Carpal tunnel- Adult Leeds

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1.  Information Resources for Patients and Carers

Patient information

Please see attached patient information leaflet on Basal Thumb Osteoarthritis.

Please see attached patient information leaflet on Dupuytren's disease.

Please see attached patient information leaflet on Trigger Finger.

Please see the attached patient information leaflet on De Quervain's Tenosynovitis.

Please see attached patient information leaflet on  ganglion cysts.

Please see the attached patient information leaflet on Carpal Tunnel Syndrome.

Decision Aid for Carpel Tunnel

Preoperative Information

Please see attached patient information leaflet for preoperative information on Basal Thumb Osteoarthritis.

Please see attached patient information leaflet for preoperative information on Dupuytren's disease.

Please see attached patient information leaflet for preoperative information on Trigger Finger.

Please see the attached patient information leaflet for preoperative information on De Quervain's Tenosynovitis.

Please see attached patient information leaflet for preoperative information on ganglion cysts.

Please see attached patient information leaflet for preoperative information on Carpal Tunnel Syndrome.

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2.  Referral Forms

Quick info:
Referral Forms

Quick View - PDF
MSK12 Non Surgical Hand-Wrist Form V3
MSK13 Surgical Hand-Wrist V3
MSK14 Problem Not on Pathway Form V3

Mail Merged
The forms below are provided as a repository. They can be downloaded to your computer and be imported to your clinical system. This is so all practices have access to the most up to date forms.

EMIS - merged
MSK12 Non Surgical Hand-Wrist Form V3
MSK13 Surgical Hand-Wrist V3
MSK14 Problem Not on Pathway Form V3

SystmOne - merged
MSK12 Non Surgical Hand-Wrist Form V3
MSK13 Surgical Hand-Wrist V3
MSK14 Problem Not on Pathway Form V3

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3.  Carpal Tunnel

Quick info:
Patient information
Please see the attached patient information leaflet on Carpal Tunnel Syndrome.

GP information
Carpal Tunnel Syndrome:

  • is the most common median nerve lesion
  • is caused by an increase in pressure in the anatomical tunnel formed by the carpal bones and the flexor retinaculum, through which the median nerve passes   this increase in pressure produces ischaemia of the median nerve, generating the symptoms
  • ssociated with Carpal Tunnel Syndrome
  • will cause symptoms in the distribution of the median nerve, thus most commonly affecting the thumb, index and middle finger; however, variation does exist, and it is possible for all the fingers to be affected
  • sensory symptoms include paraesthesiae, numbness, burning and pain, and motor symptoms include weakness, clumsiness and the patient may report dropping things.
  • symptoms tend to be worse at night, and as the condition progresses during the day too. Movements such as shaking the hand, or hanging it out of bed at night are often attempted to relieve symptoms. Symptoms may radiate to the arm, elbow and shoulder.
  • It is worth asking the patient about having to swap hands when using phone and symptoms being exacerbated by holding a steering wheel.

Aetiology:

  • generally the condition is idiopathic
  • however, it is associated with a variety of conditions including:
    • hypothyroidism
    • diabetes mellitus
    • rheumatoid disease
    • pregnancy
    • previous Colles fracture
    • acromegaly
    • it may be worth checking TFTs and a fasting glucose in new presentations
    • a first degree relative may have suffered the condition in up to 1 in 4

Examination:

  • should include:
    • Phalen’s test   a positive test is indicated by reproduction of sensory symptoms upon flexing the wrist for 1 minute
    • Tinel’s test   a positive test is indicated by reproduction of sensory symptoms by tapping lightly over the median nerve at the wrist
  • an assessment can also be made for muscle wasting at the thenar eminence, which may be noticed with advanced presentations

Assessment of severity:

  • when a patient presents with typical signs and symptoms of Carpal Tunnel Syndrome an assessment should be made as to whether the condition is mild/moderate or severe
  • severe cases may include constant unrelenting symptoms, problems with function and possibly some muscle wasting   it would be reasonable to refer these patients immediately to a Hand Surgeon
  • mild or moderate symptoms may be treated conservatively, and the pathway indicates the management options
  • atypical signs and symptoms, which do not fit into a clear pattern, perhaps with an unusual distribution, or a suspicion that the nerve lesion exists elsewhere, perhaps in the neck, or possibly an ulnar nerve lesion, should be referred to the MSK-MDT for further assessment

