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    Adherence to American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines (CPGs) for upper-extremity conditions varies among American Society for Surgery of the Hand (ASSH) members. Further research is needed to address inconsistent adherence to these important hand surgery guidelines.

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    Area of Science:

    • Orthopaedic Surgery
    • Hand Surgery
    • Clinical Practice Guidelines

    Background:

    • The American Academy of Orthopaedic Surgeons (AAOS) has established clinical practice guidelines (CPGs) for upper-extremity conditions.
    • Evaluating adherence to these AAOS CPGs among specialists is crucial for standardizing care.
    • The American Society for Surgery of the Hand (ASSH) membership represents a key group for assessing adherence to upper-extremity guidelines.

    Purpose of the Study:

    • To assess the level of adherence by ASSH members to existing AAOS clinical practice guidelines for upper-extremity conditions.
    • To specifically evaluate adherence related to carpal tunnel syndrome, distal radius fractures, and glenohumeral arthritis.

    Main Methods:

    • An email survey was distributed to current and candidate members of the ASSH.
    • The survey included questions on the diagnosis and treatment of carpal tunnel syndrome, distal radius fractures, and glenohumeral arthritis, referencing AAOS CPGs.
    • A total of 469 responses were collected, yielding a 32% response rate, and descriptive statistics were employed for analysis.

    Main Results:

    • ASSH members demonstrated inconsistent adherence to AAOS upper-extremity CPGs.
    • For carpal tunnel syndrome, only 53% adhered to nonoperative treatment waiting times, and 32% consistently used electrodiagnostic testing before surgery.
    • Adherence was higher for nighttime splinting (98%) and corticosteroid injections (85%) in carpal tunnel syndrome management, and for postreduction criteria in distal radius fractures (85%).

    Conclusions:

    • ASSH members do not universally follow AAOS clinical practice guidelines for upper-extremity conditions.
    • Specific areas of non-adherence were identified in carpal tunnel syndrome and distal radius fracture management.
    • Further investigation is warranted to understand the reasons for inconsistent adherence and to develop strategies for improvement.