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Carpal Tunnel Syndrome

Checked: 23-02-2021 by Sandi Littler Next Review: 23-02-2022

Overview

Carpal tunnel syndrome is a relatively common condition that affects the nerves of the hand causing pain, numbness and a burning or tingling sensation in the hand and fingers.

Further information regarding diagnosis, management and background information on CTS can be found on the NICE Clinical Knowledge Summary page.

Nerve Conduction Studies

Nerve conduction studies can be performed in patients presenting with possible carpal tunnel syndrome to assist diagnosis. These may need to be repeated at intervals in those managed conservatively.

Please see the Neurophysiology page for additional information on referring into this service.

Steroid Injections in Primary Care

Injecting corticosteroids near the carpal tunnel is a common treatment. Steroids reduce swelling in the connective tissue, which relieves the pressure on the median nerve. The benefits of corticosteroid injections have been tested in several studies.

Further information about the effectiveness of corticosteroid treatments can be found on the NCBI website.

Who to Refer

Patients who present with obvious wasting of the thenar eminence should be referred to MSKI for assessment.

In some cases CTS will disappear without treatment, or simple self-care measures will reduce the symptoms.

CTS in pregnant women often gets better within three months of the baby being born, although it may need treatment. In some women, symptoms can continue for more than a year.

Non-surgical treatments, such as wrist splints and corticosteroid injections, are used to treat mild or moderate symptoms.

Surgery may be required if non-surgical treatments fail to relieve the symptoms. It may also be used if there is a risk of permanent nerve damage.

NHS surgical treatment is only available if certain criteria are met as described in the BNSSG Carpal Tunnel Syndrome Surgery Criteria Based Access Policy.

Referral

If criteria are met than referrals should be made via the Musculoskeletal Interface (MSKI) Service which is usually available via managed referral on most EMIS systems. Referrals will be triaged, assessed and treatment offered where appropriate. If criteria for referral is not met then referrals may be returned.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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