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Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist in the carpal tunnel.
Please note referral criteria are applicable in this referral.
Nerve conduction studies are only indicated in the following circumstances:
For severe CTS (when the hand no longer feels normal between episodes of pins and needles; thenar wasting; weakness) there is a risk of irreversible nerve damage and therefore no place for conservative management. Refer for surgical decompression.
For all other patients, trial of conservative management with:
If persistent symptoms after 3 months of conservative management, refer for surgical decompression.
Surgical decompression involves a 15 minute operation under local anaesthetic
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
The patient is suffering from significant functional impairment, pain or sleep deprivation
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.
Click on the link for the complete NEW Devon CCG surgery for carpal tunnel syndrome commissioning policy
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.
Refer to Orthopaedics e-Referrals Service Selection
This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG.
Publication date: March 2017