{"id":3988,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/handsurgery\/"},"modified":"2023-09-13T13:20:06","modified_gmt":"2023-09-13T12:20:06","slug":"handsurgery","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/plasticsurgery\/handsurgery\/","title":{"rendered":"Hand Surgery"},"content":{"rendered":"\n

This page is currently under review – Aug 2023<\/strong><\/p>\n\n\n\nHand Surgery<\/title>\n\n\n\n<h4 class=\"wp-block-heading\">Services<\/h4>\n\n\n\n<p>Hand and wrist surgery in adults and children<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p><strong>Urgent<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Recent hand or wrist trauma (soft tissue or bony)<\/li>\n\n\n\n<li>Tumours (soft tissue or bony)<\/li>\n<\/ul>\n\n\n\n<p><strong>Non-urgent<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Nerve compressions (including carpal tunnel)<\/li>\n\n\n\n<li>Dupuytren\u2019s disease<\/li>\n\n\n\n<li>Osteoarthritis, e.g base of thumb<\/li>\n\n\n\n<li>Rheumatoid arthritis<\/li>\n\n\n\n<li>Trigger finger\/thumb<\/li>\n\n\n\n<li>Ganglia<\/li>\n\n\n\n<li>Post-traumatic reconstruction<\/li>\n\n\n\n<li>Wrist pain<\/li>\n\n\n\n<li>Tenosynovitis, e.g. de Quervain\u2019s syndrome<\/li>\n\n\n\n<li>Congenital hand anomalies<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Early mild carpal tunnel syndrome (see <a href=\"\/refhelp\/guidelines\/CarpalTunnelSyndrome\" target=\"_blank\" rel=\"noreferrer noopener\">referral pathway<\/a>)<\/li>\n\n\n\n<li>Early Dupuytren\u2019s disease (see <a href=\"\/refhelp\/guidelines\/DupuytrensDisease\" target=\"_blank\" rel=\"noreferrer noopener\">referral advice<\/a>)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Via SCI gateway (<a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/refhelp\/furtherinfo\/plastics-plastics-exceptional-aesthetic-referral-checklist\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/furtherinfo\/plastics-plastics-exceptional-aesthetic-referral-checklist\/\" target=\"_blank\">Information to include with the referral<\/a>) <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Adults: St John\u2019s Hospital Livingston<\/li>\n\n\n\n<li>Children: Royal Hospital for sick children<\/li>\n\n\n\n<li>Carpal Tunnel: St John’s Hospital>Plastic Surgery>Carpal Tunnel Referral<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Phalen\u2019s test<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Flex the wrist for 60 seconds and note occurrence of pain or paraesthesia in the median nerve distribution. <\/li>\n\n\n\n<li>Phalen\u2019s test is positive in up to 75% of electromyography (EMG) proven cases but 20% false positives are found in controls. <\/li>\n<\/ul>\n\n\n\n<p><strong>Tinel\u2019s sign<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tap lightly over the median nerve at the wrist. <\/li>\n\n\n\n<li>Positive test symptoms are distal lancinating paraesthesiae in the median nerve distribution<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-CARPAL-TUNNEL-1.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-CARPAL-TUNNEL-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg – PIL BSSH CARPAL TUNNEL Aug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-GANGLIA.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-GANGLIA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg – PIL BSSH GANGLIA Aug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-OA-THUMB.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-OA-THUMB.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg – PIL BSSH OA THUMB Aug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-TRIGGER-FINGER.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/BSSH-TRIGGER-FINGER.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Plastic Surg – PIL BSSH TRIGGER FINGERAug18<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.nice.org.uk\/\" data-type=\"URL\" data-id=\"https:\/\/www.nice.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">National Institute for Health and Care Excellence (NICE)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.guidelinesinpractice.co.uk\/home\/the-scottish-intercollegiate-guidelines-network-sign\/305547.article\" data-type=\"URL\" data-id=\"https:\/\/www.guidelinesinpractice.co.uk\/home\/the-scottish-intercollegiate-guidelines-network-sign\/305547.article\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Intercollegiate Guidelines Network (SIGN)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Wrist-Pain-Algorithm-of-Differential-Diagnoses.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Wrist-Pain-Algorithm-of-Differential-Diagnoses.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Wrist Pain Algorithm of Differential Diagnoses<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This page is currently under review – Aug 2023 Hand Surgery Services Hand and wrist surgery in adults and children<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4310,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[549],"class_list":["post-3988","page","type-page","status-publish","hentry","category-handsurgery"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/plasticsurgery\/handsurgery\/\" rel=\"tag\">Hand Surgery<\/a>","rttpg_excerpt":"This page is currently under review – Aug 2023 Hand Surgery Services Hand and wrist surgery in adults and children","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3988","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3988"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3988\/revisions"}],"predecessor-version":[{"id":16398,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3988\/revisions\/16398"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4310"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3988"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3988"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}