The Impact of Pre-Referral Advanced Diagnostic Testing on Wait Time to See a Hand Surgeon for Common Upper-Extremity Conditions

J Hand Surg Am. 2019 Dec;44(12):1013-1020.e2. doi: 10.1016/j.jhsa.2019.09.009. Epub 2019 Oct 31.


Purpose: We sought to evaluate the use of pre- and post-referral advanced diagnostic testing among patients with 3 common hand conditions, rates of subsequent tests, and differences in wait time to see a hand surgeon.

Methods: We analyzed a single academic tertiary care center administrative database of encounters from 2006 to 2015 to identify adult patients who were referred to a hand surgeon for 3 conditions (carpal tunnel syndrome [CTS], soft tissue masses [STM], and joint pain [JP]). We recorded patient characteristics, use and timing of diagnostic tests, and wait time for the initial hand surgeon evaluation.

Results: Among patients who received advanced diagnostic tests before the surgeon evaluation, CTS patients had the highest rate of receiving pre-referral advanced testing (53.4%) compared with JP (10.6% ) and STM patients (5.8%). The CTS patients had the highest rates of repeat testing (19.5%) compared with patients with JP (1.4%) and STM (0%). Across all 3 conditions, patients who received pre-referral advanced testing waited an additional 19 to 94 days to see a surgeon, compared with patients who received only post-referral testing or no testing.

Conclusions: Use of pre-referral advanced diagnostic tests is associated with an increased time to see a hand surgeon for common hand conditions.

Clinical relevance: Hand surgeons should have a role in identifying patients who do or do not benefit from advanced testing before referral to ensure that tests ordered before consultation are useful to both patients and treating surgeons.

Keywords: Carpal tunnel syndrome; electrodiagnostic studies; pre-referral advanced tests; referral timing.

MeSH terms

  • Adult
  • Aged
  • Arthralgia / diagnosis*
  • Arthralgia / surgery
  • Carpal Tunnel Syndrome / diagnosis*
  • Carpal Tunnel Syndrome / surgery
  • Diagnostic Tests, Routine*
  • Electrodiagnosis
  • Humans
  • Male
  • Middle Aged
  • Referral and Consultation*
  • Retrospective Studies
  • Soft Tissue Neoplasms / diagnosis*
  • Soft Tissue Neoplasms / surgery
  • Upper Extremity*
  • Waiting Lists*