Thomas Mitchell

Objectives Though non-traumatic wrist disorders (NTWD) are common, little is known about how clinicians direct their management. In this study, we aimed to explore clinical decision-making and practice behaviour in managing those with non-traumatic wrist disorders. Design This is a qualitative study using semi-structured, face-to-face and remote interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis Setting UK-based clinicians from across private and public healthcare settings were selected through involvement in a previous online survey. Participants Data were collected from 15 clinicians using semistructured interviews (April–August 2024). Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Results We analysed the data into five overarching themes. The first theme, ‘listening and acknowledging concerns’, described the concentration, empathy and attention involved with initial interactions. The second theme, ‘What this means to me’, described how clinicians interpreted and communicated information about a patient’s wrist condition, often co-constructing explanatory narratives with patients through the use, modification or deliberate avoidance of diagnostic labels. Clinicians differed in the value they attributed to specific diagnoses, with some viewing them as essential for guiding management and others favouring function-based explanations. In the third theme, ‘having an honest conversation’, clinicians expressed the need to reach a shared and realistic understanding of what was achievable going forwards. The fourth theme, ‘managing what matters’, reflected the pragmatic sentiment held by clinicians in working towards clear functional goals that really matter to the individual patient. The final theme, ‘sitting with uncertainty’, encompassed the importance of allowing people to find their own ways of coping and how explaining certain uncertainties may be of value to patients. Conclusions This study provides the first description of UK clinicians’ practice behaviour regarding NTWD across professional groups and healthcare settings. The findings reveal that effective care is driven by a sophisticated blend of professional integrity, relational skills and clinical pragmatism, particularly when faced with diagnostic uncertainty and resource limitations.

Introduction: Increasingly detailed investigation confirms that the best management of those with non-traumatic wrist disorders (NTWD) remains elusive, and considerable potential for improvements to care exists. This study aimed to use a modified virtual nominal group technique (vNGT) to facilitate clinician stakeholder discussions to create consensus statements and recommend priorities for future improvements in the management of NTWD in the UK. Methods: We created knowledge-gap topic areas and developed statements to reflect these. Preliminary ranking, silent reflection and idea generation occurred prior to the workshop. Two 2-hour vNGT workshops were conducted (n=8 and n=7; specialist hand therapists (8), first contact practitioners (2), generalist secondary care physiotherapists (2), wrist and hand specialist orthopaedic surgeons (2), specialist rheumatology physiotherapist) during which five nominal questions were discussed to create consensus statements (November 2025). Ranking of statements from all activities occurred 1 week following completion of the final workshop. Results: Direction was given for key components of assessment noting that specific diagnosis should be attempted, and de Quervain’s tenosynovitis should be considered a distinct entity to grouped NTWD. Where specific diagnosis was deemed unattainable, a transition to a non-specific approach was recommended. Participants emphasised the importance of considering patient’s lived experience and functional goals when informing management decisions. Prognosis and self-management strategies should be prioritised, avoiding either over-investigation for non-specific problems or generic management for distinct treatable conditions. Conclusions: UK-based clinician stakeholders, predominantly from secondary care, developed consensus-based priority statements regarding future improvements for the management of people with NTWD. Competing clinician perspectives were found regarding diagnostic specificity, resulting in apparently contradictory consensus priorities and highlighting underlying divisions in how NTWD are conceptualised and managed.

Introduction: Non-traumatic wrist disorders (NTWD) are commonly encountered across a range of healthcare settings. Uncertainty exists regarding optimal management and how this is reflected in care provision through clinical guidelines and pathways. We aimed to identify existing UK-based clinical guidelines and pathways and examine their quality. Methods: For this review, we searched MEDLINE, PubMed, Embase, CINAHL, ProQuest, Scopus, Web of Science, Google, The National Grey Literature Collection, TRIP, and the National Institute for Health and Care Excellence and undertook targeted outreach and engagement activities with healthcare professional networks. We included clinical practice guidelines and pathways for NTWD published after 2010. The AGREE II tool was used to assess guideline quality based on the domains of topic selection, best practice identification, data collection, and rigor of analysis. Results: Of 7017 records identified, 15 eligible clinical guidelines and pathways for NTWD management were eligible and included. De Quervain’s tenosynovitis and ganglion cyst were most frequently covered while other NTWD had few or no guidelines or pathways. Variation in the composition and nomenclature of sources was found. Quality assessment using the AGREE II tool identified variability and overall unsatisfactory quality. Conclusion: There is a lack of high-quality clinical guidelines and pathways for NTWD within the UK healthcare system indicating an obstacle to improvements in healthcare delivery.

Introduction: Non-traumatic wrist disorders (NTWD) are commonly encountered across care settings, but current patterns of care and clinicians beliefs about the care they provide remains unclear. Objective: This study aimed to record management approaches to care for NTWD across clinical groups and care settings. Methods: Ethical approval was sought for an online cross-sectional survey of clinicians [1 Jul - 1 Nov 2023], comprising 18 questions exploring profession, work setting, exposure to NTWD, alongside diagnostic and management confidence. UK-based musculoskeletal (MSK) clinicians were invited to participate through special interest groups, online forums, social media and professional network emails. Results: Variability was found in the domains of specificity of diagnosis and confidence in management which relates to exposure and profession. Variability was found in the domains of specificity of diagnosis and confidence in management which relates to exposure, profession and clinical setting. Several Patient Related Objective Measures (PROMS) were used by clinicians to assess treatment effect, set goals, and communicate with patients. Conclusion: This study provides the first description of UK clinicians management of non-traumatic wrist disorders across professional groups and healthcare settings. As evidence-based management remains elusive, deeper understanding of the clinical decision-making and practice behaviour of clinicians would have value in future studies into NTWD.

Introduction: Public-facing resources for non-traumatic wrist disorders (NTWD) exist, but care recipients and healthcare professionals alike are uncertain where to access the most useful resources and have raised concerns over the quality of information provided. Previous studies involving stakeholders highlight a need for quality evaluation of these resources. The aim of this study was to identify website resources accessible to UK-based online health seekers and explore their content through quality assessment. Methods: A scoping review of public-facing websites was conducted in accordance with Joanna Briggs Institute guidelines and PRISMA-ScR checklist. An a-priori search strategy was performed of publicly accessible websites using lay terms were entered into a simple Google search. The DISCERN tool was used to appraise the quality of health information with additional data charted to pre-determined criteria. Results: The 82 websites meeting inclusion criteria scored an average of 2/5 DISCERN. Nine funding categories existed with private service websites were the most common. 18 different diagnoses were found with twenty different management interventions were recommended. Conclusion: Considerable variation was found in the quality of websites providing information which people with NTWD are likely to access. Quality and trustworthiness of website information on NTWD are not the preserve of any sector or organisation and we identified potential for improvements across the board.

Introduction: Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom. Methods: An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers. Results: Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain’s syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD. Conclusion: Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD.