British Association of Hand Therapists

This event was a full meeting of the Wessex Hand Club, open to surgeons and hand therapists in the Wessex region. The day was organised by David Warwick and his team from University Hospital, Southampton. As always, the day was a happy, social, as well as business, occasion, with the opportunity for lively discussion and networking. The party spirit was enhanced by the venue – Marwell Wildlife Park, just south of Winchester. The day was organised into three main sections:

Below are a few highlights that I took from each section.

Sophie Phillips, Consultant Orthopaedic Surgeon from Queen Alexandra Hospital in Portsmouth, discussed the management of patients with Raynaud’s phenomenon and Raynaud’s disease. She described the clinical problems of patients who have painful, ulcerating areas of the nail folds and finger tips. She stressed the need to check for any underlying cause using tests for renal function and haemoglobin levels. She outlined possible medical management aimed at improving vasodilation. This included the use of small glyceryl trinitrate (GTN) patches applied to the base of the fingers. Her surgical preference was for peri-articular sympathectomy, where fine layers of adventitia are stripped away from the radial and ulnar arteries at the wrist to improve blood flow to the affected fingers. Improved blood supply results in healing of ulcerated areas and reduction in pain.

Bridgit Ellis, Physiotherapy ESP from Poole General Hospital, presented an audit undertaken with her colleague, Kirsty Bancroft, Senior OT. The audit explored the comparison between two outcome measures – the Q-Dash and the Patient Rated Wrist and Hand Evaluation (PRWHE). Both outcome measures indicated similar levels of change for any one patient. However, it was highlighted that, with both measures, it was more difficult to identify change in patients with chronic conditions such as OA and RA, where the outcome measures lost sensitivity. It was also difficult to identify change in patients who had low initial scores. This paper generated a very lively discussion about the use of outcome measures in routine practice and concerns that these might be used to commission services. Concerns were also raised about the risk of producing data that has little real value to the management of the patient. We also discussed the need to identify functional outcomes that were important to each patient.

Dr Jo Adams from the University of Southampton outlined progress on the Osteoarthritis Thumb Therapy Trial (OTTER). This large RCT is analysing hand splinting in the OA thumb and currently has 30 NHS collaborating sites around the UK, including a number from the Wessex region. At this stage the team are seeking ethical approval and refining the protocol. This includes the design of a placebo splint – it is not an easy task to produce a design that will still look credible to the patient. For further information about the trial please contact Jo:  ja@soton.ac.uk

During the Dupuytren’s Symposium we discussed two new approaches to managing Dupuytren’s disease – needle fasciotomy and Xiaper Collagenase. Duncan Avis, Registrar in Trauma and Orthopaedics at Bristol, described needle fasciotomy used to treat clearly identifiable Dupuytren’s cords. The cords are cut using the blade or bevel of a needle. Incisions are made at a number of points along the cord until it is released. This procedure is most useful to treat flexion contractures of the MCP joints, but there is a high rate of recurrence. However, it might buy some time for the patient before a fasciotomy or fasciectomy is required. 

David Warwick described a trial of Xiaper running at Southampton. Xiaper consists of enzymes called collagenases and, as their name would suggest, these chemically break down collagen. The collagenase is injected into a distinct cord. Twenty four hours later, after giving time for the enzyme to work, the patient returns to the clinic. Under a local anaesthetic the surgeon manipulates the finger into extension to break the cord. Only one cord can be treated at a time. Swelling and bruising can be expected following the procedure. In some patients skin breakdown can also occur. However, good results should be expected within one week.

Despite all the excellent presentations and discussions, it has to be said that the three six month old snow-leopard kittens at the zoo simply stole the show.

Our thanks go to David Warwick and his team for organising the day. We look forward to the next full meeting, which will be held next year in Portsmouth, hosted by Sophie Phillips.

For further information about hand therapy links in the Wessex Hand Club, please contact Carole Bexon, Head Occupational Therapist by email carole.bexon@salisbury.nhs.uk