{"id":11303,"date":"2022-10-12T14:48:05","date_gmt":"2022-10-12T13:48:05","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=11303"},"modified":"2026-04-14T14:15:30","modified_gmt":"2026-04-14T13:15:30","slug":"carpal-tunnel-syndrome-3","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/plasticsurgery\/handsurgery\/carpal-tunnel-syndrome-3\/","title":{"rendered":"Carpal Tunnel Syndrome"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color\"><strong><strong><strong>This page is currently under review<\/strong><\/strong><\/strong><\/p>\n\n\n\n<p>This condition involves the compression of the median nerve at the wrist&nbsp;<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>NICE guidelines for management of carpal tunnel syndrome in primary care<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/cks.nice.org.uk\/carpal-tunnel-syndrome#!scenario\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/cks.nice.org.uk\/carpal-tunnel-syndrome<\/a><\/li>\n<\/ul>\n\n\n\n<p>What we will see<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pins and needles +\/- muscle weakness and wasting in median nerve distribution (thumb\/index\/middle and half ring finger)<\/li>\n<\/ul>\n\n\n\n<p>What we won\u2019t see<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Early &lt;6 months intermittent pins and needles in median nerve distribution without trial of non-operative treatment (e.g. night splints)<\/li>\n\n\n\n<li>Radicular pain<\/li>\n<\/ul>\n\n\n\n<p>Specific tests<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Nerve conduction studies will be requested in clinic if thought appropriate&nbsp;<em>Trial of therapy pre-referral<\/em><\/li>\n\n\n\n<li>Wrist (Futuro splints) at night time<\/li>\n<\/ul>\n\n\n\n<p>Whom to direct referral to<\/p>\n\n\n\n<p>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<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Carpal tunnel clinic\n<ul class=\"wp-block-list\">\n<li>Run by Allied Health Professional under supervision of consultant hand surgeon.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><a href=\"%20'iframe'%7d);\">Carpal Tunnel Syndrome check list<\/a><\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"749\" height=\"714\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-3.png\" alt=\"Carpal Tunnel Syndrome\" class=\"wp-image-13735\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-3.png 749w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-3-300x286.png 300w\" sizes=\"auto, (max-width: 749px) 100vw, 749px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">NHS Lothian<\/span> flowchart courtesy of NHS Lothian<\/figcaption><\/figure>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Carpal tunnel<\/strong>&nbsp;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.&nbsp; Associated weakness of grip strength and difficulty with dextrous activities is common. Tinel&#8217;s and Phalen&#8217;s tests (see flow chart) may be positive.&nbsp; 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.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>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.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-CARPAL-TUNNEL-Aug18.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-CARPAL-TUNNEL-Aug18.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg &#8211; PIL BSSH CARPAL TUNNEL Aug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-GANGLIA-Aug18.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-GANGLIA-Aug18.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg &#8211; PIL BSSH GANGLIA Aug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-OA-THUMB-Aug18.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-OA-THUMB-Aug18.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg &#8211; PIL BSSH OA THUMB Aug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-TRIGGER-FINGERAug18.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Plastic-Surg-PIL-BSSH-TRIGGER-FINGERAug18.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg &#8211; PIL BSSH TRIGGER FINGERAug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.nice.org.uk\/\" data-type=\"URL\" data-id=\"https:\/\/www.nice.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">National Institute for Health and Care Excellence (NICE)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.sign.ac.uk\/\" data-type=\"URL\" data-id=\"https:\/\/www.sign.ac.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Intercollegiate Guidelines Network (SIGN)<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Wrist-Pain-Algorithm-of-Differential-Diagnoses.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Wrist-Pain-Algorithm-of-Differential-Diagnoses.pdf\" target=\"_blank\">Wrist Pain Algorithm of Differential Diagnoses<\/a><\/li>\n<\/ul>\n\n\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This page is currently under review This condition involves the compression of the median nerve at the wrist&nbsp;<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3988,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[550],"class_list":["post-11303","page","type-page","status-publish","hentry","category-carpaltunnelsyndrome"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/plasticsurgery\/handsurgery\/carpaltunnelsyndrome\/\" rel=\"tag\">Carpal Tunnel Syndrome<\/a>","rttpg_excerpt":"This page is currently under review This condition involves the compression of the median nerve at the wrist&nbsp;","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/11303","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=11303"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/11303\/revisions"}],"predecessor-version":[{"id":27635,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/11303\/revisions\/27635"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3988"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=11303"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=11303"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}