To paraphrase that old real estate saying, location, location, and of course location. It is noted that carpal tunnel syndrome and cubital tunnel syndrome are two very common clinical situations involving nerves of the upper extremity. Carpal tunnel syndrome compromises the median nerve at the wrist and is indicative of a compressive neuropathy underneath the carpal ligament. Cubital tunnel syndrome also noted is a compressive neuropathy compromises the ulnar nerve at the elbow where it transfers through the cubital tunnel.
The symptomology is similar; however, the location of the symptoms is markedly different. Carpal tunnel syndrome would be causative of a numbness, tingling and weakness involving the thumb, index, and middle fingers. Whereas the cubital tunnel syndrome involves the ulnar nerve, and the numbness and weakness would be limited to the ring and little fingers. Additionally, cubital tunnel syndrome would be causative of pain on the inner aspect of the elbow.
Carpal tunnel syndrome most often is a function of repetitive motion or vibrations involving the wrist or could be secondary to fluid retention or swelling as noted with pregnancy, and at times can be a function of a direct trauma to the wrist or fractures involving the osseous structures of the wrist. This particular lesion can also be a function of thyroid disorders for diabetes.
Cubital tunnel syndrome is often secondary to direct pressure on the elbow such as a leaning type of event. However, direct trauma to the elbow or repetitive motion of the elbow can be causative of this finding. Medical conditions contributing to this diagnosis would include osteoarthritis of the elbow and diabetes.
The treatment for each of these diagnoses is essentially the same. Rest, ice, and activity modification to determine if the information can be resolved is the primary methodology. This will be followed with a physical therapy intervention, or injection protocols. Appropriate activity or lifestyle modifications would be indicated. If the pathology is noted to be severe, persistent, and conservative care fails surgical intervention may be a necessary alternative.
Therefore, understanding that the titles of these lesions are close, the pathology is very similar as both are entrapment neuropathy of a specific nerve at a specific location. The difference is the location of the entrapment and the symptomatic presentation offered by the afflicted individual. Each is considered an ordinary disease of life, however, there are specific clinical situations in which these can be traumatically induced and could possibly be a compensable event. However, a detailed clinical history, a thorough physical examination, and specific objectification of the nerves involved must be obtained prior to accepting these diagnoses as part of the compensable event.
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