Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves in the hand—the median nerve—is squeezed or compressed due to hand and wrist overuse. A variety of conditions such as diabetes, rheumatoid arthritis and thyroid gland imbalance also can cause or exacerbate CTS.
The AUC scenarios include patient-reported pain and impairment, and whether or not an examination and/or electrodiagnostic testing were performed and the outcomes.
“Carpal tunnel is a complex diagnosis,” said Robert H. Quinn, MD, AUC Section Leader on the Committee on Evidence-Based Quality and Value. “With a very common condition like carpal tunnel syndrome, which has seen a significant variation in the approach, diagnosis and treatment, the AUC succinctly directs the provider toward a fairly narrow and evidence-based decision making and treatment pathway.”
When there is insufficient evidence to support CTS, “the decision making shifts to investigating alternative diagnoses,” said Dr. Quinn.
The knee osteoarthritis AUC includes 864 scenarios that take into account pain, knee instability, patient age, knee alignment and extension, the number of knee compartments affected, and varus/valgus (the direction that the distal segment of the joint points). For the most part, the criteria lean more toward TKR in older patients, and to unicompartmental surgery and realignment osteotomy in younger patients and those with more limited osteoarthritis.
“The younger you are the longer you will have to live with the treatment, and a higher likelihood that your treatment will have to be revised,” said Dr. Quinn. “We want to preserve as much of the normal anatomy as possible for as long as possible.”
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