Category
Threshold Criteria
Carpal tunnel syndrome (CTS) is a common condition that causes a tingling sensation, numbness, and sometimes pain in the hand and fingers.
These sensations usually develop gradually and start off being worse during the night. They tend to affect the thumb, index finger and middle finger.
The Carpal Tunnel procedure should be performed in a Primary Care Service. Those with recurrent CTS, ambiguous diagnosis or require GA for anxiety should be referred to secondary care.
Patients should be referred urgently if there is evidence of neurological deficit or median nerve denervation e.g. sensory blunting, muscle wasting or weakness of thenar abduction
Eligibility
| LLR ICB will fund this referral if the following criteria is met · Patients with mild to moderate presentation who have recurrent symptoms for more than 6 months and have had conservative therapies i.e. local corticosteroid injection and/ or nocturnal splinting AND · After 6 months symptoms persist or deteriorate OR · Patients with severe symptoms |
Electromyography (EMG)
EMG is not required for every person with CTS as the diagnosis in most cases can be confirmed with an appropriate history and clinical assessment
The following table defines the severity of presentation
| Mild | Moderate | Severe |
| Intermittent paraesthesia or pain | Constant paraesthesia interfering with activities of daily living or causing considerable sleep disturbance. Symptoms may be relieved by clenching or shaking the hand | The patient has constant numbness or pain, with weakened or wasting of the thumb muscles |
Guidance
| http://www.bssh.ac.uk/education/guidelines/carpal_tunnel_syndrome.pdf http://www.coventryrugbygpgateway.nhs.uk/pages/carpal-tunnel-syndrome/ |
| ARP 18 Review Date: 2026 |
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