Carpal Tunnel Syndrome 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. Other symptoms of carpal tunnel syndrome include:
pins and needles (paraesthesia)
a dull ache in the hand or arm
Carpal Tunnel Syndrome is caused by compression of the median nerve, which controls sensation and movement in the hands. The carpal tunnel is a narrow passage in your wrist made up of small bones and a tough band of tissue that acts as a pulley for the tendons that bend the fingers. In most cases, it isn't known why the median nerve becomes compressed. However, some things do increase the risk of Carpal Tunnel Syndrome.
a family history of Carpal Tunnel Syndrome
pregnancy – up to about 50% of pregnant women develop Carpal Tunnel Syndrome
injuries to the wrist
other health conditions, such as diabetes and rheumatoid arthritis
strenuous, repetitive work with the hand
Carpal Tunnel Syndrome is more common in women and becomes more likely as you get older.
Proposed revisions to the eligibility criteria
Patients with wasting of the hand muscles should be urgently referred to either Trauma & Orthopaedics or the Hand Therapy Service at MKUHFT (outside the scope of this policy). The CCG commissions surgery for Carpal Tunnel Syndrome on a Restricted basis.
Community based conservative treatment should be initiated for all patients with suspected Carpal Tunnel Syndrome for a period of 6 months, excluding those who meet the criteria outlined below:
Patients with Carpal Tunnel Syndrome can be referred for a procedure if any of the following apply:
The patient has had community based conservative treatment for a period of 6 months
Severe symptoms (fewer than 5% of patients) uncontrolled by conservative measures, has a demonstrable significant detrimental impact on daily activities with a functional limitation.
Neurological deficit i.e. constant sensory blunting or weakness of thenar abduction (wasting or weakness of abductor pollicis brevis).