CONSULT REQUEST GUIDELINES                                                                         Print

Hand Pain

Suggested Pre-Referral Evaluation and Management Guidelines
  • Consider osteoarthritis especially if carpometacarpal joint involved without inflammatory component
  • If pain is neurogenic (numbness, tingling or burning sensation) consider radiculopathy, carpal tunnel syndrome or ulnar mononeuropathy.
  • If pain is neurogenic consider gabapentin 100 mg po TID
  • If pain is radicular, consider NSAIDs, Medrol dose pack; reserve narcotics for severe pain
  • If vasomotor signs and symptoms present, consider reflex sympathetic dystrophy (chronic region pain syndrome)
Suggested Additional Test/Management Prior to Specialty Visit
  • If associated with numbness, tingling or burning sensation refer for EMG
  • If associated with weakness, refer for EMG
  • Consider wrist splint (with wrist in neutral) if complaints associated with numbness in digits 1,2 and 3
  • If unilateral pain, consider x-ray for arthritis; if snuff box of wrist is tender, include lunate views
  • If pain bilateral and associated with red or hot joints, obtain x-ray of bilateral hands and feet. Obtain WESR, ANA, rheumatoid factor. Consider rheumatology consult
    Patient Education/Information (includes preps)  
    Appointment Timeframe  
    How to Get Results to Consultant UMHS Patients: See MiChart
    External Patients: hand carry medical records including obstetric records, previous EMGs, x-rays and surgical evaluations and clinic notes to visit
    Clinic Contact Information Physician: 800-962-3555
    Patient: 734-936-7175
    Clinic Location Sites Burlington Building - Ann Arbor
    UM Consulting Physician Physical Medicine and Rehabilitation Physicians
    Revised on: 12/22/2015



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