Red flags for elbows, wrists and hands

Prior to referral consider / screen to exclude:

Key Clinical Observations of concern

  • Hot / red / swollen joint with raised body temperature
  • Rapidly worsening deformity
  • Neuro-vascular compromise
Urgent elbow / wrist / hand referral

Patients with any of the following suspected should be sent to A&E:

  • Fracture or dislocation
  • Suspected infection
  • Recent tendon or ligament rupture

Urgent appointments can be made in elective Hand Clinics for patients with:

  • Rapidly worsening symptoms
  • Hand pain with confirmed presence of cancer on imaging.
  • Constant unrelenting hand or forearm pain / especially unrelenting night pain in presence of cancer
  • Progressive or significant neurological loss suggestive of acute peripheral nerve compression
GP / Primary Clinician
  • Consider Diagnosis (discuss within peer review).
  • Exclude red flags especially infection.


  • Prolonged repeated pressure on point of elbow
  • Direct trauma
  • Arthritis
  • Infection


  • Usually pain free swelling posterior aspect elbow.
  • Usually full active range of movement

If Serious pathology suspected or rapidly increasing neurological symptoms refer directly to surgeon via Interface Team.


If no serious pathology suspected:

  • Ice
  • Avoid direct pressure
  • Ergonomic advice
  • Wait and see
  • NSAIDs

If no improvement:

  • Consider Aspiration of bursa
  • Consider Steroid injection
  • Physiotherapy is not indicated for this condition.

If no improvement after interventions above refer to surgeons via the Interface Team.


X-ray if suspicious of trauma, infection or tumour.

Interface Team
  • Consider  previous assessment diagnosis and management.
  • Local steroid injection may be considered (up to 2 Injections.)
  • Onward referral as surgical criteria below.

If patient fits the criteria below refer to Surgeon.


X-ray prior to surgical referral.

Surgical Criteria
  • Referral is appropriate if requiring a surgical opinion or for complex diagnosis.
  • Persistent or recurrent bursitis in spite of aspiration and injection surgery.
  • Discuss the following:
    • willingness to undergo surgery
    • general health
    • understand recovery period post surgery

Partial or complete removal of bursa: 3-4 weeks before able to use elbow and  may need a pad on elbow for several months to prevent re-injury.