Oxfordshire INTERIM Treatment Threshold Statement Policy name: Surgery for carpal tunnel syndrome Reference: ITTS/1 Clinical Executive decision: 8 October 2009 Date of issue: 15 October 2009 Date of review: before March 2011 Oxfordshire Primary Care Trust has considered published evidence, and local and national guidelines, for carpal tunnel surgery. 1. Carpal tunnel surgery is a LOW PRIORITY procedure for patients with intermittent OR mild to moderate symptoms and will not be commissioned. Referral for consideration of surgery for diagnosed mild to moderate Carpal Tunnel Syndrome should be made only if patients have not responded to 3 months of conservative management, including - >8 weeks of night-time use of wrist splints - corticosteroid injection in appropriate patients 2. Carpal tunnel surgery for advanced/severe symptoms (constant pins and needles, numbness and muscle wasting) will be commissioned following specialist assessment. Open or endoscopic surgery will be funded. 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. Symptoms can be intermittent, and range from mild to severe. Patients typically present with nocturnal dysaethesia in the hand, which wears off with activity. If considered necessary to aid diagnosis, orthopaedic specialists may undertake nerve conduction studies/electromyography. It is estimated that up to 5% of women and 3% of men have carpal tunnel syndrome. Most cases are in people aged 45-64 years. Carpal tunnel syndrome is also common in pregnant women, possibly due to fluid retention. The likely prognosis of carpal tunnel syndrome seems to depend on the severity of symptoms. Patients with intermittent or mild/moderate symptoms should be managed conservatively in the first instance, in line with Oxfordshire PCTs referral guidelines (available on the PCTs intranet), as this may offer an opportunity to avoid surgery.

NOTES: 1. This threshold statement has been developed in consultation with specialists at the Nuffield Orthopaedic Centre 2. A date for review has been identified, but earlier review will be undertaken if significant new evidence is provided or national

guidance is received from NICE. 3. An Equality Impact Assessment was undertaken on this threshold statement in October 2009. 4. Potentially exceptional funding circumstances will be considered by Oxfordshire PCT through its Individual Funding Request

process

Policy name: Surgery for carpal tunnel syndromeReference: ITTS/1