Every three to five years, the NHS Lancashire and South Cumbria ICB reviews its clinical policies to ensure they reflect the latest evidence-based guidance and best practice. We are currently reviewing the following policies and would welcome your views on the proposed changes.
Carpal tunnel syndrome happens when a nerve in the wrist (the median nerve) becomes compressed. This can cause:
· Pain, tingling or numbness in the thumb, index and middle fingers
· Symptoms that are worse at night
· In severe cases, muscle weakness or wasting at the base of the thumb
Some people get better on their own or with basic treatment such as splints or a steroid injection.
Currently, NHS Lancashire & South Cumbria ICB funds carpal tunnel surgery only when specific criteria are met. Before surgery, most people must try eight weeks of non-surgical treatment, such as night splints, activity changes, or one steroid injection, unless symptoms are severe. Surgery is only offered when:
· Symptoms disturb sleep or daily activities and don’t improve after non-surgical treatment
· There is loss of feeling, muscle weakness, or thenar muscle wasting
· Symptoms are severe or worsening, where urgent surgery is needed
· In pregnancy‑related cases, surgery is only considered 12 weeks after birth
The current policy can be found at: https://www.healthierlsc.co.uk/application/files/7316/7576/5524/LSCICB_Clin16_Policy_for_Carpal_Tunnel_Syndrome_Surgery_v2.3_with_Pathway.pdf
Under the new policy, there is a more flexible 6–12 week non‑surgical period. The criteria for immediate surgery have been broadened to include people with recurring cases that weren’t covered before.
We have also updated guidance around pregnancy‑related carpal tunnel saying surgery should be avoided if possible. This is because it is usually only temporary during pregnancy, and we want to avoid unnecessary surgery, but there is no longer a restriction of waiting 12 weeks after birth because this was not supported by any evidence.
Overall, this should mean that more people can have the surgery, but only when it is absolutely necessary.
You can read the full new wording below:
New wording:
Surgery for carpal tunnel syndrome is routinely commissioned for patients with mild or moderate symptoms when:
· Symptoms significantly impact sleep or function.
AND
· A 6–12-week course of conservative therapy (for example, night splinting and/or one corticosteroid injection) has been trialled as appropriate.
Surgery is also routinely commissioned for patients in the following circumstances, with no requirement for a trial of conservative therapy prior to surgery:
· When there are any of the following: persistent paraesthesia/hypoesthesia/weakness; constant pain; absence of pain in advanced disease; objective sensory loss or motor weakness; thenar wasting.
OR
· When there are recurrent symptoms following previous carpal tunnel surgery.
For patients with a reversible cause of carpal tunnel syndrome (for example, pregnancy) surgery should be avoided if possible.
Exclusions:
· Emergency presentations are excluded and therefore not restricted by this policy.
· Surgery for presentations suggestive of malignancy is excluded and therefore not restricted by this policy.
Please note this survey closes at midnight on 29th March 2026