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Stenosing tendinopathy in the hand commonly occurs at the A1 pulley at the metacarpophalangeal joint. It commences with palmar discomfort during movement, progresses to a painful ‘triggering’ as the patient flexes and extends the digit and ultimately may lead to locking of the digit. A number of treatment options are available – splints, corticosteroid injections and surgery being the most commonly offered. This paper reviews the outcome of three patients presenting with this condition and treated with corticosteroid injections, in the extended scope practice clinic run by a hand therapist. Whilst all patients gained some short-term benefit, two required further injections and one was finally referred for a surgical release. Further analysis of these outcomes highlights the implications of presenting signs and the differences in patient requirements.

Physiotherapists and occupational therapists working within hand therapy in the United Kingdom are undertaking roles working beyond their normal professional boundaries. The aim of this study was to reach consensus on the role parameters and required knowledge, training and competencies desirable for such extended roles. A panel of 21 expert stakeholders comprising hand therapy clinicians, educators, doctors, existing extended scope practitioners and a representative from a patient group participated in three survey rounds using the Delphi technique. They examined three groups of parameters with reference to the competencies, knowledge and activities desirable for such extended roles. A prioritised list of parameters was developed. Data were analysed using descriptive statistics. Response rates for each round were consistently 95% or greater. The results showed areas of clear consensus, with prioritisation supporting the development of an independent practitioner working without direct supervision by a medical practitioner. Specific criteria were identified for such practice with regards to knowledge, training and activities, such as the ability to order, understand and interpret clinical investigations. In-house formal training tailored to individual service needs was the favoured approach. The results of this study can inform the development of a national strategy for the implementation of new ways of working while ensuring the provision of a quality health service.

Power handgrip strength is recorded by clinicians as a quick and viable measure of hand impairment and function that can serve as a useful evaluation of hand status and treatment progress. This paper explores the procedure and reliability of measuring handgrip using different equipment. The extent of usefulness of grip strength as an indicator of structural impairment and ability measures in patient populations is questioned and the relevance of recording grip strength as part of a clinical assessment is summarised.

Extended scope practitioners (ESPs) are specialist occupational therapists and physiotherapists working beyond their recognised scope of practice. Thirty-five hand therapists were identified as working in this role in Britain, primarily in pre- and post-operative settings. A postal survey of the 31 consultants with whom they worked investigated their views on the nature of this role and service; the facilitating and constraining factors to this development; and on required qualifications, training and supervision. Seventeen consultants, all hand surgeons, replied. They reported that the principle reasons for the development of ESPs were the need to reduce the waiting list and the consultants’ workload. A variety of roles had been created, reflecting the different service needs and the skills of the therapists. Training was largely experiential. Extended scope practitioners had had a significant impact on waiting lists. There was variation in the surgeons’ views regarding further development of these posts. Concerns were identified regarding these posts, such as professional isolation, the transferability of skills, inappropriate extension of the role and the potential for litigation.

Extended scope practitioners (ESPs) are specialist occupational therapists and physiotherapists working beyond their recognised scope of practice.The aims of this study were to identify the number, training and scope of practice of hand therapists working as ESPs. Thirty-five ESPs were identified and sent a questionnaire examining aspects of their practice. Thirty-two ESPs (91%) replied.The findings show that the ESPs worked in four models of practice: own clinic environment, rheumatology, preoperative and post-operative clinics. Their activities included making diagnoses, injections, joint aspirations and wound care. ESPs referred patients for surgery, investigative procedures and therapy. Training was largely experiential and there were unmet training needs. It can be concluded from this study that ESPs are undertaking aspects of care that traditionally have been undertaken by doctors and nurses. The development of ESPs has training implications.

Measurement of range of motion (ROM) at a joint is regarded by many clinicians as objective and is therefore frequently used as an assessment tool. There are many methods of measurements available to the clinician and the researcher, but information about their reliability may be less accessible. Some techniques of measurement, such as goniometry, have been studied frequently, whereas other popular techniques have little or no published evidence to support their use. The aim of this paper is to summarise the results from the literature surrounding methods of measurement, particularly those concerned with hand assessment.