With increased use of technology, like computers and mobile phones, we see a significant increase in carpal tunnel syndrome and tendon problems like tendonitis of the wrist and elbow. The primary care physician should understand what they are dealing with when somebody presents with elbow or hand pain, and what they can do or where they can get the help of a specialist, such as a physiatrist or a neurologist. Taking a minute or two to listen to the patient and do a brief physical examination but with the focus on the anatomy of the hand and elbow, is critical. Knowing the basic anatomy will help in differentiating a nerve problem versus a tendon problem, which is important because the management is different.
As a physiatrist I believe in multimodal treatment. We all use the medications, but also engage the physical therapist, the occupational therapist, or the chiropractor. When you combine all of these I think we have a much better success rate. When considering when to refer to a specialist—if you’re seeing a patient whose pain is uncontrollable or if you start seeing muscle atrophy, which basically means there is a lot more damage than we would like to see, or a severe tendonitis or severe carpal tunnel syndrome—I think it’s better to get a specialist involved sooner than later.