13 July 2018
If more patients with a hand problem see a hand specialist from the outset, we can ensure better patient outcomes, a more streamlined process and savings to vital NHS resources. To help achieve this, we must ensure that patients with a hand problem know to ask GPs for a hand specialist, and that GPs are aware of the large number of hand specialists available.
Hand injuries are very common: one fifth (20%) of all visits to A&E departments in England are currently for hand trauma.  But while there is a role for improving the flow of patients to hand specialists from A&E, there is greater disparity in referral to hand specialists for elective hand problems. Although most A&E departments have good access to hand specialists for obvious injuries, few patients understand how to request specialist help for undiagnosed hand conditions.
Elective hand surgery for common conditions is set to increase by 39% over the next 10 years. This is driven by the increasing presentation of conditions such as carpal tunnel syndrome, Dupuytren’s disease, osteoarthritis and other degenerative hand problems especially in the elderly. To help address these increases, patients need to be seen quickly by the right specialist to ensure correct initial treatment: this is critical to restoration of pain free function.
For example, numbness and tingling in the hand is most commonly due to carpal tunnel syndrome, but could be due to nerve compression in the neck or a systemic neuropathy. Patients with hand numbness who do not see a hand specialist are more likely to undergo an electrical test, which in most cases is not necessary.
Hand specialists are able to help identify and address hand problems more quickly, and can help prevent unnecessary tests and appointments. Referral to the wrong specialist may lead to delayed treatment, at a cost to both the patient and the NHS.
With research and development leading to new techniques, the title ‘hand surgeon’ no longer truly represents the role and scope of hand specialists. Surgery is an increasingly small part of treatment; injections or hand therapy are the first lines of treatment and often resolve problems without the need for surgery. The recent use of collagenase, an enzyme to treat Dupuytren’s disease, highlights the role of non-surgical treatment in the management of hand problems.
The sophistication of medical techniques available today, combined with tight budgets and the need for efficient achievement of good patient outcomes, means it is critical that the concept of specialism has to become better understood amongst the public and across the healthcare system.
In the same way that patients with a heart problem would request to see a cardiologist and those with a skin problem ask to see a dermatologist, there is a need for the different disciplines within orthopaedic surgery to become recognised by the body parts they treat.
Medical professionals can’t all do everything: the most effective treatment is provided by a team of specialists, each focused on a different part of the human body.
By helping make patients aware that they can routinely ask to see a hand specialist, we can reap the benefits of earlier diagnosis and treatment, and improved patient outcomes.
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