Appropriate Use Criteria

Click to complete in-office diagnostic evaluation required for the first indication.

Assumptions:

1. For this CTS AUC, all patients receive an in-office diagnostic evaluation including a completed CTS-6 or Katz Hand Diagram.
2. This AUC addresses adult patients with suspected primary carpal tunnel syndrome and excludes failed treatment after surgery.
3. If patients are diabetic and a steroid injection is rated appropriate, the clinician and patient should be aware that the steroid medication may cause a transient, but substantial elevation of blood glucose level.
4. If operative treatment by carpal tunnel release is appropriate, endoscopic or open may be performed at the practicing clinician’s discretion.
5. In the absence of reliable evidence, it is the opinion of the work group that CTS during pregnancy should be treated at the discretion of patients and their clinicians within the confines of the clinical practice guideline.
6. Duration of symptoms as an indication can be difficult to accurately quantify and therefore is not addressed in this AUC.
7. The EDS are ordered based on clinical judgement and are of sufficient quality to investigate the diagnosis of CTS and/or alternative diagnoses when appropriate.
8. For the indication group “response to previous treatment,” non-operative treatment assumes no prior steroid injection.
9. When surgery is the most appropriate treatment but the patient is unwilling or there is a medical contraindication to surgery, clinicians may select non-operative treatment options.

Exclusions:
This AUC does not apply to:

• acute carpal tunnel syndrome
• untreated inflammatory arthritis
• untreated diabetes
• thyroid disease
• Pernicious Anemia
• patients with a known space-occupying lesion in the carpal tunnel
• failed treatment after surgery
• pediatric and adolescent patients

Links:
CTS Clinical Examination Tools (CTS-6 and Katz)

Disclaimer:

Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment.