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Review
. 2014 May;64(622):262-3.
doi: 10.3399/bjgp14X679903.

Diagnosing and managing carpal tunnel syndrome in primary care

Claire Burton  1 , Linda S Chesterton, Graham Davenport
Affiliations
Review

Diagnosing and managing carpal tunnel syndrome in primary care

Claire Burton et al. Br J Gen Pract. 2014 May.
No abstract available

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Figures

Figure 1.
Figure 1.
Decision tree to be used in conjunction with the questions in Box 1. © Keele University.
Figure 2.
Figure 2.
Suggested method for injection of the carpal tunnel

  1. Equipment: chlorhexidine wipe; 1 ml syringe, 23 gauge (blue) or 25 gauge (orange) needle for injection; corticosteroid without lidocaine; simple dressing.

  2. Explain and consent the patient for the treatment. Ensure there are no contraindications to a local steroid injection.

  3. Use a sterile ‘no-touch’ technique.

  4. The patient places hand palm up in a neutral or slightly extended wrist position (patient sitting).

  5. Clean skin following standard local practice.

  6. Insert needle at proximal skin crease at wrist, avoiding median nerve which lies under palmaris longus.

  7. Aspirate back into the syringe to avoid intravascular injection.

  8. Inject. Do not inject against resistance or if severe pain: if this occurs, reposition the needle and inject again.

  9. Ensure haemostasis and apply dressing.

  10. Provide patient with leaflet regarding the carpal tunnel steroid injection.

  11. The patient should be advised to wait in the surgery for 30 minutes following injection or alternatively ensure that they are accompanied by a responsible adult for that time.

See this image and copyright information in PMC

References

    1. Bland JDP, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991–2001. J Neurol Neurosurg Psychiatry. 2003;74(12):1674–1679. - PMC - PubMed
    1. Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006;77(2):263–265. - PMC - PubMed
    1. Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012;6:69–76. - PMC - PubMed
    1. American Academy of Orthopaedic Surgeons Clinical practice guideline on the diagnosis of carpal tunnel syndrome. 2007 http://www.aaos.org/Research/guidelines/CTS_guideline.pdf (accessed 11 Apr 2014). - PMC - PubMed
    1. Burton C, Chesterton L, Davenport G, et al. Developing agreed clinical criteria for the diagnosis of carpal tunnel syndrome in primary care — a clinical consensus exercise. Society of Academic Primary Care Annual Conference; 4 July 2013; Nottingham. p. 2E.2.

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