Diagnosing and managing carpal tunnel syndrome in primary care by Claire Burton, Linda S Chesterton, and Graham Davenport BJGP Volume 64(622):262-263 April 26, 2014 ©2014 by British Journal of General Practice

Decision tree to be used in conjunction with the questions in Box 1 Decision tree to be used in conjunction with the questions in Box 1. © Keele University. Decision tree to be used in conjunction with the questions in Box 1. © Keele University. Claire Burton et al. Br J Gen Pract 2014;64:262-263 ©2014 by British Journal of General Practice

Suggested method for injection of the carpal tunnel Equipment: chlorhexidine wipe; 1 ml syringe, 23 gauge (blue) or 25 gauge (orange) needle for injection; corticosteroid without lidocaine; simple dressing. Suggested method for injection of the carpal tunnel Equipment: chlorhexidine wipe; 1 ml syringe, 23 gauge (blue) or 25 gauge (orange) needle for injection; corticosteroid without lidocaine; simple dressing. Explain and consent the patient for the treatment. Ensure there are no contraindications to a local steroid injection. Use a sterile ‘no-touch’ technique. The patient places hand palm up in a neutral or slightly extended wrist position (patient sitting). Clean skin following standard local practice. Insert needle at proximal skin crease at wrist, avoiding median nerve which lies under palmaris longus. Aspirate back into the syringe to avoid intravascular injection. Inject. Do not inject against resistance or if severe pain: if this occurs, reposition the needle and inject again. Ensure haemostasis and apply dressing. Provide patient with leaflet regarding the carpal tunnel steroid injection. The patient should be advised to wait in the surgery for 30 minutes following injection or alternatively ensure that they are accompanied by a responsible adult for that time. Claire Burton et al. Br J Gen Pract 2014;64:262-263 ©2014 by British Journal of General Practice