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Carpal tunnel NS MOM
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diagnosis, conservative and surgical management of carpal tunnel syndrome (CTS) in primary and secondary care, including pregnant women
Out of scope:
repetitive strain syndrome
CTS occurs when the median nerve becomes compressed within the carpal tunnel 
CTS causes numbness or tingling in the fingers innervated by the median nerve (ie the thumb, index and middle fingers)
The care map has been updated in line with the following guidelines:
 American Academy of Orthopaedic Surgeons (AAOS). Clinical practice guideline on the diagnosis of carpal tunnel syndrome. Rosemont, IL, US: AAOS; 2007.
 PRODIGY. Carpal tunnel syndrome. Version 1.0. Newcastle upon Tyne: PRODIGY; 2008.
 American Academy of Orthopaedic Surgeons (AAOS). Clinical practice guideline on the treatment of carpal tunnel syndrome. Rosemont, IL, US: AAOS; 2008.
Further information was provided by the following references: [3,4,5,7-12].
Clinical presentation :
tingling numbness or pain in the distribution of the median nerve:
half the ring finger
symptoms are often worse at night, causing wakening
some people present atypically, eg sensory changes in all digits
Typical signs and symptoms of carpal tunnel syndrome (CTS) include:
discomfort, paraesthesia, weakness, or clumsiness in the median nerve distribution 
dull, aching discomfort in the hand, forearm, or upper arm 
paraesthesia in the hand 
weakness or clumsiness of the hand, particularly :
thumb grip, causing the person to drop objects
fine finger function
provocation of symptoms by :
sustained hand or arm positions
repetitive actions of the hand or wrist
mitigation of symptoms by :
changing hand posture
shaking the wrist
hand changes :
Physical examination can be normal, or reveal :
sensory loss in the median nerve distribution, including loss of two-point discrimination
weakness or atrophy of thenar muscles
dry skin of the thumb, index, and middle fingers
positive Phalen's test – flexing the wrist for 60 seconds causes pain or paraesthesia in the median nerve distribution
positive Tinel's sign – lightly tapping the median nerve at the wrist causes a distal lancinating paraesthesia in the median nerve distribution
positive carpal tunnel compression test – pressure over the proximal edge of the carpal ligament causes paraesthesia to develop or increase in the median nerve distribution
MSK Interface provide assessment, diagnostic and treatment of a wide variety of musculoskeletal conditions. This includes both simple and complex problems that may traditionally have been referred direct to orthopaedics.
Primarily the role is assessment of non-surgical cases or assessing and triaging those patients where the need for surgery is not obvious.
Treatments include an injection service, exercise therapy, self-management programs and referral on for physiotherapy, podiatry and surgical appliances as required.
Diagnostics includes access to MRI and ultrasound when deemed clinically relevant by the clinician