Common Conditions Affecting the Hand and Wrist

Top 10 priorities

(In no order of priority)

• Can scar/fibrosis formation be manipulated to improve results following hand surgery/trauma?
• In patients with Dupuytren's disease, what invasive techniques give the best results in terms of function, recurrence and cost?
• In the treatment of common hand conditions, such as peripheral nerve compression syndromes (for example carpal tunnel syndrome), ganglia or arthritis of the fingers/thumb/wrist, do surgical interventions have a demonstrable benefit in patient reported outcome when compared with non-surgical methods or placebo (sham) surgery?
• Regarding patient and cost benefits, which interventions (for example movement preserving surgeries such as joint or cartilage replacement, fusion operations permanently stiffening the joint and novel therapies) give the best results in the treatment of painful joints in the hand/wrist?
• What are the most effective non-surgical methods for treating early arthritis in the hand and fingers?
• What interventions/treatments will have the most positive effect following nerve injury?
• What methods are most accurate, user friendly and demonstrate the best clinical utility in measuring patient reported outcomes in common hand conditions?
• Which hand therapy techniques enable the most efficient return to full function following surgery or injury?
• Which hand/finger/thumb injuries would benefit from surgical intervention over hand therapy or no formal treatment, considering both functional outcome and societal cost?
• Which patients with acute ligament injuries to the wrist or chronic wrist/distal radio-ulnar joint (the joint on the little finger side of the wrist) instability benefit from surgical treatment rather than from non-surgical method?

The following questions were also discussed at the workshop (in no order of priority):

• Can a more holistic approach (psychologically, socially, spiritually, culturally informed) to hand therapy have additional benefits for patients with common hand conditions including traumatic injuries?
• Can hand therapy or hand surgery help in the management of complex regional pain syndrome?
• Compared with removing the trapezium bone (a bone at the bottom of the thumb) in arthritis of the base of the thumb, are any other surgical or non-surgical techniques better in terms of patient outcome, power, movement and pain relief?
• Do pre-existing systemic pain conditions (where patients have difficult to treat pain as well as a hand injury or problem) have a negative effect on the outcomes following hand injury or surgery?
• Do surgical or non-surgical methods give the best results in post-traumatic stiffness of the proximal interphalangeal joint (the middle knuckle of the finger)?
• How can patient participation in hand therapy be maximised?
• In common hand conditions that require splinting to maintain function or prevent deformity, what are the best splint designs and regimens for their use?
• In patients with ulnar sided wrist pain (pain on the little finger side of the wrist), what interventions give a reliable improvement in function and pain?
• In previously treated Dupuytren's disease, do any additional techniques (for example splinting, therapy, stretching, massage) help prevent recurrence?
• Is denervation (where the nerves that take pain from the joint to the brain are intentionally cut) of a painful joint a better option than alternative surgical treatment, and if so what are the best techniques for denervation and in which joints?
• Is revision surgery useful in recurrent Dupuytren's disease?
• What are the best methods of treating tendon injuries?
• What are the most effective non-surgical methods of treating peripheral nerve compression (for example carpal tunnel syndrome or cubital tunnel syndrome)?
• What is the best rehabilitation following treatment for acute or chronic wrist instability?
• What is the role of steroid injections in the treatment of arthritis of the hand and wrist?
• What non-surgical treatments have benefits over surgery in the treatment of Dupuytren's disease?
• What patient or surgical factors may contribute to complications or ongoing symptoms following treatment for common hand conditions?
• What treatments are most effective for the treatment of ongoing symptoms following surgery for carpal or cubital tunnel syndrome (or other entrapped nerves in the arm)?
• When and in whom should treatment for Dupuytren's be commenced?
• When should patients with pain or deformity following joint damage or arthritis undergo surgery to correct/improve it?

Key documents

Common Conditions Affecting the Hand and Wrist PSP Protocol