Reviewed on : 16 May 2019

Reviewed by : Coventry & Rugby CCG

Expires : 16 May 2021

Carpal Tunnel Surgery is a Low Priority Procedure.

Prior approval from the Clinical Commissioning Group will be required before any treatment proceeds in secondary care.

Exclude pregnancy, hypothyroidism and diabetes, clinically or by investigation.

Classification

The following criteria should be used to establish if the condition is mild, moderate or severe:

Mild Carpal Tunnel Syndrome

Intermittent paraesthesia

Moderate Carpal Tunnel Syndrome

There is constant parathesia, interfering with activities of daily living or causing considerable sleep disturbance.  The symptoms may be relieved by clenching or shaking the hand.

Severe Carpal Tunnel Syndrome

The patient has constant numbness or pain, with weakness or wasting of the thumb muscles.

Management and Treatment of Carpal Tunnel Syndrome

Mild and Moderate Carpal Tunnel Syndrome

Treat in Primary Care and consider activity/workplace modification, if a clear association is apparent.

Offer a nocturnal, neutral wrist splint.

Refer to MSK Physiotherapy via NHS E-referral. The patient will see a physiotherapy assistant to ensure correct fitting, normally within a couple of weeks.

Moderate to Severe Carpal Tunnel Syndrome

Prior approval from the CCG will be required before any treatment proceeds in secondary care. 

Refer to Secondary Care provider via RSS using the appropriate Prior Approval Referral Form

Nerve Conduction Studies if available are suggested for consideration before surgery to predict positive surgical outcome or where the diagnosis is uncertain.

Surgical treatment of carpal tunnel will be funded if ONE of the following criteria are met:

• Symptoms significantly interfere with daily activities and sleep and have not settled to a manageable level with either one local corticosteroid injection and/or nocturnal splinting for a minimum of 8 weeks;

OR

• A permanent (ever-present) reduction in sensation in the median nerve distribution OR muscle wasting or weakness of thenar abduction (moving the thumb away from the hand)