What are the current guidelines for the non-surgical management of carpal tunnel syndrome in primary care?

Non-surgical management of carpal tunnel syndrome (CTS) in primary care involves the following key steps:

• Initial assessment and diagnosis: Establish a working diagnosis of CTS based on clinical assessment.
• Provide patient information and support: Offer advice on sources of information such as patient leaflets from the British Society for Surgery of the Hand, Royal College of Surgeons of England, Versus Arthritis, and NHS websites to support understanding and self-management.
• Lifestyle advice: Advise patients to avoid repetitive hand and wrist movements and to take regular breaks from tasks that precipitate symptoms. Consider the need for workplace assessment and adaptation, including referral to Occupational Health if appropriate, especially if work-based risk factors like hand-transmitted vibration are present.
• Optimize management of underlying conditions: Address any contributory medical conditions that may exacerbate CTS symptoms.
• Offer a trial of conservative treatment for mild to moderate symptoms: A 6-week trial of conservative treatments is recommended. Options include:
• Use of a wrist splint in a neutral position at night, which may be fitted by local musculoskeletal services depending on referral pathways.
• A single corticosteroid injection into the carpal tunnel, which can be administered in primary care if expertise is available, or else by referral to musculoskeletal or surgical services.
• Hand exercises and median nerve mobilization techniques, potentially offered by local musculoskeletal services.
• Review and follow-up: Arrange review after 6 weeks to assess symptom persistence or improvement, with earlier review if symptoms worsen or new clinical features develop.
• Referral criteria: Refer to appropriate specialists (musculoskeletal service, rheumatologist, orthopaedic or hand surgeon, neurologist) if diagnosis is unclear, symptoms persist despite conservative treatment, symptoms progress or severe disease features develop, or if symptoms recur after surgery.

This approach aims to provide effective symptom relief while avoiding unnecessary delays to surgical intervention if conservative management fails.