Hand, Wrist, and Forearm Disorders Guideline Effective January 7, 2019 Contributors to The Hand, Wrist, and Forearm Disorders Guideline Editor-in-Chief: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Evidence-based Practice Hand, Wrist, and Forearm Panel Chair: J. Mark Melhorn, MD, FAAOS, FACOEM, FAADEP, FACS, FASSH, FAAHS Evidence-based Practice Hand, Wrist, and Forearm Panel Members: James Ausfahl, MD M. Felix Freshwater, MD Charles P. Prezzia, MD, MPH, MMM, FACOEM David M. Rempel, MD, MPH, FACOEM, FACP Shawn C. Roll, PhD, OTR/L, RMSKS, FAOTA Arlen J. Rollins, DO, MSc, FACOEM, FACPM Robert A. Werner, MD, MS, FAAPMR Jason L. Zaremski, MD, CAQSM These panel members represent expertise in occupational medicine, orthopedic surgery, hand surgery, occupational therapy, physical medicine and rehabilitation, sports medicine, internal medicine, family practice, forensic medicine, and electrodiagnostic medicine. As required for quality guidelines (Institute of Medicine’s [IOM] Standards for Developing Trustworthy Clinical Practice Guidelines and Appraisal of Guidelines for Research and Evaluation [AGREE]), a detailed application process captured conflicts of interest. The above Panel has none to declare relevant to this guideline. Methodology Committee Consultant: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Research Conducted By: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Matthew A. Hughes, MD, MPH Matthew S. Thiese, PhD, MSPH Ulrike Ott, PhD, MSPH Emilee Eden, BS, MPH Harkomal Kaur, BS Jenna K. Lindsey, BS Michael L. Northrup, BS Skyler D. Walker, BS Chapman B. Cox Vivian Nguyen Deborah Gwenevere Passey, PhDc, MS Atim Effiong, MPH Kristine Hegmann, MSPH, CIC Alzina Koric, MPP Copyright ©2020 Reed Group, Ltd. Page | 1 Brenden Ronna, BS Austen J. Knudsen Pranjal A. Muthe Leslie MC Echeverria, BS Jeremiah L. Dortch, BS Anh Tran Dillon J. Fix Specialty Society and Society Representative Listing: ACOEM acknowledges the following organizations and their representatives who served as reviewers of the Hand, Wrist, and Forearm Disorders Guideline. Their contributions are greatly appreciated. By listing the following individuals or organizations, it does not infer that these individuals or organizations support or endorse the hand, wrist, and forearm treatment guidelines developed by ACOEM. American Academy of Physical Medicine & Rehabilitation American Association of Occupational Health Nurses David A. Allcott, MSN, APRN, ANP-BC, COHN-S, FAAOHN Association for Applied Psychophysiology and Biofeedback Gabriel E. Sella, MD, MPH, MSC, PhD, FAADP, FAAFP, FACPM American College of Emergency Physicians Charles Gerardo, MD, MHS, FACEP American Society of Anesthesiologists Richard W. Rosenquist, MD The American Occupational Therapy Association, Inc. Debbie Amini, EdD, OTR/L, CHT, FAOTA Copyright ©2020 Reed Group, Ltd. Page | 2 Table of Contents Impact ................................................................................................................................................................................................................ 11 Overview ........................................................................................................................................................................................................... 11 General Approach and Basic Principles .............................................................................................................................................. 11 Carpal Tunnel Syndrome ................................................................................................................................................................................................... 12 Triangular Fibrocartilage Complex (TFCC) Tears ................................................................................................................................................. 12 Crush Injuries and Compartment Syndrome ........................................................................................................................................................... 12 Kienböck Disease ................................................................................................................................................................................................................... 12 Wrist Sprains ........................................................................................................................................................................................................................... 12 Mallet Finger ............................................................................................................................................................................................................................ 12 Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)...................................................................................................................... 13 Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)13 Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome) ........... 13 Radial Nerve Entrapment .................................................................................................................................................................................................. 14 Non-Specific Hand/Wrist/Forearm Pain ................................................................................................................................................................... 14 Scaphoid Fracture ................................................................................................................................................................................................................. 14 Distal Phalanx Fractures and Subungual Hematoma ........................................................................................................................................... 14 Middle and Proximal Phalangeal and Metacarpal Fractures ........................................................................................................................... 15 Distal Forearm Fractures .................................................................................................................................................................................................. 15 Fracture Classification and Diagnostic Criteria ...................................................................................................................................................... 16 Ganglion Cyst ........................................................................................................................................................................................................................... 16 Hand Arm Vibration Syndrome ...................................................................................................................................................................................... 17 Laceration Management .................................................................................................................................................................................................... 17 Human and Animal Bites and Associated Lacerations ........................................................................................................................................ 18 Hand/Finger Osteoarthrosis ............................................................................................................................................................................................ 18 Initial Assessment ......................................................................................................................................................................................... 18 Carpal Tunnel Syndrome ................................................................................................................................................................................................... 19 Triangular Fibrocartilage Complex (TFCC) Tears ................................................................................................................................................. 19 Crush Injuries and Compartment Syndrome ........................................................................................................................................................... 19 Kienböck Disease ................................................................................................................................................................................................................... 19 Wrist Sprains ........................................................................................................................................................................................................................... 19 Mallet Finger ............................................................................................................................................................................................................................ 20 Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit)...................................................................................................................... 20 Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)20 Ulnar Nerve Entrapment at the