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Primary care management of patients with carpal tunnel syndrome referred to surgeons: are non-operative interventions effectively utilised?
  1. Frank D Burke1,
  2. Mary J Bradley1,
  3. Shiladitya Sinha1,
  4. E F Shaw Wilgis2,
  5. Norman H Dubin2
  1. 1The Pulvertaft Hand Centre, Derbyshire Royal Infirmary, Derby, UK
  2. 2The Curtis National Hand Center, Union Memorial Hospital, Baltimore, Maryland, USA
  1. Correspondence to:
 Dr Shaw Wilgis
 c/o Anne Rupert Mattson, Editor, Curtis National Hand Center, Union Memorial Hospital, 3333 N. Calvert Street, #400, Baltimore, MD 21218, USA; anne.mattson{at}


Aim: To investigate the non-operative primary care management (splintage, task modification advice, steroid injections and oral medications) of carpal tunnel syndrome before patients were referred to a hand surgeon for decompression.

Design and setting: Preoperative data were obtained on age, gender, body mass index, employment, symptom duration, and preoperative clinical stage for patients undergoing carpal tunnel decompression (263 in the USA, 227 in the UK).

Results: Primary care physicians made relatively poor use of beneficial treatment options with the exception of splintage in the US (73% of cases compared with 22.8% in the UK). Steroid injections were used in only 22.6% (US) and 9.8% (UK) of cases. Task modification advice was almost never given. Oral medication was employed in 18.8% of US cases and 8.9% of UK cases.

Conclusions: This study analyses the non-operative modalities available and suggests that there is scope for more effective use of non-operative treatment before referral for carpal tunnel decompression.

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  • Funding: This study received research support from the Derbyshire Acute Hospitals NHS Trust Matching Grant Research Scheme and the Pulvertaft Hand Centre Trust Funds. This study was also supported in part by funds from the American Foundation for Surgery of the Hand, the Raymond M Curtis Research Foundation, and MedStar Research Institute. The funding sources had no involvement in the study design; collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

  • Competing Interests: The authors have no financial interests that influence this study.

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