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Referral guidelines: carpal tunnel syndrome.

The contribution on the postoperative management and rehabilitation of patients with carpal tunnel syndrome should be carefully considered by every surgeon. The operation is simply not over when the last stitch goes in; careful postoperative management is quite important if one is to obtain optimal surgical results. The principles outlined here are valuable and help to explain the occasional poor outcome. We have become convinced that the use of a dorsal splint in the 1st week to 10 days following surgery is a helpful measure. It is designed to prevent the median nerve from prolapsing forward and becoming adherent to or trapped by the edges of the severed transverse carpal ligament. With regard to surgical management of carpal tunnel syndrome. It is exceedingly important to continue producing outcome studies showing that our interventions really do eliminate the problem and allow people to return to productive work. Templates for outcome assessment are under development by the Outcomes Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and also by the American College of surgeons. Hopefully, they can be applied to the treatment of carpal tunnel syndrome. The following segment represents some suggested referral guidelines for patients with carpal tunnel syndrome. The present differential diagnosis, methods of confirming the diagnosis, and appropriate indications for considering surgery. These guidelines have been reviewed by the various authors who have contributed to this issue of Neurosurgical Focus and other colleagues in neurosurgery, orthopedics, plastic surgery, neurology, and occupational therapy. It is hoped that they will be a reasonable start in our efforts to inform referring physicians as to the nature of median thenar neuropathy and its overall management.