Peripheral nerve palsies and compression entrapments Referral Access Criteria

• Trauma with neurovascular compromise
• Suspected acute compartment syndrome

• Symptomatic malignant tumour 

• Upper limb peripheral nerve palsies and compression/entrapments not responsive to conservative management, e.g.:
  
  • carpal tunnel syndrome
  • ulnar nerve entrapment
  • posterior interosseous nerve syndrome

NB: For facial nerve palsy, see Craniofacial conditions

Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reasons). This information is required to inform accurate and timely triage.

If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset, severity, and duration of symptoms (e.g. handedness, pain, numbness, altered sensation, frequency)
• Degree of functional impairment (e.g. impact on employment/ADLs)
• Current medication list
• Any known allergies
• Details of current and previous treatment and outcome (e.g. allied health input and steroid injections)

• Sensory or motor deficit distribution e.g. median, ulnar, radial nerves

• Nil

• Details of smoking and/or vaping (containing nicotine) status
• Advise whether or not your patient is taking any anti-platelets or anti-coagulants
  
  • if so, state the indication
• Occupational Therapy/Physiotherapy report

• BMI

• If diabetic patient - HbA1c
• If suspicious of peripheral neuropathy - Vitamin B12
• Consider ultrasound (US) if suspected mass causing compression.
  • NB: Otherwise, routine ultrasound is not required as a diagnostic tool for compression neuropathy
• Nerve conduction studies (NCS) if performed (NCS will support accurate triage urgency)

Category 1

Appointment within 30 days

• Sudden onset severe symptoms suggestive of acute nerve compression without trauma or acute event
• Peripheral nerve compression syndrome or palsy with:
  
  • rapidly progressing and/or severe neurological deficit OR
  • associated with disabling pain syndrome
• Pressure from external lesion (symptomatic benign tumour)

Category 2

Appointment within 90 days

• Frequent and/or progressive peripheral nerve compressive symptoms or palsy with corresponding clinical signs
• Recurrence of significant symptoms or clinical signs after surgical decompression
• Peripheral nerve entrapment syndromes or palsy with severe pain

Category 3

Appointment within 365 days

• Intermittent or mild symptoms of peripheral nerve compression or palsy failing to respond to conservative management and considered to warrant assessment for surgical management

• Peripheral nerve compressions/entrapments of the lower limb
  • refer to Neurosurgery or Orthopaedics
• Brachial Plexus Injury
  
  • refer to Orthopaedics
• Thoracic outlet syndrome
  
  • refer to Vascular
• Central nerve compression
  
  • refer to Neurosurgery or Orthopaedic (Spine)

• Routine ultrasound scans are not indicated for the diagnosis of peripheral nerve compression or entrapment
• Carpal tunnel syndrome can be referred to the following specialties:
  
  • Plastic and Reconstructive Surgery
  • Orthopaedics
  • Neurosurgery
  • General Surgery
• Diabetic peripheral neuropathy will require comprehensive diabetic management.
  • see Clinician Assist WA: Peripheral Neuropathy

Conservative management strategies

• Consider:
  
  • treating underlying causes, e.g. Vitamin B12 deficiency, alcohol excess, diabetes
  • analgesia for neuropathy, e.g. SNRI, TCAs, antiepileptics
  • hand therapy, See Clinician Assist WA: Occupational Therapy Requests or Clinician Assist WA: Physiotherapy Requests
  • splinting
  • steroid injection if not contraindicated