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Carpal Tunnel Syndrome

Please click here to view the full Carpal Tunnel Syndrome Commissioning Statement.  

Please click here to access the referral form.

Commissioning Position

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).

Moderate symptoms

Patients are experiencing symptoms that are interfering with activities of daily living AND all of the following have been tried:

OR

Severe symptoms

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.