This is a summary of the NHS Devon CCG commissioning policy for surgery for carpal tunnel syndrome.
Supporting referral guidelines
Western: Carpal Tunnel clinical referral guideline
South Devon and Torbay: Carpal Tunnel clinical referral guideline
- Carpal Tunnel Syndrome is caused by irritation or compression of the median nerve where it passes under the carpal ligament in the wrist. This region is a closed space within which pressure may rise. Thickening of tendon sheaths or encroachment by other structures leads to a sustained rise in pressure within the canal. This pressure is further increased by flexion or extension of the wrist.
- Untreated carpal tunnel syndrome may improve in a quarter to a third of cases with mild or moderate symptoms with a reduction in stress to the hand.
- Wrist splinting and local corticosteroid injection may be useful in the non-surgical treatment of mild or moderate cases of carpal tunnel syndrome although the benefit may be short term.
- Patients with motor deficit should be referred before considering conservative therapy.
- Surgery is recommended for patients with severe symptoms and for patients with symptoms which have persisted despite conservative therapy.
- Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.
Surgery for carpal tunnel syndrome is commissioned in the following circumstances
- Symptoms persisting for more than three months after conservative therapy with either local corticosteroid injection and/or nocturnal splinting OR
- The patient is suffering from significant functional impairment, pain or sleep deprivation OR
- There is neurological deficit resulting in constant altered sensation, muscle wasting, or weakness of thenar abduction.
Significant functional impairment is defined as a loss or absence of an individual's capacity to meet personal, social or occupational demands.
Commissioning policy - surgery for carpal tunnel syndrome
Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.
Individual funding requests
Publication date: 1 October 2014
Carpal tunnel syndrome (surgery)
- First line
- Second line