This page was last reviewed 10-04-20
This condition involves the compression of the median nerve at the wrist
NICE guidelines for management of carpal tunnel syndrome in primary care
What we will see
- Pins and needles +/- muscle weakness and wasting in median nerve distribution (thumb/index/middle and half ring finger)
What we won’t see
- Early <6 months intermittent pins and needles in median nerve distribution without trial of non-operative treatment (e.g. night splints)
- Radicular pain
Specific tests
- Nerve conduction studies will be requested in clinic if thought appropriate Trial of therapy pre-referral
- Wrist (Futuro splints) at night time
Whom to direct referral to
If mild intermittent symptoms, normal sensation, and no thumb weakness, the patient should have a trial of splintage before referral. Then, the patient can be referred to
- Carpal tunnel clinic
- Run by Allied Health Professional under supervision of consultant hand surgeon.
- Carpal Tunnel Syndrome check list
Carpal tunnel typically presents with intermittent paraesthesia of the middle and index fingers and thumb, which is often worse at night. Palmar sensation is spared when the palmar cutaneous branch of the median nerve arises before the nerve enters the carpal tunnel. Associated weakness of grip strength and difficulty with dextrous activities is common. Tinel’s and Phalen’s tests (see flow chart) may be positive. In advanced cases, muscle wasting of the thenar eminence may be apparent. There may be a family history and there is an association with pregnancy, OA and previous wrist trauma, but the condition is very common anyway.
Conservative treatment should be initiated with use of a night splint to hold the wrist in extension. Steroid injection around the carpal ligament is effective, but symptoms not infrequently recur after a few months. Surgical decompression is performed as an outpatient local anaesthetic procedure through a 3cm incision in the proximal palm. The speed and degree of resolution of the symptoms depends upon their duration and severity.
Post-operatively the patient is likely to experience scar tenderness and decreased grip strength for a few months and may require several weeks off work.
- Plastic Surg – PIL BSSH CARPAL TUNNEL Aug18
- Plastic Surg – PIL BSSH GANGLIA Aug18
- Plastic Surg – PIL BSSH OA THUMB Aug18
- Plastic Surg – PIL BSSH TRIGGER FINGERAug18
- National Institute for Health and Care Excellence (NICE)
- Scottish Intercollegiate Guidelines Network (SIGN)
- Wrist Pain Algorithm of Differential Diagnoses
