Red flags for elbows, wrists & 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):

  • Boutonniere / Swan Neck deformity.
  • Mallet finger.
  • Flexion contracture at PIP joint.
  • Instability following chronic ligament injury.


  • Optimal analgesia/ NSAIDS.
  • If function not affected reassure patient.
  • If function affected +/- increasing deformity refer to Physiotherapy / Occupational Therapy.


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

Physiotherapist or Occupational Therapist
  • Consider guidelines in previous section.
  • Assessment / Diagnosis /Detailed advice.
  • Corrective or supportive splinting.
  • Mobilisation/Exercise.

If not responding consider referral to Interface Team.

Interface Team
  • Consider previous assessment and management.
  • If not responding to comprehensive conservative management consider referral to surgeon if surgical criteria applicable.


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

Surgical Criteria

The patient is suffering from significant pain related functional impairment.

Consider referral to Orthopaedic surgeon for complex diagnosis or if surgical opinion required consider the following:

  • willingness to undergo surgery
  • general Health
  • understanding of recovery period post surgery.
  • Soft tissue release: return to driving 2 -3 weeks, return to function 6-12 weeks.
  • Soft tissue reconstruction around affected joint: return to driving 8-10 weeks, return to function 12 weeks.
  • Joint fusion: return to driving 6 weeks, return to function 6-12 weeks.