Hand disorders and injuries often result in significant functional deficits if not diagnosed and treated in a timely manner. Unfortunately, in Canada, hands are often undertreated or treated too late, with potentially serious consequences for both the patient and society due to prolonged disability.
Hand conditions are complex and require specialized knowledge to diagnose and treat correctly. Unfortunately, primary care physicians rarely have the training or expertise to accurately diagnose and treat hand conditions, resulting in delayed referral to specialists and inadequate treatment.
Hand surgeons can be difficult to access, even in large urban centers, leading to further delays in managing these patients.
To make matters worse, hand conditions and injuries are often given a low priority compared to other health problems, so funding and resources for hand conditions are limited.
Recently, physiotherapists have been given the right to prescribe X-rays, and programs are being piloted in the Quebec City, Canada, area to integrate them into the emergency departments of several hospitals to manage musculoskeletal problems. This initiative to use the expertise of these professionals to help a health system on its knees and to relieve the burden on emergency physicians is to be welcomed.
Is it not time to do the same with occupational therapists?
Indeed, occupational hand therapists could play a key role in solving these problems as frontline (non-surgical) hand specialists.
Hand therapists are allied health professionals with specific training in assessing, diagnosing, treating, and preventing hand conditions.
They have a thorough knowledge of the anatomy and biomechanics of the hand and upper extremity. They are trained in various treatment techniques, including splinting, exercise, and manual therapy. They understand surgical indications and are often already involved in post-operative care, taking off and applying dressings, managing wounds, and removing stitches to relieve the surgeons.
They already work with hand surgeons, physiotherapists, and rheumatologists to provide a multidisciplinary approach to hand care. Their expertise can prevent unnecessary referrals to surgeons, allowing them to spend time with patients who need surgery.
It would therefore be of particular benefit to the public if they could also order simple imaging tests, such as X-rays or ultrasounds.
The more judicious use of valuable resources, such as the expertise of occupational hand therapists, should be considered in a collective effort to improve access to care and the quality of care.
Jean Paul Brutus is a hand surgeon.
