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A proposal justifying an alternative referral practice from primary care for three common hand surgery diagnoses
  1. Frank D Burke,
  2. Mary J Bradley
  1. Pulvertaft Hand Centre, Derby, UK
  1. Professor Frank D Burke, 28 Midland Place, Derby DE1 2RR, UK; frank.burke{at}

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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.

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.

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Table 1 Changes in the 10 most common elective hand conditions


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 …

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  • All authors declare that they have no competing interests and nothing to declare