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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome. A New Care Pathway. 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

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Carpal Tunnel Syndrome

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  1. Carpal Tunnel Syndrome A New Care Pathway

  2. 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

  3. 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

  4. 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

  5. Rheumatology aspects

  6. 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->chronic. • Loss of function e.g. work disability • Diagnosis made clinically in majority • Conservative treatment effective in majority

  7. CTS2. 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. 

  8. CTS3. Guidelines • Guidelines for diagnosis & management of CTS • 1995 Rheumatology guidance/advice enclosed

  9. 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

  10. 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

  11. Orthopaedic aspects

  12. CTS Care Pathway

  13. Pairs to consider pathway

  14. Questions and Comments to panel

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