Carpal Tunnel Syndrome
Please click here to view the full Carpal Tunnel Syndrome Commissioning Statement.
Nerve conduction studies (NCS) are NOT available from primary care (see commissioning statement). The need for NCS to confirm and predict positive surgical outcome in specific cases is a matter for surgeons and neurophysiologists consideration.
NHS Scarborough & Ryedale and Vale of York CCGs will commission surgical decompression under local anaesthetic, for the treatment of carpal tunnel syndrome only in the following circumstances. For classification of symptoms of CTS, please see Appendix 1 in the full statement (link above).
Patients are experiencing symptoms that are interfering with activities of daily living AND all of the following have been tried:
- The patient has not responded to a minimum of 6 months of conservative management, including at least 8 weeks of night time use of well-fitting wrist splints and
- Appropriate analgesia has been tried and
- Corticosteroid injections (given at least once prior to referral, unless clinically contraindicated) and
- Lifestyle/workplace modification e.g. weight loss, if appropriate
- Patient is experiencing advanced or severe, neurological symptoms of Carpal Tunnel Syndrome such as constant pins and needles, numbness, muscle wasting and prominent pain or
- Sudden or traumatic in origin
Surgery should only be undertaken under local anaesthetic. Fear of the procedure, or patient choice are not adequate reasons for requesting surgery under GA, unless supporting mitigating factors are submitted to the IFR panel by the requesting clinician.
Patients who do not meet the criteria outlined above, can be considered on an individual basis where their GP or Consultant believes there is an exceptional clinical need that justifies deviation from this policy. In those instances an application should be made to the IFR panel. To submit an application to the CCG's Individual Funding Request Panel, please click here for further information.
In all cases the patient should have been informed about the shared decision making tool for Carpal Tunnel Syndrome available here.
Both splinting and steroid injection produce improvement in the majority of patients at least temporarily and should both be tried for patients with less severe symptoms and findings who are likely to include the 35% of patients who will not need further intervention.