ulnar neuropathy (DUN) or cubital tunnel syndrome within the last 3 months
* Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs)
* Impaired skin barrier in the area to be taped (e.g., open wound, cellulitis, burn) or presence of malignant tissue in that region
* Acute deep vein thrombosis (DVT)
* Presence of cognitive or psychiatric disorders that would prevent participation in the study

• Sahin MA, Cigdem-Karacay B, Konar NM, Tuncay F. Comparison of the Effectiveness of 2 Different Kinesio Taping Techniques Added to Exercises in the Treatment of Carpal Tunnel Syndrome: Randomized Controlled Trial, Double-Blind, Parallel Groups. Arch Phys Med Rehabil. 2024 Sep;105(9):1657-1665. doi: 10.1016/j.apmr.2024.05.023. Epub 2024 Jun 6. PMID 38851555
• Geler Kulcu D, Bursali C, Aktas I, Bozkurt Alp S, Unlu Ozkan F, Akpinar P. Kinesiotaping as an alternative treatment method for carpal tunnel syndrome. Turk J Med Sci. 2016 Jun 23;46(4):1042-9. doi: 10.3906/sag-1503-4. PMID 27513402

• Şebnem K. Doğan, Prof.Dr., Principal investigator, Antalya Training and Research Hospital