Hand and Wrist Pain
Musculoskeletal Skills for Primary Care Course
Royal College of Surgeons of Edinburgh
Acute pain with red flags like
trauma, childhood,
Adolescence, possible
sepsis, malignancy
REFER FOR URGENT
OPINION!
RULE OUT CERVICAL SPINE
PAIN
TraumaticRefer to A&E
HAND/WRIST PATHWAY
Inflammation/Swelling
/Decreased
Movement
Septic Arthritis
Gout
Radial Pain
Inflammatory
Arthritis
Median Nerve pain/night symptoms/+ve
Phalen’s Test
Refer to A&E
Carpal Tunnel Syndrome (CTS)
Atypical Pain- CTS/Cervical root pain
Hand Pain
Non Traumatic
No Inflammation/Swelling
Tenderness Radial Styloid /Normal Thumb
Movement
DeQuervain’s Tenosynovitis
Common Lumps
Ganglion
Lipoma
Schwanoma
Dupuytrens nodule
Trigger nodule
Beware of rapidly growing deep
seated lumps
ContractureDupuytren’s
Decreased Movement/Pain in CMC Joint
Base of thumb Osteoarthritis
Palmar Nodule- Trigger
Finger
UlnarNerve Pain
Finger NodulesOsteoarthritis
Ulnar Nerve Entrapment
Ulnar Pain
Please refer to management
guidelines below prior to onward
referral
Atypical Pain
CTS/Cervical root pain
http://www.pathways.scot.nhs.uk
/Orthopaedics/Orthopaedics%20h
and%2023Sep05.htm
Summary
• Diagnostic Pathway
• Nonoperative Management:
Noninvasive/Invasive
• Watch the Injection/Examination Videos