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.

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 of the 2000 audit, all local GPs were asked: “How difficult was it to diagnose carpal tunnel syndrome, triggering and ganglia?” The results from 201 GPs are shown in table 2. Triggering and ganglia were not considered to present much of a diagnostic dilemma, with carpal tunnel syndrome proving …