Reviewed on : 26 Apr 2022

Reviewed by : Lucy Dyde Coventry & Warwickshire CCG IFR and Gateway Editor

Expires : 1 Oct 2025

Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Surgery is a Low Priority Procedure.

Prior approval from the ICB will be required before any treatment proceeds in secondary care.

Exclude pregnancy, hypothyroidism and diabetes, clinically or by investigation.

Classification

The following criteria should be used to establish if the condition is mild, moderate or severe:

Mild Carpal Tunnel Syndrome

• Intermittent paraesthesia

Moderate Carpal Tunnel Syndrome

• There is constant paraesthesia, interfering with activities of daily living or causing considerable sleep disturbance.  The symptoms may be relieved by clenching or shaking the hand.

Severe Carpal Tunnel Syndrome

• The patient has constant numbness or pain, with weakness or wasting of the thumb muscles.

Management and Treatment of Carpal Tunnel Syndrome

Eligibility Criteria


Mild cases with intermittent symptoms causing little or no interference with sleep or activities require no treatment.

Cases with intermittent symptoms which interfere with activities or sleep should first be treated with:

a. Corticosteroid injection(s) (injected into the wrist: good evidence for short (8-12 weeks) term effectiveness) OR

b. Night splints (a support which prevents the wrist from moving during the night: not as effective as steroid injections).

Nerve conduction studies, if available, are suggested for consideration before surgery to predict positive surgical outcome or where the diagnosis is uncertain

Please refer to the following GP Gateway pages on Hand & Wrist conditions

GP Gateway Hand & Wrist Pins & Needles

Gp Gateway Hand & Wrist Loss of Function

GP Gateway Hand & Wrist Swelling or Lump

GP Gateway Hand & Wrist Pain

Prior approval will still be required for interventions including Trigger Finger and Carpal Tunnel Syndrome

Please note that any references to “MSK Hub” should be currently interpreted as Community Physiotherapy pending future MSK Hub service development

Referral Criteria

Prior approval from the ICB will be required before any treatment proceeds in secondary care. 

Refer to Secondary Care provider using the appropriate Prior Approval Referral Form

1. Please confirm that the patient meets the criteria for one of the following sections:

Section a

The symptoms significantly interfere with daily activities and sleep symptoms and have not settled to a manageable level with either one local corticosteroid injection and/or nocturnal splinting for a minimum of 8 weeks

Section b

There is either:

• Permanent (ever-present) reduction in sensation in the median nerve distribution OR
• Muscle wasting or weakness of thenar abduction (moving the thumb away from the hand)