Incidence and management of mallet finger in Dutch primary care: a cohort study

Background: A mallet finger (MF) is diagnosed clinically and can be managed in primary care. The actual incidence of MF and how it is managed in primary care is unknown.Aim: To determine the incidence of MF in primary care and to obtain estimates for the proportions of osseous and tendon MF. An additional aim was to gain insight into the management of patients diagnosed with MF in primary care.Design & setting: A cohort study using a healthcare registration database from general practice in the Netherlands.Method:Patients aged ≥18 years with a new diagnosis of MF from 1 January 2015-31 December 2019 were selected using a search algorithm based on International Classification of Primary Care (ICPC) coding.Results:In total, 161 cases of MF were identified. The mean incidence was 0.58 per 1000 person-years. A radiograph was taken in 58% (n = 93) of cases; 23% (n = 37) of cases had an osseous MF. The most applied strategies were referral to secondary care (45%) or conservative treatment in GP practice (43%). Overall, 7% were referred to a paramedical professional.Conclusion: On average, a Dutch GP assesses ≥1 patient with MF per year. Since only a minimal number of patients required surgical treatment and a limited number of GPs requested radiography, the recommendation in the guidelines to perform radiography in all patients with MF should potentially be reconsidered. The purpose of requesting radiographs should not be to distinguish between a tendinogenic or osseous MF, but to assess whether there is a possible indication for surgery

Incidence and management of mallet finger in Dutch primary care: a cohort study

Background: A mallet finger (MF) is diagnosed clinically and can be managed in primary care. The actual incidence of MF and how it is managed in primary care is unknown.Aim: To determine the incidence of MF in primary care and to obtain estimates for the proportions of osseous and tendon MF. An additional aim was to gain insight into the management of patients diagnosed with MF in primary care.Design & setting: A cohort study using a healthcare registration database from general practice in the Netherlands.Method:Patients aged ≥18 years with a new diagnosis of MF from 1 January 2015-31 December 2019 were selected using a search algorithm based on International Classification of Primary Care (ICPC) coding.Results:In total, 161 cases of MF were identified. The mean incidence was 0.58 per 1000 person-years. A radiograph was taken in 58% (n = 93) of cases; 23% (n = 37) of cases had an osseous MF. The most applied strategies were referral to secondary care (45%) or conservative treatment in GP practice (43%). Overall, 7% were referred to a paramedical professional.Conclusion: On average, a Dutch GP assesses ≥1 patient with MF per year. Since only a minimal number of patients required surgical treatment and a limited number of GPs requested radiography, the recommendation in the guidelines to perform radiography in all patients with MF should potentially be reconsidered. The purpose of requesting radiographs should not be to distinguish between a tendinogenic or osseous MF, but to assess whether there is a possible indication for surgery

Psychometric qualities of the patient rated Wrist/Hand evaluation (PRWHE) in dutch primary care patients with wrist complaints

BACKGROUND: Knowledge on the course, disability and functionality of wrist complaints is still compendious in primary care guidelines, despite the high prevalence in primary care. Valid questionnaires can facilitate the monitoring of patients in primary care and research initiatives. In this study, we aimed to study the psychometric qualities of the Dutch version of the Patient Rated Wrist/Hand Evaluation (PRWHE-DLV) among adults with (sub)acute wrist complaints in primary care. METHODS: An observational cohort of 35 adults with (sub)acute wrist complaints in Dutch primary care was established. The content validity of the PRWHE-DLV was validated by assessing the floor and ceiling effects at baseline (T0). Reproducibility was assessed by the test-retest reliability between T0 and T1 (2–5 days after T0), using the Intra-class Correlation Coefficient. The construct validity was assessed based on the correlation between the PRWHE-DLV and the Quick-DASH, Physical Component Score (SF-12), VAS-function, Physical Functioning (SF-12), VAS-pain and Bodily Pain (SF-12) at T0. Responsiveness was defined as the ability of the PRWHE-DLV to measure change 3 weeks after T0 (internal) and the relation of these changes to clinically important outcomes (external). RESULTS: Psychometric qualities of the PRWHE-DLV demonstrated high content validity with no floor or ceiling effects, excellent reliability (Intra-class correlation coefficient = 0.90; 95% CI 0.80–0.95), high construct validity with the validated Quick-DASH and VAS score (r = 0.85 with Quick-DASH, r = 0.75 with VAS-function and r = 0.78 with VAS-pain) and high responsiveness. CONCLUSION: The PRWHE-DLV provided reliable and adequate information for primary care clinical practice

Educational online prevention programme (the SPRINT study) has no effect on the number of running-related injuries in recreational runners:a randomised-controlled trial

