Carpal and Cubital

Diagnosis/Definition

Pain, loss of strength or sensory changes (paresthesias) in the distribution of the median or ulnar nerves not associated with neck pain.

Initial Diagnosis and management

• History and physical exam (screen for associated conditions, i.e., diabetes, pregnancy, Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE).
• Assessment with provocative tests to include Tinel's and Phalen's sign tests of specific nerves.
• Plain radiographs are not required (unless there was trauma); MRI/CT are not indicated.
• For Carpal Tunnel Syndrome (CTS) symptoms prescribe a wrist splint (wrist in a neutral position) to wear at night and during the day for aggravating activities (take splint off every 2 hours and move wrist to prevent stiffness).
• For cubital tunnel syndrome, educate the patient to avoid pressure on elbow.
• For both, try work simplification techniques using ergonomic principles and activity modification to decrease symptoms.

Ongoing Management and Objective

• Expect resolution or decreasing symptoms within two to four weeks.
• Consider confirming the diagnosis with EMG/NCV (PM&R or Neuro diagnostics) if symptoms have not resolved within 6 weeks or if there has been no response to treatment.  
• Continue NSAID and splint use.

Indication a profile is needed

• Any limitations that affect strength, range of motion, and general efficiency of upper arms.
• Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent hand-to-hand fighting and disqualifies for prolonged effort.
• Defects or impairments that require significant restriction of use