

Whole hand or both hands pins and needles or numbness consider:
- cervical spine pathology and radiculopathy – refer to spine pathway
- peripheral mononeuropathies – refer to Neurology
- combined and/or bilateral CTS and CuTS - see below
Volar Radial 3½ digits
Classical Carpal tunnel syndrome (CTS) distribution of pins and needles
- Mild or moderate symptoms
- Intermittent altered feeling or tingling
- May be worse at night
- Positive Durkins &/or Tinels/Phalens test
- Work up:
- night wrist splints and reassure
- steroid injection (Community Physiotherapy (pending MSK Hub development))
- BSSH carpal tunnel syndrome
- consider Low Priority Procedure Policy prior to referral
- If not improving or severe symptoms (continuous symptoms of altered feeling, tingling feeling clumsy, muscle wasting):
- refer urgently to hand surgeons
Volar Ulnar 1½ digits
Classical Ulnar nerve compression or Cubital Tunnel Syndrome (CuTS)
- Mild or moderate symptoms
- Intermittent altered feeling or tingling
- May be worse at night
- May have positive Tinels at elbow
- Work up:
- reassure
- consider physiotherapy
- consider Low Priority Procedure Policy prior to referral
- If not improving or severe symptoms (continuous symptoms of altered feeling, tingling feeling clumsy, muscle wasting):
- urgent nerve conduction studies (NCS)
- refer urgently to hand surgeons
- BSSH cubital tunnel syndrome
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