Hand & wrist surgery in Great Missenden

The hand and wrist are complex parts of the body, which means that pain, swelling or stiffness can have several different causes. Some disorders will be apparent, such as a fracture following injury, prompting an appointment with an orthopaedic hand specialist.

However, other injuries to the hand and wrist can be more subtle and develop over many months. This kind of injury can start as a minor discomfort or stiffness, which is generally manageable. Still, it is important to investigate this sort of symptom to avoid irreversible longer-term problems such as osteoarthritis.

Aside from acute injury and wear and tear, many other conditions affect the hand and wrist. For example, trapped nerves in the elbow, forearm and hand can cause pain, numbness, tingling and weakness. The most common nerve disorder is carpal tunnel syndrome, in which the median nerve is trapped, prompting these symptoms in the hand and tips of fingers, particularly at night.

Osteoarthritis is common in joints of the fingers and thumbs. Pain can often be controlled for years with injections. Still, many patients get excellent pain relief from carefully tailor-made procedures such as removal of arthritic bones, joint replacement and joint fusions. Rheumatoid arthritis is an auto-immune condition that, amongst other symptoms, can cause swelling in various joints around the body, particularly the hands and wrists. While most people with rheumatoid arthritis respond well to the latest medication, sometimes operations are needed to reduce pain and improve hand function. These include joint replacements, joint fusions, tendon transfers (to restore motion) and nerve releases.

Painful and restrictive lumps and bumps are very common in the hand and often increase with age. A hand and wrist specialist can help diagnose these and treat conditions like Dupuytren's disease (in which fingers bend inwards towards the palm) generally with minimally invasive outpatient procedures. Another condition commonly seen in hand clinics is trigger finger and trigger thumb, in which fingers develop painful locking and clicking.

Hand disorders have unique importance to particular occupations and hobbies, from playing musical instruments to creating fine art, cycling to field sports, cabinet making to jewellery-design. Our hand specialists pride themselves on having a broad understanding of all your occupational needs.

It can be confusing to consider the hand and wrist's numerous disorders, and a hand specialist will aim to establish an accurate diagnosis as early as possible by listening closely to your story and using careful examination and investigations. For some patients with longstanding pain, the diagnosis can be challenging to make, and our hand specialists often see people who have struggled to find a diagnosis in other units. Establishing an accurate diagnosis is the usual basis for deciding on the treatment options, which must be considered carefully and tailored to peoples' individual needs.

Almost all patients in this speciality are day cases and can therefore go home the same day as their treatment. Most procedures are conducted under local anaesthetic, which means that patients are fully awake throughout the operation.

The treatment plan itself will always consider the patient's goals, expectations, and lifestyle and may involve painkillers, physiotherapy, splints, injections, and surgery. For example, in osteoarthritis of the thumb, the cartilage at the base of the thumb joint has worn away, creating constant aching and additional sharp pain during specific tasks. A specialist may suggest fitting a custom splint which can reduce pain during activity. Depending on their goals, other patients may wish to consider steroid injections and even surgery, such as a trapeziectomy, which is a more significant undertaking but can give excellent pain relief if another treatment has not been sufficient.

Many hand and wrist conditions, including carpal tunnel syndrome, tendonitis and trigger finger, benefit from steroid injections for pain and inflammation. These injections provide relief from symptoms and can sometimes provide a long-term cure, but are also used to buy time while more long term solutions are sought, such as wide-awake surgery under local anaesthetic.

Dupuytren's disease, a progressive closure of the fingers into the palm, can often be treated with needle fasciotomy, a very minimalist local anaesthetic outpatient treatment with no scars and a rapid recovery. In more severe or recurrent cases, day case operations can also be used to restore straight fingers.

Our specialists commonly treat fractures of the many bones in the hand and wrist, particularly involving the scaphoid and end of the radius. While many of these heal adequately in plaster, we specialise in procedures that fix more complex fractures with operations. Similarly, our team sees patients with old, unhealed or badly-healed fractures of the wrist and advise on reconstructive surgery options. We also see many children with wrist and forearm fractures (some of whom may have had previous care in NHS hospitals) and advise on their ongoing care and physiotherapy.

Contact our enquiry team to book an appointment with a hand and wrist specialist at The Chiltern Hospital. They will offer you a choice of consultants and arrange a time convenient to your schedule.

At our main reception, you will be greeted and directed to the outpatient area, where your consultant will meet you. During your initial consultation, your consultant will discuss your symptoms and conduct a physical examination of the affected area. After this, they will refer you for diagnostic tests arranged onsite within the following two weeks.

The diagnostic technology at The Chiltern Hospital is highly advanced and available with no waiting lists. A typical test at this stage, particularly to assess your ligaments and muscle damage, would be an advanced imaging scan such as an MRI, MR arthrogram, or ultrasound. To investigate arthritis or a potential break, you may undergo an x-ray. At the same time, suspected nerve problems could be referred to a neurophysiology specialist, who can carry out specific tests on the nerves in your hands.

You will come in next for a follow up to discuss these tests' results, which will lead to a conversation about your treatment options. It may be that physiotherapy is all that's needed at this stage, and your consultant can refer you to a dedicated hand specialist to assist with this. If surgery is required, your consultant will discuss this with you, answer any questions you have and agree on a suitable time and date with you for the procedure.

If you are paying for the procedure yourself, you will be sent a fixed quote in writing, while those using medical insurance should contact their provider to obtain an authorisation code.

The clean and comfortable environment and supportive care of our staff will ensure you enjoy a fantastic care experience with us. After your procedure, dedicated hand specialists and the hospital's excellent physical therapists will be there to put together a tailored recovery program for you, make custom splints if needed and generally support your successful rehabilitation.

Our consultants are highly experienced in patient-focused care, sensitive to their patient's individual goals and expectations. From your desired course of treatment to your choice of sedation or local anaesthetic for your procedures, your consultant's focus is an exceptional care experience with the best results for you. 

To manage the complexities of the hand and wrist - and the many conditions which could be causing symptoms - your consultant can work closely with other specialists from radiology, neurology, rheumatology, physical therapy and beyond, all within The Chiltern's onsite network of expert consultants. 

Please speak with our friendly enquiry team today to book your initial consultation with a hand and wrist surgeon.