This page is currently under review – Aug 2023
Services
Hand and wrist surgery in adults and children
Who to refer:
Urgent
- Recent hand or wrist trauma (soft tissue or bony)
- Tumours (soft tissue or bony)
Non-urgent
- Nerve compressions (including carpal tunnel)
- Dupuytren’s disease
- Osteoarthritis, e.g base of thumb
- Rheumatoid arthritis
- Trigger finger/thumb
- Ganglia
- Post-traumatic reconstruction
- Wrist pain
- Tenosynovitis, e.g. de Quervain’s syndrome
- Congenital hand anomalies
Who not to refer:
- Early mild carpal tunnel syndrome (see referral pathway opens a new window)
- Early Dupuytren’s disease (see referral advice opens a new window)
How to refer:
Via SCI gateway (Information to include with the referral opens a new window)
- Adults: St John’s Hospital Livingston
- Children: Royal Hospital for sick children
- Carpal Tunnel: St John’s Hospital>Plastic Surgery>Carpal Tunnel Referral
Phalen’s test
- Flex the wrist for 60 seconds and note occurrence of pain or paraesthesia in the median nerve distribution.
- Phalen’s test is positive in up to 75% of electromyography (EMG) proven cases but 20% false positives are found in controls.
Tinel’s sign
- Tap lightly over the median nerve at the wrist.
- Positive test symptoms are distal lancinating paraesthesiae in the median nerve distribution
- Plastic Surg – PIL BSSH CARPAL TUNNEL Aug18 opens a new window
- Plastic Surg – PIL BSSH GANGLIA Aug18 opens a new window
- Plastic Surg – PIL BSSH OA THUMB Aug18 opens a new window
- Plastic Surg – PIL BSSH TRIGGER FINGERAug18 opens a new window
- National Institute for Health and Care Excellence (NICE) opens a new window
- Scottish Intercollegiate Guidelines Network (SIGN) opens a new window
- Wrist Pain Algorithm of Differential Diagnoses opens a new window
