Criteria for referral to public hospital service

• Neurogenic injury confirmed by nerve conduction study with either:
  • severe disabling symptoms with weakness and wasting
  • rapid progression
  • unresponsive to at least three months of medical management (that is at least two of hand therapy, orthotics/splinting, ergonomic modifications, local steroid injection, oral steroids, alone or in combination)
• Recurrence of neurogenic injury after surgical decompression.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Recent nerve conduction study report
• Description of onset, nature, progression, recurrence and duration of symptoms
• How symptoms are impacting on daily activities including impact on work, study or carer role
• Details of previous medical and non-medical management including the course of treatments and outcome of treatments
• If referral relates to recurrence after surgical decompression, details of previous surgery including when and where procedure(s) were performed
• Statement about the patient’s interest in having surgical treatment if that is a possible intervention.

Provide if available

• Details of any previous related surgery
• If the person identifies as an Aboriginal and/or Torres Strait Islander
• If the person is part of a vulnerable population.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

As the finding of a nerve conduction study is needed for referral, people experiencing barriers to accessing a nerve conduction study may need to be referred to a public health service for this imaging service.

Patients presenting with mild carpal tunnel syndrome should be offered conservative management, which may include hand therapy, orthotics/splinting, ergonomic modifications, local steroid injection or oral steroids. Combined therapies may be more beneficial than therapies in isolation of one another. 

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

• Vulnerable populations include:
  • people from culturally and linguistically diverse backgrounds
  • older Australians
  • carers of people with chronic conditions
  • people experiencing socio-economic disadvantage
  • people living in remote, or rural and regional locations
  • people with a disability
  • people with mental illness
  • people who are, or have been, incarcerated.

Vulnerable patient groups also include terminally ill patients, patients with experiences of family violence, in out-of-home care, foster care and those in state care.

Referral to a public hospital is not appropriate for

• Diagnosis unconfirmed by nerve conduction study
• Where at least three months of medical management (that is at least two of hand therapy, orthotics/splinting, ergonomic modifications, local steroid injection or oral steroids, alone or in combination), has not been trialled.