PhD defence P. (Patrick) Krastman

Brief summary of the doctoral thesis:

The current Dutch guideline for GPs on the assessment, diagnosis, and treatment of patients with hand and wrist complaints in general practice has limited scientific support. Therefore, the diagnostic process and management of hand and wrist complaints in general practice is a challenge. In this thesis the epidemiology, diagnostic possibilities, and course of hand and wrist complaints in primary care are described. A GP assesses more patients per year with hand disorders than wrist disorders, a trigger finger is the most common diagnosis, and a wrist fracture or ligament injury of the hand and wrist are seen only sporadically. 

Dominant management strategies for patients with mallet fingers were referrals to secondary care and conservative treatment. The purpose of requesting a radiograph should not be to distinguish between a tendinogenic and osseous mallet finger, but to assess whether there is a possible indication for surgery. Furthermore, a radiograph should only recommend if the mallet finger developed after high-energy trauma.

In our systematic reviews about the diagnostic accuracy of history taking, physical examination and imaging for hand and wrist disorders, no studies are available on the diagnostic accuracy in primary care.  For this reason, GPs have limited diagnostic tools when assessing patients with hand or wrist complaints. Physical examination showed limited diagnostic accuracy for diagnosing finger, hand, or wrist disorders in hospital care. In addition, there is no accurate imaging modality showing acceptable diagnostic performance in hospital care, when taking the moderate quality of the eligible studies into account.