Hand, Wrist and Elbow Surgery

There are many components of the hand, wrist and elbow including: bones, muscles, tendons, nerves and ligaments. These upper body tissues undergo a great deal of stress and strain and so hand, wrist and elbow complaints are common. These conditions can have a major impact on your ability to carry out normal daily activities, from writing to getting dressed.

Our multidisciplinary team brings together the expertise of orthopaedic surgeons, experienced orthopaedic nurses, sports medicine specialists and physiotherapists to provide you with the best possible care.

Duchy Hospital offers diagnosis and treatment for a wide range of injuries, disorders and joint conditions that can affect your hands, wrists and elbows. These might be due to sports injuries such as wrist sprains and fractures, and tennis elbow. One of the more common overuse injuries today is carpal tunnel syndrome from repetitive motion of the wrist and hand. Hand disorders including thumb arthritis and Dupuytren’s contracture also cause pain to the hands.

We offer a variety of non-surgical options to treat hand, wrist and elbow pain and injuries, including bracing or splinting, medication, activity changes and steroid injections. If these don’t work then surgery will be recommended to alleviate your pain and restore the function of your hands, wrist and elbow.

Carpal tunnel release surgery

If you’ve carpal tunnel syndrome (CTS), you'll notice numbness, tingling and pain in your hand, wrist and arm which is caused by pinching of your median nerve. This nerve controls sensation and movement in your hands. It passes through a tunnel in your wrist, that’s formed by bones and ligaments, known as the carpal tunnel. Narrowing of your carpal tunnel or swelling of tissues inside the carpal tunnel put pressure on the median nerve.

Wrist splinting or steroid injections may be effective in treating early diagnosed carpal tunnel syndrome. If they aren’t successful in providing pain relief carpal tunnel release surgery, also known as carpal tunnel decompression, will be recommended. This surgery can be performed as open or keyhole surgery. Your surgeon will cut the roof of the carpal tunnel, known as the carpal ligament, and this will reduce the pressure on your median nerve.

Dupuytren's fasciectomy

Dupuytren’s contracture or Dupuytren's disease is a benign thickening of the connective tissue (fascia) of your palm and fingers. If the condition worsens the scar-tissue contracts and your fingers are pulled towards your palm and cannot be straightened anymore.

There is no cure but treatment may be helpful.  Radiation, needle aponeurotomy (severing of the fibrous tissue in your hand), injections and surgery are options. Surgery called Dupuytren’s fasciectomy will be recommended if you can’t straighten your hand after other treatments. During surgery all of the scar-like tissue from your fingers and palm of the hand is removed and replaced with a skin graft or the fibrous band in your hand is cut.

Tennis elbow

Tennis elbow is a very common injury that results from overuse, injury, or strain of the tendon that attaches the forearm muscles to the bony part of the outside of the elbow. Tennis elbow is not limited to tennis players. It can occur with any activity that involves repetitive gripping, turning, bending or extending the wrist backwards.

The majority of people respond to conservative treatment including: rest, a strap, painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy, corticosteroid injections and shock wave therapy. If these don’t relieve the pain, then surgery may be recommended. During surgery the damaged part of your tendon is removed.

Thumb arthritis

The cartilage on bone ends of your thumb can wear away over time and this is known as thumb arthritis. It can be painful, cause swelling and your joint may be immobile. Thumb pinch activities such as opening a jar, turning keys or lifting heavy saucepans worsen the pain.

If diagnosed early, thumb arthritis can be treated using splints, medication and injections.

Surgery is recommended for troublesome symptoms that aren’t alleviated by non-surgical methods. Surgery will restore proper use of your hand. There are a number of surgical options including: trapeziectomy (removing the trapezium bone) and joint replacement (removing all or part of your thumb joint and replacing it with a graft), osteotomy (repositioning the bones in your thumb joint), joint fusion (fusing your thumb joint bones).

The following Consultants specialise in hand, wrist and elbow surgery

Mr Al-Shawi

Mr Poulter

Mr Scott

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