Pain in base of thumb- Adult Leeds

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1.  Information Resources for Patients and Carers

Quick info:

Patient information

Please see attached patient information leaflet on Basal Thumb Osteoarthritis.

Please see attached patient information leaflet on Dupuytren's disease.

Please see attached patient information leaflet on Trigger Finger.

Please see the attached patient information leaflet on De Quervain's Tenosynovitis.

Please see attached patient information leaflet on  ganglion cysts.

Please see the attached patient information leaflet on Carpal Tunnel Syndrome.

Decision Aid for Carpal Tunnel

Preoperative Information

Please see attached patient information leaflet for preoperative information on Basal Thumb Osteoarthritis.

Please see attached patient information leaflet for preoperative information on Dupuytren's disease.

Please see attached patient information leaflet for preoperative information on Trigger Finger.

Please see the attached patient information leaflet for preoperative information on De Quervain's Tenosynovitis.

Please see attached patient information leaflet for preoperative information on ganglion cysts.

Please see attached patient information leaflet for preoperative information on Carpal Tunnel Syndrome.

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2.  Referral Forms

Quick info:
Referral Forms

Mail Merged
The forms below are provided as a repository. They can be downloaded to your computer and be imported to your clinical system. This is so all practices have access to the most up to date forms.

EMIS - merged
MSK12 Non Surgical Hand-Wrist Form V3
MSK13 Surgical Hand-Wrist V3
MSK14 Problem Not on Pathway Form V3

SystmOne - merged
MSK12 Non Surgical Hand-Wrist Form V3
MSK13 Surgical Hand-Wrist V3
MSK14 Problem Not on Pathway Form V3

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3.  Pain in Base of Thumb

Quick info:
Patient information
Please see attached patient information leaflet on Basal Thumb Osteoarthritis.

GP Information
If a patient presents with pain in the base of the thumb then consideration should be given to the following:

  • are features present suggestive of carpal tunnel syndrome (see carpal tunnel guidance)?
  • are features present suggestive of De Quervain’s tenosynovitis (see De Quervain's guidance)?
  • has there been recent or past trauma, or features suggestive of an inflammatory process?

If the answer is yes to any of these questions then continue on the appropriate pathway/manage accordingly.
If the pain is likely to be due to osteoarthritis of the first carpo-metacarpal joint, then an X-ray of this joint should be requested to confirm the diagnosis.
If the diagnosis is confirmed see guidance on ‘First-line Management’.
If the diagnosis is not confirmed and symptoms persist, reconsider alternatives.

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8.  First-line Management

Quick info:
GP information
After X-ray confirmation of the diagnosis of base of thumb osteoarthritis, discuss with the patient the following management options:

  • rest and activity modification
  • appropriate analgesia
  • corticosteroid injection:
    • in-house if expertise exists
    • refer if unable to perform in-house

Subsequent options for management should symptoms persist, include:

  • referral for splinting
  • persistent symptoms following trial of splinting warrant discussion with patient whether or not they would consider surgery:
    • if yes, refer to hand surgeon
    • if no, consider referral to image guided injection of joint

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9.  Unguided Steroid Injection, In House or Refer MSK-MDT Referral Form (MSK12)

Quick info:
Referral Form:
MSK12 Non Surgical Hand-Wrist Form V3

If the skills exist within the practice then please undertake the unguided injection, otherwise:

Choose & Book

You can find this clinic on Choose & Book under

Speciality: Orthopaedics
Clinic type:Hand & Wrist

Provider information
The only provider of the MSK-MDT clinic in the city is the Leeds Musculoskeletal Service. This is a multiprofessional clinic including senior physiotherapists and musculoskeletal physicians.

This clinic provides diagnosis, investigation, treatment and onward referral if needed.

This service is directly bookable via Choose and Book. Please complete the appropriate form and send via Choose and Book.

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10. Refer Occupational Therapy for Splinting Referral Form (MSK12)

Quick info:
Referral Form:
MSK12 Non Surgical Hand-Wrist Form V3

Choose & Book

You can find this clinic on Choose & Book under
Speciality:Orthopaedics
Clinic type:Hand & Wrist
Service:O.A Thumb - Occupational Therapy

Provider Information
There is only one provider of custom splinting for Leeds patients and that is the Occupational Therapy department at Leeds
Teaching Hospitals Trust.
Please complete appropriate form and send via Choose and Book.

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11. Surgery Acceptable - Refer Hand Surgeon Referral Form (MSK13)

Quick info:
Referral Form:
MSK13 Surgical Hand-Wrist V3

Patient informationPlease see attached patient information leaflet for preoperative information on Basal Thumb Osteoarthritis.

Choose & Book

All providers except LTHT appear under;

Speciality: Orthopaedics
Clinic type: Hand & Wrist.

LTHT appears under;

Speciality: Surgery - Plastics
Clinic: Upper Limb
Service: Adult Upper Limb - Surgery Plastics

Provider information
Common providers of this procedure to Leeds patients include:

  • LTHT
  • Spire   please note, exclusions apply
  • Yorkshire Clinic   please note, exclusions apply
  • BRI
  • Harrogate
  • Mid Yorks
  • Calderdale Royal Infirmary
  • Eccleshill   please note, exclusions apply

Where exclusions apply, common exclusions include:

  • anaesthetic risk
  • previous anaesthetic complication
  • significant co-morbidity
  • severe psychiatric morbidity

Please see Choose & Book Directory of service for additional information.

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12. Surgery Not Acceptable - Consider Ultrasound Guided Injection

Quick info:
Provider Information
Please refer to the appropriate radiology department of patient's choosing.

Key Dates
Published: 16-Dec-2015, by Leeds
Valid until: 19-Feb-2016

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