Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome

• A New Care Pathway

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Format

• Introduction (5mins) SL
• Current Rheumatology issues (15mins) AY
• Current Orthopaedic Issues (10mins) ND
• Introduction to pathway (5mins) SL
• Pairs to consider pathway (10mins) ALL
• Questions/ comments to panel (10mins) ALL

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Burden of disease

• Incidence of one new case per 1,000 population
  per year suggests
• 140 new cases per year in PCT
• 2 new cases per GP per year
• Prevalence of 3 suggests
• 4,000 cases in PCT
• 60 cases per GP

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Health care activity data

• 85 episodes of carpal tunnel decompression in
  2003
• 75 (64) SACH
• 11 (9) QE2
• 5 (4) HHGH
• 2 (2) Stoke Mandeville

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Rheumatology aspects
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CARPAL TUNNEL SYNDROME.West Herts Hospitals
Trust. SACH 2005. Adam Young1. Background.

• Common
• Prevalence 3
• Incidence 52/100,000 person yrs for men
• 149/100,000 person yrs for women
• Painful and or unpleasant condition.
  Acute-gtchronic.
• Loss of function e.g. work disability
• Diagnosis made clinically in majority
• Conservative treatment effective in majority

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CTS 2. Problems

• Diagnostic difficulties figures for this in
  primary care not known
• Under and or inappropriate treatment in 1ry/2ry
  care
• e.g. results of West Herts primary care audit
  project showed that 50 patients with diagnosis
  of CTS were offered NO treatment while waiting
  for 2ry care opinion
• Waiting lists for diagnosis and treatment in
  secondary care. 

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CTS3. Guidelines

• Guidelines for diagnosis management of CTS
• 1995 Rheumatology guidance/advice enclosed

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CTS4. One stop Clinical assessment/NCS/EMG clinic

• Developed at SACH from 1995 in Dept Rheumatology
• All GP letters triaged by AY
• Standard clinic assessment /- NCS/EMG
• Management initiated further advice given to GP
• 1 Clinic/week at SACH 0.5 clinic/wk at HHGH
• EMG database generated tables which reflect
  current service figures are enclosed
• Reasons for referral by year i.e. 2000 to 2004 (n
  )
• Reasons for referral by source of referral (n
  ) relevant to CTS

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One stop Clinical assessment/NCS/EMG clinicSACH
EMG database tables

• These show Rheumatology Dept performs 350-420
  studies/year
• 75-82 are CTS referrals, of which
• 8 from Hand Surgeons
• 22 from orthopaedics
• 67 from one stop NCS/EMG clinic

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Orthopaedic aspects
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CTS Care Pathway
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Pairs to consider pathway
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Questions and Comments to panel