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

Dean, Benjamin J.F.; Carr, Andrew; Trickett, Ryan W.; Kluzek, Stefan; Riley, Nicholas; Bretherton, Christopher P.; Wilson, Melanie K.; Hayton, Mike J.; Rupani, Neal R.; Hsieh, Ching Cheng Daniel; Clifton, Laura J.; Dacombe, Peter; Milnes, Lydia K.; Jayasuriya, Raveen L.; George, Harvey A.; Das, Rishi; Mayne, Alistair; Brown, Matthew T.; Lipscombe, Stephen J.; Eastwood, Gillian L.; Unsworth, Richard M.; Wright, Lucie J.; As-Sultany, Mohammed

Abstract

Abstract
Objectives
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.

Methods
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.

Results
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.

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.

Conclusion
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.

Citation

Dean, B. J., Carr, A., Trickett, R. W., Kluzek, S., Riley, N., Bretherton, C. P., …As-Sultany, M. (2020). The presentation, diagnosis and management of non-traumatic wrist pain: an evaluation of current practice in secondary care in the UK NHS. Rheumatology Advances in Practice, 4(2), Article rkaa030. https://doi.org/10.1093/rap/rkaa030

• Journal Article Type: Article
• Acceptance Date: Jun 11, 2020
• Online Publication Date: Jul 7, 2020
• Publication Date: Jul 7, 2020
• Deposit Date: Jul 21, 2020
• Publicly Available Date: Jul 22, 2020
• Journal: Rheumatology Advances in Practice
• Electronic ISSN: 2514-1775
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Issue: 2
• Article Number: rkaa030
• DOI: https://doi.org/10.1093/rap/rkaa030
• Public URL: https://nottingham-repository.worktribe.com/output/4781135
• Publisher URL: https://academic.oup.com/rheumap/article/doi/10.1093/rap/rkaa030/5868418