NHS Doncaster CCG - Community Carpel Tunnel Service (AQP) (PIN not PQQ)

Carpal tunnel syndrome (CTS) is caused when the median nerve, which runs through a tunnel in the palm of the hand called the carpal tunnel, is compressed. CTS decompression surgery is performed by cutting across the roof of the carpal tunnel to release pressure on the median nerve inside.

The surgical decompression of the carpal tunnel is labelled as a procedure within the South Yorkshire and Bassetlaw (SYB) Commissioning for Outcomes (CFO) Policy (including National Evidence Based Interventions) and the Royal College of Surgeons (RCS) recommend that it is more cost effect to offer this service within primary care.

CTS is the most common form of nerve entrapment, nationally affecting 7-16% of the UK population and currently a third of UK patients diagnosed with CTS require surgery. It is most common in women, with a UK General Practice research database finding that 88 men and 193 women presented with new CTS cases per 100,000 population, per year.

(RCS Commissioning Guide, 2017)

Most cases of carpal tunnel syndrome are idiopathic. The symptoms of carpal tunnel syndrome have been estimated to be bilateral in up to 73% of cases, although they may not manifest concurrently. Other causes or associations have been identified with pregnancy, overuse of the hand or wrist, wrist trauma, obesity, hypothyroidism, renal failure, diabetes, and inflammatory arthropathy. Evidence also suggests a genetic component for carpal tunnel syndrome, although the exact basis of this has not yet been established. (The British Medical Journal (BMJ), 06 November 2014)

The British Society for Surgery of the Hand (BSSH) state that surgery is an effective treatment for patients with severe persistent carpal tunnel syndrome symptoms and provides a permanent and complete cure in 80 - 90% of patients.

We know that there are approximately 100 open release Carpal Tunnel procedures per 100,000 UK population currently, per annum as evidenced by the RCS (2017). Locally in Doncaster we fund approximately 260 procedures per year.