HNY Policy and Pathway Repository - Humber

NHS Neurophysiology departments specialize in diagnosing and managing nervous system disorders—such as epilepsy, nerve injuries (e.g., carpal tunnel), and muscle diseases—by measuring electrical activity. Services include EEG, EMG, nerve conduction studies, and evoked potentials, serving both adults and children.  The service at Hull University Teaching Hospitals Trust is purely a diagnostic service and therefore referrals for most of these tests will only be accepted from secondary care clinicians.

Tests that can be request by GPs are for adults only who present with signs and symptoms of Carpal Tunnel Syndrome, or Cubital Tunnel Syndrome (Ulnar Neuropathy)

For Epilepsy and other nervous system disorders – please refer to Neurology or check information for referrals to Neurosurgery

For any symptoms of Stroke –

• F = Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
• A = Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S = Speech Difficulty – Is speech slurred?
• T = Time to call 911 – Stroke is an emergency. Every minute counts. Call 911 immediately. Note the time when any of the symptoms first appear.

Symptoms and signs of Carpal Tunnel Syndrome

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 paraesthesia 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 – e.g. 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 paraesthesia 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.

Neurophysiology are able to confirm carpal tunnel syndrome but cannot treat this.  Please follow the commissioning policy process if surgical treatment is required. -

Carpal tunnel syndrome release - Hull - HNY Policy and Pathway Repository

Do Not Refer

Referrals can only be accepted for Carpal Tunnel syndrome or Cubital Tunnel Syndrome, diagnostics.  Referral for any other condition will be rejected or delayed if not sent to the appropriate service.

Referral Criteria

Referrals are typically made by hospital consultants (e.g., neurologists), though some GP referrals are accepted for specific tests.

For diagnostic test for Carpal Tunnel syndrome or Cubital Tunnel Syndrome

Utilise the referral form available on ARDENS (CTS – UN GP DOS).  Send this via eReferrals Service (eRS) to Hull University Teaching Hospitals NHS Trust (RWA), Neurology and sub service “Suspected Carpal tunnel syndrome (Direct Access Service – Neurophysiology for Carpel Tunnel Syndrome”

For surgery for Carpal Tunnel syndrome,  please follow the IFR Policy and process Carpal tunnel syndrome release - Hull - HNY Policy and Pathway Repository

• Hull University Teaching Hospitals