Common Hand Conditions Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives

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1 NHS Dorset Clinical Commissioning Group Common Hand Conditions Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives

2 POLICY TRAIL AND VERSION CONTROL SHEET: Policy Reference: Version 2 Document Status: Current Developed by: Policy Number: Review, Design and Delivery Date of Policy: June 2014 Next Review Date: June 2017 Name of iginator/author: Sponsor: Approving Committee or Group: Date Approved: June 2014 Version Date Comments By Whom 2 June 2014 No changes required at review date. Target Audience All staff and Members within NHS Dorset Clinical Commissioning and relevant referring and receiving clinicians. Intranet Distribution Clinical Commissioning Group Website to Staff Page 1 of 4

3 NHS DORSET CLINICAL COMMISSIONING GROUP COMMON HAND CONDITIONS CONTENTS 1 Dupuytren s Contracture Carpal Tunnel Syndrome Trigger Finger...4 Page 2 of 4

4 1. Dupuytren s contracture NHS DORSET CLINICAL COMMISSIONING GROUP COMMON HAND CONDITIONS 1.1 Dupuytren s contracture is a fairly common condition that causes one or more fingers to bend into the palm of the hand. The symptoms of Dupuytren s contracture are often mild and painless and do not require treatment, however regular follow-up is needed to detect early joint contracture. There is great variation in the rate of progress, but it is usually possible to distinguish the more aggressive form of the disease early on. 1.2 Surgery is the only effective method of treatment for Dupuytren s contracture. However, patients should be advised that probably 40% of people will have a recurrence following surgery. Dupuytren s contracture can return to the same spot on the hand or may reappear somewhere else. Recurrence is more likely in younger patients; if the original contracture was severe; or if there is a strong family history of the condition. Criteria to Access Treatment 1.3 Requests for treatment will be considered when: Metacarpophalangeal joint contracture of 30 o or more, Any degree of proximal interphalangeal joint contracture, Patients under 45 years of age with disease affecting 2 or more digits and loss of extension exceeding 10 0 or more. 2. Carpal Tunnel Syndrome 2.1 Carpal tunnel syndrome is a relatively common condition that affects the nerves of the hand causing pain, numbness and a burning or tingling sensation in the hand and fingers. Symptoms can be intermittent, and range from mild to severe. Patients with intermittent or mild/moderate symptoms should be managed conservatively in the first instance. 2.2 Carpal tunnel surgery is regarded as a procedure of low clinical priority for patients with intermittent or mild to moderate symptoms and is therefore not routinely funded by the Clinical Commissioning Group. Criteria to Access Treatment 2.3 Requests for treatment will be considered when: Acute, severe symptoms persist after conservative therapy with either local corticosteroid injection and/or nocturnal splinting Mild to moderate symptoms persist for at least 4 months after conservative therapy with either local corticosteroid injection (if appropriate) and/or nocturnal splinting (used for at least 8 weeks) Page 3 of 4

5 There is neurological deficit e.g. sensory blunting, muscle wasting or weakness of thenar abduction, or proven EMG changes Severe symptoms significantly interfere with daily activities. 3. Trigger Finger 3.1 Trigger finger is a common disorder. A tender nodule in the flexor tendon at the base of a finger or thumb causes catching, snapping or locking of the involved finger flexor tendon. It can cause dysfunction and pain as the finger is extended from a flexed position. 3.2 Conservative treatment may include: Rest from precipitating activities; non-steroidal anti-inflammatory drugs with splinting; at least 2 x injections of corticosteroid injections. 3.3 Referral to secondary care may only be considered when the following criteria have been met: There is fixed flexion deformity that cannot be corrected; No improvement after conservative treatment of steroid injection (at least 2 injections) or splinting and non-steroidal anti-inflammatory drugs. 3.4 Patients who are not eligible for treatment under this protocol may be considered on an individual basis where their GP or consultant believes clinically exceptional circumstances exist that warrant deviation from this protocol. 3.5 In such cases the requesting clinician must provide further information to support the case for being considered as an exception. The fact that treatment is likely to be effective for a patient is not, itself a basis for exceptional circumstances. 3.6 Individual cases will be reviewed at the Individual Patient Treatment Panel upon receipt of a completed application form from the Patient s GP, Consultant or Clinician. Applications cannot be considered from patients personally. Page 4 of 4

Trigger Finger Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives

NHS Dorset Clinical Commissioning Group Trigger Finger Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives 1. INTRODUCTION AND SCOPE NHS DORSET CLINICAL COMMISSIONING GROUP