When you come to Princess Margaret for your initial consultation, your consultant will first take a detailed medical history, and ask you to describe your symptoms. They will likely ask you:
- What symptoms have you been experiencing?
- How long have these symptoms lasted?
- Have they become progressively worse over time?
- What type of pain is it? Pain when moving or nerve pain?
- Is the pain localised or does it spread up through your arm?
- Have you tried any treatments previously?
- Are you currently taking any medication?
Seeing our consultants privately brings the benefit of longer consultations, usually around 30 minutes, allowing for much greater detail and a chance to get to know you and how your condition has been affecting you.
They will then perform a clinical examination of your hand and/or wrist, manipulating the joint and pressing along the hand to assess your responses. They may also ask you to perform some simple tasks and movements to demonstrate your symptoms.
Sometimes this is enough to make a firm diagnosis, but further investigations may be carried out to confirm any suspected condition or injury.
Typically, your consultant will start out with an x-ray to get an idea of the bony structure of the hand and wrist. This allows them to rule out the bony structures if there are no abnormalities, instead focusing on the soft structures, such as the tendons, ligaments, muscles and nerves. Depending on the availability of our radiologists, an x-ray may be arranged on the same day.
An ultrasound can help when looking at structures close to the skin, and an MRI or CT scan is useful for deeper structures, and all of these scans can be arranged in our on-site Imaging unit.
In some cases, your consultant may request an assessment from one of our dedicated Hand Therapists in order to assist with diagnosis and offer expert hand therapy treatments, which can be crucial in getting good outcomes.
Occasionally, an arthroscopy of the wrist may be used for the purposes of diagnosis if your scans have been inconclusive. Certain procedures can then be carried out at the same time, saving the need for further surgery.
A definitive treatment plan can then be introduced, and may include steroid injections, physiotherapy, or if necessary, an operation. Your consultant can outline all possible treatment options, allowing you to make the final decision.