HNY Policy and Pathway Repository - Humber

The department of Neurophysiology offers a wide range of neurophysiological studies including nerve conduction studies (NCS), electromyography (EMG), multiple sleep latency tests (MSLT), electro-encephalography (EEG) and evoked potentials (EP).  This is however a purely diagnostic service and therefore referrals for the majority of these tests will only be accepted from secondary care clinicians.

No Red Flags Listed

Carpal tunnel syndrome occurs as a consequence of "entrapment" or "irritation" of the median nerve as it traverses the carpal tunnel.

The typical symptoms are those of numbness, tingling and/or paraesthesiae in the distribution of the median nerve below the wrist. These symptoms are typically worse at night or on awakening. They can occur in the day with certain activities – eg prolonged driving. The digits involved are the thumb, index, middle and the median part of the ring finger.

If the patient has symptoms in the upper arm or forearm as well, then this is more likely to be caused by a more proximal median nerve problem or cervical radiculopathy.

Clinical examination may show sensory dysfunction as in the diagram above. There may be a positive Tinel’s or Phalen’s sign. If the entrapment is severe, there could be wasting and weakness of the hypothenar muscle.

Symptoms and signs of Cubital tunnel syndrome (Ulnar neuropathy at the level of the elbow).

Cubital tunnel syndrome occurs if there is “entrapment” or irritation of the ulnar nerve at the level of the cubital tunnel in the elbow.

The typical symptoms of ulnar neuropathy at the level of the elbow are those of numbness, tingling and/or paraesthesiae in the little and the lateral part of the ring finger below the wrist. These symptoms may be worse when the patient has the elbows flexed.  If there is more significant compression of the ulnar nerve, there could be wasting of the small muscles of the hand.  If symptoms and signs involve areas above the wrist this suggests a more proximal ulnar nerve lesion above the elbow or cervical radiculopathy.

All referrals must follow the Humber IFR process