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Trigger Finger/Thumb
Osteoarthritis of the Hand/Thumb
Mallet Finger
Ganglion
Dupuytren’s Contracture
De Quervain’s Tenosynovitis
Carpal Tunnel Syndrome
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Carpal Tunnel Syndrome
Last updated 2nd December 2022
Signs/Symptoms
- Pain, numbness, burning or tingling in median nerve distribution of hand – thumb, index and middle fingers and half of the ring finger.
- Symptoms often worse at night/first thing in morning
- May have difficulty holding / dropping objects
- Feeling of hand weakness, reduced sensation and reduced grip strength
- Positive on provocative testing i.e. Tinels, Durkans, Phalens median distribution, little finger usually spared
Advice in Primary Care
- Vary activities during the day, minimising tasks that require repeated squeezing, gripping, wringing, etc.
- Alternate activities between heavier and lighter activities to reduce any strain.
- Avoid prolonged wrist flexion/extension for any period of time.
- Hanging arm out of bed or shaking the hand, when they are numb or tingling may help
- If overweight, losing some weight may help
- Symptoms can settle within a year or so in 1 in 4 cases. So, not treating is an option, particularly if symptoms are mild or if pregnant or under 30 years old
- Optimising management of any underlying condition, i.e. diabetes, hypothyroidism.
Actions in Primary Care
- Confirm diagnosis of CTS through clinical history, provocative testing. Rule out neck related issues
- Provide patient with the CTS information leaflet, and emphasize importance of trying a night splint (info on splints in the below hyperlink):
- Direct Patient to NHS Inform Website for further information
- Carpal tunnel syndrome information leaflet
Referral to Secondary Care
- Moderate/Severe symptoms including thenar muscle wasting
- Symptoms involving ulnar nerve; nerve conduction tests may be required
- If symptoms persist following 6-8 weeks of self management – REFER VIA SCI GATEWAY TO OCCUPATIONAL THERAPY HAND CLINC and INCLUDE FOLLOWING IN REFERRAL:
- Duration of: self management – ? tried splint for 6 weeks or more
- Precipitating factors i.e. injury/trauma, Occupation
- Provocative testing (Tinel’s Durkan’s, Phalen’s) results , median distribution or not, ?hypothenar muscle wasting
- Night-time symptoms
- Hand dominance, activity related symptoms
Links
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