Carpel Tunnel - Community Surgery


What is the service?

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist in the carpal tunnel.   This is the commonest form of nerve entrapment. The prevalence of Carpal tunnel syndrome in the UK is 7–16%. A UK General Practice Research Database found those 88 men and 193 women present as new cases per 100,000 populations.

Carpal tunnel syndrome is normally diagnosed in primary care and early management is non-surgical.

In secondary care 52,996 procedures are undertaken annually. The surgical decompression rate is 43–74 per 100,000. The proportion of carpal tunnel release procedures undertaken as day cases varies between 96.69% and 99%.

The overall aim of the service is to provide a high quality carpal tunnel service within the community and ensure that the network of GP practices are able to access the services both north and south of the county.

Care Pathway

Assessment

Mild History

  • intermittent paraesthesia in the correct distribution
  • nocturnal symptoms (or pain/paraesthesia exacerbated at night) Examination
  • subjective sensory impairment in the correct distribution in more severe cases
  • subjective weakness in the thumb/loss of co-ordination Investigation
  • Nerve Conduction Studies (NCS) are not indicated
  • blood tests are only needed if the history and examination suggests a specific secondary cause
  • Red flags: may include fracture, onset of tingling/ numbness after injury, nerve tumour, tumour
  • Yellow flags: urgent referral (<2/52), neurological diseases, inflammatory joint disease (including gout and Rheumatoid arthritis), peripheral limb ischaemia (thoracic outlet syndrome or Raynaud’s disease) cervical nerve root entrapment. This could result in referral to secondary care: including Orthopaedic, Rheumatology or Vascular surgery.

Management

Mild symptoms:

  • patient information
  • patients with mild carpal tunnel syndrome can be treated with a trial of conservative management by involvement of the MDT

Physiotherapy

  • wrist splints (wrist in neutral) at night for Carpal tunnel syndrome

Patients with a potential reversible cause (pregnancy, hypothyroidism) can be considered for conservative treatment.

Patients with mild carpal tunnel syndrome should be improved in up to 6 weeks of such management.  

This service is currently being provided by the following practices:

  • Albany House Medical Centre

Last updated: 26 Feb 2019