In clinical practice, carpal tunnel syndrome and elbow tunnel syndrome, are often misdiagnosed as cervical spondylosis, and rarely is cervical spondylosis misdiagnosed as carpal tunnel syndrome or elbow tunnel syndrome. In patients without neck and shoulder pain but with numbness in the hand or forearm, careful questioning and examination is required to identify the relationship between cervical spondylosis and both. Carpal tunnel syndrome is usually numbness in the entire palm of the hand or in 1 to 3 fingers of the hand. It is more common in women and the numbness is worse at night and often flings the hand during sleep at night to relieve the symptoms.
Tinnel’s sign in the carpal tunnel is positive. Elbow canal syndrome, numbness mainly in the medial forearm and the 4-5 fingers of the hand. In severe cases, there is muscle atrophy of the hand and the fingers cannot move inwardly and outwardly, i.e. when using the fingers to hold paper, they cannot hold it, and the elbow canal Tinnel’s sign is positive. An ultrasound examination of the corresponding area and a neurophysiological examination of the corresponding segment will clarify the diagnosis. Sometimes neurogenic cervical spondylosis coexists with carpal tunnel syndrome or elbow canal syndrome and it needs to be clearly explained to the patient that the most severe area should be selected for surgery first and, depending on recovery, a decision should be made to operate on the other area.
Spinal cervical spondylosis is relatively easy to differentiate from carpal tunnel syndrome and elbow canal syndrome. Spinal cervical spondylosis is an injury to the cervical medulla, which is a superior neuronal injury and will present with a positive Hoffman’s sign, increased muscle tone, a positive ankle clonus reflex and a hyperactive knee reflex. Nerve root cervical spondylosis, on the other hand, is sometimes more difficult to differentiate from elbow canal syndrome, which causes a relatively wide range of numbness on the ulnar side of the forearm hand. In contrast, it is relatively easy to identify with carpal tunnel syndrome because the numb sensory area of the hand in carpal tunnel syndrome is usually limited to the palm of the hand and not higher than the wrist joint.