Treatment guidelines for hand, wrist, forearm injuries available

Tags: workplace safety

The American College of Occupational and Environmental Medicine (ACOEM) on October 20 published new medical treatment guidelines for providing care to workers with injuries of the hand, wrist and forearm. The new guidelines, which represent the latest chapter in ACOEM’s comprehensive publication, Occupational Medicine Practice Guidelines, are available online now via ACOEM’s APG-I Web application; a print version will be available in the fall of 2010, when the next hard-copy edition of the Practice Guidelines is published.


More than 300 recommendations are featured, focusing on diagnostic testing and treatments for 20 disorders of the hand, wrist and forearm. Included are guidelines for carpal tunnel syndrome, wrist sprains, mallet finger, scaphoid fractures, middle and proximal phalangeal, and metacarpal fractures, distal forearm fractures, human and animal bites, and hand/finger osteoarthrosis.


The new guidelines were developed by a multi-disciplinary panel that included specialists in occupational medicine, orthopedic surgery, occupational therapy, physical medicine and rehabilitation, and neuromuscular and electrodiagnostic medicine. The guidelines follow ACOEM’s enhanced methodology, highlighted by original systematic research and evidence-weighted recommendations.


“The Hand, Wrist, and Forearm Disorders guidelines have gone through an extensive update to reflect the latest in evidence-based medicine and will serve as a great resource to improve care for injured workers and patients with injured extremities,” said J. Mark Melhorn, MD, FACOEM, FAAOS, FAADEP,FACS, FASSH, FAAHS, chair of ACOEM’s Evidence-based Practice Hand, Wrist, and Forearm Panel.


An extensive volume of literature was used to develop the evidence-based recommendations in the new chapter. Approximately 1,000 references are featured, including almost 350 randomized controlled trials or crossover trials.


Other highlights of the new chapter include:

         60 specific recommendations for carpal tunnel syndrome, including imaging and electro-diagnostic procedures, and splinting, injection and surgical release interventions.

         Recommendations for post-operative rehabilitation and rehabilitation of patients with functional deficits, as well as discussion of ergonomic interventions for distal upper extremity musculoskeletal disorders with an occupational basis.

         An overview for each treatment option, including background notes about any evidence cited, opinions on whether the treatment is considered costly or invasive, and whether it has high/low risks or side effects.

         Algorithms for the different hand, wrist, and forearm disorders which offer quick and accurate guidance for cases with different progressions, circumstances or outcomes.

         An appendix that covers treatment options for patients with Dupuytren’s disease.


To order an electronic version of the new chapter, or for more information about Occupational Medicine Practice Guidelines, visit, or call 847-818-1800.