Mr Andrew Logan is a leading consultant hand surgeon who has performed urgent hand surgery throughout the coronavirus COVID-19 pandemic. In this article, he explains how the pandemic has affected the waiting lists for elective hand surgery, highlights the critical need of seeking a doctor’s advice for hand pain and explains what to do if you think you’ve injured your hand and/or wrist.
What are some common orthopaedic problems someone might experience when working from home?
During the COVID-19 pandemic, working from home has increased significantly. There are several hand conditions where symptoms become apparent when the hand is used more. These conditions would include:
- Carpal tunnel syndrome
- Cubital tunnel syndrome
- De Quervain’s tendinitis
- Pain from arthritis in the joints of the hand
Therefore, such conditions tend to occur when a person is at work i.e. when the hand is used the most. Working from home in that sense is no different than going out to work.
How has the COVID-19 pandemic altered the presentation of common hand conditions?
Some hand conditions such as nerve compression in the upper limb (carpal tunnel syndrome and cubital tunnel syndrome) can worsen if untreated. In more severe cases, a delay to treatment for nerve compression may result in nerve damage that cannot be fully reversed by releasing that nerve at operation.
There are also greatly increased waiting times to be seen by a hand specialist on the NHS when referred by the patient’s general practitioner. When a general practitioner refers patients to the hospital, the referrals are prioritised by the specialist. If the patient has a condition where treatment should not be delayed, the hand specialist can arrange for you to be seen quickly.
Not unreasonably, patients are concerned about face-to-face appointments in the healthcare setting because of the risk of catching COVID-19. This can result in a delay regarding visiting the general practitioner. However, it is still important to be seen so that the doctor can assess the urgency of the case. Technology is available for video consultation which removes the COVID-19 risk.
What if I injure my hand or wrist during the COVID-19 pandemic?
There is a wide spectrum of hand and wrist injuries ranging from broken bones to cuts where important structures can be injured. Most hand injuries do not involve broken bones or structural damage and will heal without treatment.
Consult a doctor
It is not possible to know what damage has been done from the painful symptoms alone. To assess the significance of an injury, the patient will need to be examined by a doctor, usually in the accident and emergency department.
Time is critical if the hand injury needs treatment. This means that if such treatment is delayed beyond two to three weeks, it may be too late to treat the condition. Or, if it is treated, the outcome may not be as good.
Can I visit the hospital if there is a risk of catching the virus?
During the COVID-19 pandemic, there is a balance between having an injury treated and putting yourself at risk of catching COVID-19 from face-to-face contact with the doctor. This balance does depend on age and health as this determines how well you can be if you caught the virus.
The risk of catching the virus from a face-to-face consultation cannot be eliminated completely, but hospitals strictly adhere to social distancing guidelines and therefore, make it as safe as possible for a patient to attend without catching COVID-19.
The difficult decision of whether to attend Accident and Emergency following an injury to the hand or wrist has to be made by the patient. A video consultation with either the general practitioner or a hand consultant such as myself can help guide that decision.
How has the pandemic affected orthopaedic surgery?
The ability of the orthopaedic department to treat injuries has not changed.
As far as non-urgent treatment is concerned, there has been a significant impact. Outpatient clinic numbers have had to reduce significantly to prevent waiting-room overcrowding. In some centres, the services have been moved between hospitals to free up space to treat patients with COVID-19. This results in less space available to see elective cases in the clinic. This has seen outpatient waiting lists for non-urgent treatment rise significantly.
Anaesthetists and their assistants
The ability to operate on nonurgent patients has also been affected. As part of the COVID-19 response, teams have been set up to deal with the most serious cases and doctors skilled in airway management are needed for these teams.
This means that anaesthetists and their assistants have to be taken out of elective surgical care to be put on these teams. As a result, the ability to operate on cases that need an anaesthetist has been limited.
Hand surgery patients
Fortunately, a significant proportion of hand surgery cases can be done under local anaesthetic. Therefore, operations have continued for this group of patients
However, there is still an impact on hand cases that require an anaesthetist and the waiting list for those procedures on the NHS has increased significantly.
When should I speak to an orthopaedic surgeon about pain in my hands or wrists?
If it is a long-standing pain or one that has occurred without a history of injury, the patient has to balance the risks of seeing a hand consultant (taking into account their age and medical problems). Non-face-to-face consultations are available via video link for those that are concerned.
- If the symptoms of pain are such that they become severe, then the balance of risk may then favour a consultation.
- If the pain in the hands or wrists is following an injury, it’s important to have a consultation urgently (whether this is via video link or face-to-face). In most cases, following an injury, an X-ray would be required in which case face-to-face would be unavoidable.
Are you worried about how the increased NHS waiting lists caused by COVID-19 could affect your hand pain and surgery? Visit Mr Andrew Logan’s profile and get in touch to learn how he can assist you.