Carpal tunnel syndrome

Abstract

Carpal tunnel syndrome (CTS) is a collection of symptoms and signs arising from compression and/or traction on the median nerve at the level of the carpal tunnel. It is a common condition, with a prevalence of 3.8 % in a healthy population and is probably on the increase, related to an increasing mean Body Mass Index (BMI) [1, 2]. It is the commonest nerve compression syndrome and is therefore of great interest to health purchasers and providers alike. The response to the financial burden of treating carpal tunnel syndrome has been varied throughout the UK. In some areas carpal tunnel release (CTR) has been designated as an operation that requires exceptional funding, whilst in other areas it is available on a one stop clinic basis. The 2013 tariff for CTR is between £900 and £1,250 and it is likely to be one of the conditions that is very appealing to healthcare providers, in that it is usually simple to diagnose and straightforward to treat [3]. CTS is a clinical diagnosis, requiring assessment by a clinician with sufficient experience to filter out those patients that need investigation of an alternative cause of their symptoms. There is concern that the oversimplification of the treatment pathway, if there is no assessment by a hand surgeon, may lead to problems such that some patients may undergo unnecessary or unsuccessful CTR surgery before it is established that CTS is an incorrect diagnosis. Also the operation, though usually straightforward, is not without complications which can, on rare occasions, be catastrophic.