Diagnosis and management of patients with hand and wrist problems in general practice

1) To describe diagnoses made by general practitioners (GPs) in patients with hand or wrist problems, 2) to describe management, and 3) to determine the association between diagnostic information and two outcomes: persistent symptoms and specialist referral.

GPs recruited patients with hand or wrist problems and completed a standardized form recording information about patient history, observations, palpation, and physical tests. Patients were sent a questionnaire at baseline, 3, and 12 months, containing questions on characteristics and symptom severity. Logistic regression analyses were used to determine the association between diagnostic information and the odds of persistent symptoms or specialist referral.

The three most frequently recorded diagnoses were osteoarthritis (17%), tenosynovitis (16%), and nerve entrapment (13%). "Wait and see" (30%) and painkillers (24%) were most often advised. Higher probability of persistent symptoms at both 3 and 12 months was associated with being female, higher age, long baseline symptom duration, and higher baseline pain intensity score; positive DeQuervain test was associated with lower probability of persistent symptoms. Having a recurrent problem was associated with higher odds of specialist referral.

In primary care, physical tests and information about physical signs are of importance in diagnosing patients with hand or wrist problems, but provide limited prognostic information.