MSK Physiotherapy for people with wrist and hand problems is provided within a specialist clinic setting at St Johns Hospital. A level of specialist service is also in partnership with the physiotherapy department within the Royal Infirmary of Edinburgh and the Western General Hospital. These clinics receive referrals only from the Consultant clinics within Plastic Surgery. At this stage this specialist MSK Physiotherapy clinic does not receive referrals directly from primary care clinicians.
MSK Physiotherapy for people with wrist and hand problems is also provided within MSK Physiotherapy services within community settings across the Lothian’s. Please see the guidance below to help support decision making with regard to referrals.
Currently there is no direct pathway between MSK Physiotherapy in the community setting and the specialist MSK Physiotherapy hand service within St John’s, RIE or the WGH. This situation is currently under review.
Below the table with referral guidance please see information and advice relating to specific conditions affecting the wrist and hand
For additional clinical support and referral guidance to Plastic Surgery / Hand Surgery please visit https://apps.nhslothian.scot/refhelp/PlasticSurgery/HandSurgery
For further information please visit https://lothianvirtualhandclinic.co.uk/
| Who not to refer/red flag presentations | Serious pathology as a cause of MSK conditions is considered rare, but needs to be managed either as emergency or urgent referral to relevant secondary care service. Consider below & also see relevant body area tab for further specific information and advice. Please make sure all red flag concerns have been managed prior to any MSK Physiotherapy referral For further support & guidance and refer to: https://apps.nhslothian.scot/refhelp/PlasticSurgery/HandSurgery |
| Emergency conditions | Recent Hand or wrist trauma Tumours |
| Urgent Conditions | Primary and secondary cancers- suspected New inflammatory arthritis/ myositis- suspected Peripheral Neuropathy Upper extremity nerve injuries, wrist drop, ulnar nerve, cubital tunnel symptoms. History of trauma / fall outstretched hand Peripheral Vascular disease |
| Consider serious pathology as a differential diagnosis if person presents with: | escalating pain and progressively worsening symptoms that do not respond to conservative management or medication as expected systemically unwell (fever, weight loss) night pain that prevents sleep due to escalating pain |
| What not to refer/other: | Presence of significant red flags as detailed above Age <16 Non MSK complaints Refer people with the following conditions directly to Plastic Surgery Department Trigger Finger / thumb Congenital Hand Anomalies Clasp Hand Radial nerve palsy White finger Raynaud’s disease Dupuytren’s Disease Cysts / Ganglia / lumps & nodules Skin conditions or lesions |
Who to refer:
People with musculoskeletal wrist and hand pain who have not responded to initial primary care management, do not have the presence of significant red flags and do not meet the criteria for referral to secondary care Plastic Surgery speciality https://apps.nhslothian.scot/refhelp/PlasticSurgery/HandSurgery
See detail below for additional advice regarding specific conditions affecting the wrist and hand
How to refer:
Refer via SCI Gateway Referral “AHP-Physiotherapy” then choose local site.
Please provide as much detail as possible to help the triage process.
- NHS Lothian Hand Unit Website was developed in 2021 with the aim of improving the information provided to patients following referral, and to avoid unnecessary face to face appointments. The information is intended to compliment what patients are told in clinic and offer a trusted source of information. https://thelothianhandunit.wordpress.com
- The British Society for Surgery of the Hand website provides a wealth of information for patients and medical professionals on hand conditions including injuries and disorders, hand surgery and hand therapy. https://www.bssh.ac.uk/
- The British Association of Hand Therapists (BAHT) is a registered UK charity and clinical interest group for anyone interested in the rehabilitation of hands, with a dedicated patient section on hand injuries and disorders https://www.hand-therapy.co.uk/
- NHS Inform – Scotland’s National health information service- contains a range of self management information, tools and exercises for supporting people to make informed decisions about their health and MSK problems. This links directly to hand and wrist problems. https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/wrist-hand-and-finger-problems
- Versus arthritis have a range of resources to support clinicians and patients https://www.versusarthritis.org/. Versus arthritis have a professional network you can join, which gives monthly up-date on MSK. They also have a range of training programmes and resources designed to improve MSK care. You might also be interested in their Clinical Assessment Guide and Decision Support Tools
- NHS Education for Scotland- MSK Evidence Base Hub http://www.knowledge.scot.nhs.uk/musculoskeletal.aspx
- NHS 24 MSK Help app https://www.nhsinform.scot/care-support-and-rights/tools-and-apps/nhs-24-msk-help-app
- NHS UK Website on Hand and Wrist Conditions and Pain https://www.nhs.uk/conditions/hand-pain/
- RefHelp Plastic Surgery / Hand Surgery is designed to help GP’s and other clinicians to make the best possible referrals within Lothian https://apps.nhslothian.scot/refhelp/PlasticSurgery/HandSurgery
- Radial neuropathy information – Refhelp https://apps.nhslothian.scot/refhelp/guidelines/RadialNeuropathy.aspx
- NHS Lothian Physiotherapy Leaflets for the upper limb: physiotherapy/PatientInfoLeafletNetwork/Pages/UpperLimb.aspx
