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Postgraduate Medical Journal 2007;83:616-617; doi:10.1136/pgmj.2007.060723
Copyright © 2007 The Fellowship of Postgraduate Medicine
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EDITORIALS

Primary care

A proposal justifying an alternative referral practice from primary care for three common hand surgery diagnoses

Frank D Burke , Mary J Bradley

Pulvertaft Hand Centre, Derby, UK

Correspondence to:
Professor Frank D Burke, 28 Midland Place, Derby DE1 2RR, UK; frank.burke@virgin.net

A hand therapy primary care clinic offering advice on task modification at work and in the home and the use of splints was found to almost halve referrals of carpal tunnel syndrome from a single primary care trust. Dorsal ganglion aspiration and steroid injection for trigger digits can also be safely performed in primary care, further reducing the need for hospital care.

Keywords: carpal; tunnel; ganglia; trigger; digits

The first 150 words of the full text of this article appear below.

Wildin and others1 compared hand surgery activity from two audits and identified a 36% increase in elective referrals between 1989/90 and 2000 (table 1). In such circumstances there is a need to optimise treatment in a primary care setting to ensure referral is limited to those patients needing treatments, which require hospital facilities or expertise. Three elective hand surgery conditions are reviewed (carpal tunnel syndrome, ganglia, and triggering of digits). Referrals with these diagnoses constituted 39% of the total in district referrals to a hand unit at the 2000 audit.


View this table:



  		Table 1 Changes in the 10 most common elective hand conditions

 

EASE OF DIAGNOSIS
Diagnostic difficulty in primary care is a common reason for referral to hospital. If more comprehensive treatment is to be offered in primary care for the three common hand conditions, diagnosis by a general practitioner (GP) without undue difficulty must be possible in most cases. As part . . . [Full text of this article]






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