In this section : Hand Pathways
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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Dupuytren’s Contracture
Last updated 2nd December 2022
Signs/Symptoms
- Characterised by Chords and Nodules in Palm / Fingers
- Flexion deformities typically at MCPJs and PIPJs
- Not usually painful
- Can slowly progress over months/years or have a rapid progression since onset
Advice in Primary Care
- No evidence splintage or exercise arrests development of contracture
- Good practice to avoid gripping over prolonged periods – take regular breaks to stretch the hand and fingers
Actions in Primary Care
- Direct Patient to NHS Inform Website for further info
- Perform a Heustons Table Top Test i.e. lay hand palm down flat on table. IF Negative (flat hand – no gaps) – No further action required.
- Advise patient to monitor Table Top Test regularly.
Referral to Secondary Care
- Positive Heustons Table Top Test i.e. unable to lay hand flat , gaps between palm/fingers and table (push a pencil through)
- Obvious flexion deformity at either MCPJ / PIPJ or both
- REFER VIA SCI GATEWAY TO OCCUPATIONAL THERAPY HAND CLINC and INCLUDE FOLLWING IN REFERRAL:
- ONLY refer if patient wishes to pursue surgery (Do not wait until finger fully flexed to palm)
- Refer urgently if there is a soft tissue lump or swelling which is rapidly increasing in size, painful or has atypical features.
- Durati
- Description of deformities i.e. flexion of MCPJs or PIPJs
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