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
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 opens a new window
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 opens a new window 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
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 opens a new window
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/ opens a new window
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/ opens a new window
