Carpal tunnel syndrome release

For the treatment of

Median nerve compression in the carpal tunnel

Commissioning position

This intervention is only commissioned if the following criteria have been met:  

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

ever-present reduction in sensation in the median nerve distribution OR
muscle wasting or weakness of thenar abduction.

Summary of rationale

Carpal tunnel syndrome is very common, and mild cases may never require any treatment. Cases which interfere with activities or sleep may resolve or settle to a manageable level with non-operative treatments such as a steroid injection (good evidence of short-term benefit (8-12 weeks) but many progress to surgery within 1 year). Wrist splints worn at night (weak evidence of benefit) may also be used but are less effective than steroid injections and reported as less cost-effective than surgery.

In refractory (keeps coming back) or severe cases, surgery (good evidence of excellent clinical effectiveness and long term benefit) should be considered. The surgery has a high success rate (75 to 90%) in patients with intermittent symptoms who have had a good short-term benefit from a previous steroid injection. Surgery will also prevent patients with constant wooliness of their fingers from becoming worse and can restore normal sensation to patients with total loss of sensation over a period of months.