Old man with hand muscle wasting

68 year old African-American man, with h/o HTN and early prostate cancer, presents with "muscle thinning" in both the hands and progressive weakness, although symptoms seems to be more prominent on the Lt hand. He does not volunteer any symptoms of paraesthesias. He continues to work as a manual laborer with a construction company. He smokes a pack every day and is intermittently compliant with his meds- Verapamil, Enalapril and HCTZ
On exam, his vitals are stable. Hand shake displays a weak grip. Hand exam shows mild clawing of the left hand, wasting of the interossei (prominent guttering of the back of the hand), of the web-space between thumb and index finger and softening and flattening of the hypothenar eminence, more prominent on the left hand. Tinel’s sign was positive. Reflexes were bilaterally symmetrical at 1+. Sensory exam was not done. Forearm and arm muscles did not show signs of atrophy.
Fasting Blood sugar in January 2005 was 120. Prostate biopsy done in 8/03 showed high-grade neoplasia. He has not followed up with his urologist since then.

1. Occupation induced carpal tunnel plus cubital tunnel syndrome- CORRECT ANSWER
2. Inclusion body myositis
3. Syringomyelia
4. Cervical disc disease
5. Unrecognized diabetes