The presentation, diagnosis and management of non-traumatic wrist pain: an evaluation of current practice in secondary care in the UK NHS

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objectives</jats:title> <jats:p>The study aims were to assess the burden of non-traumatic wrist pain in terms of numbers of referrals to secondary care, and to characterise how patients present, are diagnosed and are managed in secondary care in the United Kingdom National Health Service.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Ten consecutive patients presenting with non-traumatic wrist pain were identified retrospectively at each of 16 participating hospitals and data was extracted for twelve months following the initial referral.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The 160 patients consisted of 100 females and 60 males with a median age of 49, accounting for approximately 13% of all new hand/wrist referrals. The dominant wrist was affected in 60% of cases and the mean symptom duration was 13.3 months. Diagnoses were grouped into: osteoarthritis (OA) (31%), tendinopathy (13%), ganglion (14%), ulnar sided pain (17%) and other (25%). The OA group was significantly older than other groups, while other groups contained a predominance of females.</jats:p> <jats:p>The non-surgical interventions in decreasing frequency of usage were: steroid injections (39%), physiotherapy (32%), splint (31%) and analgesics (12%). Of those who underwent surgery, all patients had previously received non-surgical treatment, however 42% had undergone only one non-surgical intervention.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Non-traumatic wrist pain represents a significant burden to secondary care both in terms of new patient referrals and in terms of investigation, follow up and treatment. Those presenting with osteoarthritis are more likely to be older and male, while those presenting with other diagnoses are more likely to be younger and female.</jats:p> </jats:sec>

A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders

“…The appetite for investigating new forms of scanning equipment or to validate new clinical tests for biomechanical diagnosis is consistent, however it is interesting that some authors have questioned the reductionist premise that biomechanical lesions are the modifiable factors to target in assisting patients with NTWD. 7 , 9 , 10 , 28 , 157 , 162 , 172 , 202 The other reviews (systematic, literature and scoping) represent well-conducted enquiries into the methods of conservative/non-operative management of wrist disorders and provide good information on the risk factors and epidemiology of wrist pain.…”

“… 24 When evaluating musculoskeletal care for the shoulder, low back and knee, pathoanatomical diagnosis frequently fails to explain the sufferers’ pain experience and disability in non-traumatic disorders, nor improve outcomes, leading to recommendations for the use of grouped conditions to frame management. 25 – 27 This viewpoint has synergy with The Management of Wrist Pain Group (MOWP) which suggests grouping specific non-traumatic wrist diagnoses into a broader category of non-traumatic wrist pain 28 to promote holistic rather than lesion-specific management. Through mapping the literature of all diagnoses making up NTWD, the areas of strength for particular categories can be identified.…”