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7.  Refer MSK-MDT Referral Form (MSK12)

Quick info:
Referral Form:
MSK12 Non Surgical Hand-Wrist Form V3

Choose & Book

You can find this clinic on Choose & Book under
Speciality: Orthopaedics
Clinic type:Hand & Wrist

Provider information
The only provider of the MSK-MDT clinic in the city is the Leeds Musculoskeletal Service. This is a multiprofessional clinic including senior physiotherapists and musculoskeletal physicians.

This clinic provides diagnosis, investigation, treatment and onward referral if needed.

This service is directly bookable via Choose and Book. Please complete the appropriate form and send via Choose and Book.

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8.  GP to discuss options of night splinting, steroid injection, surgery

Quick info:
GP information

Decision Aid for Carpel Tunnel

For mild to moderate symptoms of carpal tunnel syndrome, the following treatment options should be considered:

  • night splinting:
    • to prevent wrist flexion during sleep (flexion increases pressure in the carpal tunnel)
    • difficult to wear during the day due to restrictions on function
  • corticosteroid injection:
    • response rates vary (up to 3 in 4 success rate with single injection but symptoms may recur):
      • consider in-house if expertise available
      • refer if no in-house expertise
  • surgery:
    • probably the best chance of cure
    • may require several weeks off work
    • indicated for progressive symptoms and failure of conservative management

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10. Refer Tier 1 physio for Wrist Splinting Referral Form (MSK12)

Quick info:
Referral Form:
MSK12 Non Surgical Hand-Wrist Form V3

Provider Information

The Leeds MSK Service is going to provide wrist splints for those patients who do not wish to buy their own. Please refer on the appropriate form via Choose and Book Tier 1 Physiotherapy.

Choose & Book

You can find this clinic on Choose & Book under;

Speciality: Physiotherapy
Clinic: Musculoskeletal

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11. Unguided Steroid Injection, In House or Refer MSK-MDT Referral Form (MSK12)

Quick info:
Referral Form:
MSK12 Non Surgical Hand-Wrist Form V3

If the skills exist within the practice then please undertake the unguided injection, otherwise:

Choose & Book

You can find this clinic on Choose & Book under
Speciality: Orthopaedics
Clinic type:Hand & Wrist

Provider information
The only provider of the MSK-MDT clinic in the city is the Leeds Musculoskeletal Service. This is a multiprofessional clinic including senior physiotherapists and musculoskeletal physicians.

This clinic provides diagnosis, investigation, treatment and onward referral if needed.

This service is directly bookable via Choose and Book. Please complete the appropriate form and send via Choose and Book.

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15. Refer to Hand Surgeon Referral Form (MSK13)

Quick info:
Referral Forms
MSK13 Surgical Hand-Wrist V3

Patient information

Please see attached patient information leaflet for preoperative information on Carpal Tunnel Syndrome.

Choose & Book

All providers except LTHT appear under;

Speciality: Orthopaedics
Clinic type:Hand & Wrist

LTHT appears under;

Speciality:Surgery - Plastics
Clinic:Upper Limb
Service:Adult Upper Limb - Surgery Plastics

Provider information
Common providers of this procedure to Leeds patients include:

  • LTHT
  • Spire   please note, exclusions apply
  • Yorkshire Clinic   please note, exclusions apply
  • BRI
  • Harrogate
  • Calderdale Royal Infirmary
  • Eccleshill   please note, exclusions apply

Where exclusions apply common exclusions include:

  • anaesthetic risk
  • previous anaesthetic complication
  • significant co-morbidity
  • severe psychiatric morbidity

Please see Choose & Book Directory of service for additional information.

Key Dates

Published: 16-Dec-2015, by Leeds
Valid until: 19-Feb-2016

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