OBJECTIVES: The aim of this study was to examine the effectiveness of an enhanced online injury prevention programme on the number of running-related injuries (RRIs) in recreational runners. METHODS: We conducted a randomised-controlled trial in runners who registered for running events (distances: 10-42.195 km) in the Netherlands. Adult runners who provided informed consent were randomised into the intervention or control group. Participants in the intervention group received access to the online prevention programme, which included items to prevent RRIs. Participants in the control group followed their regular preparation for the running event. The primary outcome measure was the number of new RRIs from baseline to 1 month after the running event. To determine differences between injury proportions, univariate and multivariate logistic regression analyses were performed. RESULTS: This study included 4050 recreational runners (63.5% males; mean (SD) age: 42.3 (12.1) years) for analyses. During follow-up, 35.5% (95% CI: 33.5 to 37.6) of the participants in the intervention group sustained a new RRI compared with 35.4% (95% CI: 33.3 to 37.5) of the participants in the control group, with no between-group difference (OR: 1.03; 95% CI: 0.90 to 1.17). There was a positive association between the number of items followed in the injury prevention programme and the number of RRIs (OR: 1.05; 95% CI: 1.00 to 1.11). CONCLUSION: The enhanced online injury prevention programme had no effect on the number of RRIs in recreational runners, and being compliant with the programme paradoxically was associated with a slightly higher injury rate. Future studies should focus on individual targeted prevention with emphasis on the timing and application of preventive measures.NL7694

Hand and wrist complaints in primary care:You only see it when you get it!

The current Dutch guideline for GPs on the assessment, diagnosis, and treatment of patients with hand and wrist complaints in general practice has limited scientific support. Therefore, the diagnostic process and management of hand and wrist complaints in general practice is a challenge. In this thesis the epidemiology, diagnostic possibilities, and course of hand and wrist complaints in primary care are described.A GP assesses more patients per year with hand disorders than wrist disorders, a trigger finger is the most common diagnosis, and a wrist fracture or ligament injury of the hand and wrist are seen only sporadically. Dominant management strategies for patients with mallet fingers were referrals to secondary care and conservative treatment. The purpose of requesting a radiograph should not be to distinguish between a tendinogenic and osseous mallet finger, but to assess whether there is a possible indication for surgery. Furthermore, a radiograph should only recommend if the mallet finger developed after high-energy trauma.In our systematic reviews about the diagnostic accuracy of history taking, physical examination and imaging for hand and wrist disorders, no studies are available on the diagnostic accuracy in primary care. For this reason, GPs have limited diagnostic tools when assessing patients with hand or wrist complaints. Physical examination showed limited diagnostic accuracy for diagnosing finger, hand, or wrist disorders in hospital care. In addition, there is no accurate imaging modality showing acceptable diagnostic performance in hospital care, when taking the moderate quality of the eligible studies into account.<br/

Hand and wrist complaints in primary care:You only see it when you get it!

The current Dutch guideline for GPs on the assessment, diagnosis, and treatment of patients with hand and wrist complaints in general practice has limited scientific support. Therefore, the diagnostic process and management of hand and wrist complaints in general practice is a challenge. In this thesis the epidemiology, diagnostic possibilities, and course of hand and wrist complaints in primary care are described.A GP assesses more patients per year with hand disorders than wrist disorders, a trigger finger is the most common diagnosis, and a wrist fracture or ligament injury of the hand and wrist are seen only sporadically. Dominant management strategies for patients with mallet fingers were referrals to secondary care and conservative treatment. The purpose of requesting a radiograph should not be to distinguish between a tendinogenic and osseous mallet finger, but to assess whether there is a possible indication for surgery. Furthermore, a radiograph should only recommend if the mallet finger developed after high-energy trauma.In our systematic reviews about the diagnostic accuracy of history taking, physical examination and imaging for hand and wrist disorders, no studies are available on the diagnostic accuracy in primary care. For this reason, GPs have limited diagnostic tools when assessing patients with hand or wrist complaints. Physical examination showed limited diagnostic accuracy for diagnosing finger, hand, or wrist disorders in hospital care. In addition, there is no accurate imaging modality showing acceptable diagnostic performance in hospital care, when taking the moderate quality of the eligible studies into account.<br/

To splint or not to splint for carpal tunnel syndrome?

Er zijn diverse niet-operatieve opties voor de behandeling van het carpaletunnelsyndroom (CTS). In een recente cochrane­review zijn de voor- en nadelen van spalken onderzocht in vergelijking met geen behandeling of andere niet-chirurgische behandelingen. Het onderzoek laat zien dat er onvoldoende bewijs is om te concluderen of spalken gunstig is bij CTS

To splint or not to splint for carpal tunnel syndrome?

Er zijn diverse niet-operatieve opties voor de behandeling van het carpaletunnelsyndroom (CTS). In een recente cochrane­review zijn de voor- en nadelen van spalken onderzocht in vergelijking met geen behandeling of andere niet-chirurgische behandelingen. Het onderzoek laat zien dat er onvoldoende bewijs is om te concluderen of spalken gunstig is bij CTS

Diagnostic tests recommended for the clinical assessment of patients with wrist complaints, an e-Delphi study

Background: Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited. Purpose: To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints. Study Design: An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed. Methods: In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario. Results: Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain. Conclusions: This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks).</p