Hand Surgery

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)
• Early Dupuytren’s disease (see referral advice)

How to refer:

Via SCI gateway (Information to include with the referral) 

• 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
• Plastic Surg – PIL BSSH GANGLIA Aug18
• Plastic Surg – PIL BSSH OA THUMB Aug18
• Plastic Surg – PIL BSSH TRIGGER FINGERAug18
• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Wrist Pain Algorithm of Differential Diagnoses