DipMSK Revision Guide · Chapter 6 of 18

Wrist & Hand Conditions

Carpal tunnel, trigger digit, De Quervain, Dupuytren, thumb-base OA and the scaphoid.

Syllabus: Wrist & Hand Conditions

Written by Dr David Palethorpe, MBBS, BSc (Hons), MRCGP · NHS GP PartnerReviewed 14 September 202620 min readChapter 6 of 18

Before you start

Try this first

A patient has constant median numbness and thenar wasting. What does that represent, and what does EBI do with it?

Not a worse version of the same problem but established axonal loss — EBI sends those patients straight to surgery without a further conservative trial. Splints will not recover a denervated muscle.

2 more warm-up questions in the full chapter.

What this chapter covers

  • 6.1Carpal tunnel syndromeNight-waking numbness in the median distribution that eases on shaking the hand. Thenar wasting and constant numbness ar…Preview below
  • 6.2Stenosing tenosynovitis — trigger digit and De Quervain’sMembers
  • 6.3Dupuytren’s diseaseMembers
  • 6.4The arthritic hand — thumb base OA and the inflammatory patternMembers
  • 6.5Wrist lumps and wrist trauma — ganglion, TFCC and the scaphoidMembers
  • —Referral, by timeframeRed flags below

Carpal tunnel syndrome

Core Lens — the takeaway

Night-waking numbness in the median distribution that eases on shaking the hand. Thenar wasting and constant numbness are not “severe” carpal tunnel — they are established axonal loss, and those patients go straight to surgery.

Recognise

  • Numbness and tingling in the thumb, index, middle and radial half of the ring finger that wakes the patient at night and eases on shaking the hand.
  • Patients often report the whole hand rather than a tidy median distribution. Do not discard the diagnosis on that basis.
  • Constant numbness, clumsiness and thenar wasting mark established axonal loss, not a worse version of the same problem.

The rest of this chapter is in the DipMSK guide

4 more topics, every section opened up, the recall questions and the guidance summaries — written and reviewed by practising UK doctors.

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Referral, by timeframe

Same day · Emergency
  • Acute carpal tunnel syndrome — rapidly progressive severe median symptoms within hours of a distal radius injury
  • Fever, a penetrating injury and Kanavel signs — septic flexor tenosynovitis; never inject a steroid
  • One hot, swollen, exquisitely tender finger or wrist joint with pain on minimal passive movement
  • Open fracture, vascular compromise, or rapidly progressive median nerve symptoms after wrist injury
  • Snuffbox, tubercle or proximal pole tenderness after a fall on the outstretched hand or a punch

Also in the full chapter: Cancer pathway · Urgent · Routine.

← Chapter 5Elbow Region Conditions

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