Hello, my name is James Nicholl. My name is Mark Pickford. I'm Lisa Leonard. And my name is Pascal Smith. I have an interest in all areas of hand and wrist surgery, but also treat a lot of elbow problems. Within hand surgery, fractures of the wrist so fractures of the distal radius and fractures scaphoid are areas I find particularly interesting and challenging. I'm interested in all of the common conditions referred to hand surgeons including degenerative arthritis of the hand which affects the thumb base, the wrist and the digital joints. Also compression neuropathy is affecting the hand and upper limb including carpal tunnel syndrome and cubital tunnel syndrome and also Dupuytren's disease, a very common condition characterized by contraction of the digits and progressive inability to open the hand. Of course there are many, many other conditions that routinely are referred to us here at the Horus Centre. I think one of the fascinating things about hand and wrist surgery and elbow surgery to a lesser extent is the fact that we deal with all areas of the tissue. So we deal with soft tissues and nerves, but also bones, joints, ligaments, tendons and that makes it really varied and really interesting. So that's one of the best things I think to enjoy about. Also finding out what exactly is the problem for each individual patient because sometimes it can be a little bit of a magical mystery tour finding out what the real problem is. So those are the things I enjoy most about hand surgery. I specialise in the assessment and treatment of hands, wrists and the upper limb. I'm particularly interested in the thumb as it provides forty percent of your hand function. The most common hand condition that I treat is carpal tunnel syndrome. This is where the nerve that runs through the front of the wrist gets compressed and patients experience pins and needles, numbness and sometimes a burning pain going into their hand. This can be very troublesome at night, waking the patient up frequently, and it's a condition that's very easily treatable. Probably the commonest condition I treat here at the Horse Centre is arthritis, degenerative arthritis or osteoarthritis that is, and that can affect many parts of the hand. It's extremely common. The thumb base is probably the most commonly affected joint that I treat in the hand but also the small joints of the digits themselves. The cause is probably simple wear and tear but there may be genetic factors contributing to that, and the range of treatments that are open to us surgically include joint fusions but much more commonly operations that preserve joint mobility including joint replacements. One of the commonest hand conditions I see is arthritis at the base of the thumb. The cause is usually mechanical wear and tear osteoarthritis rather than an inflammatory rheumatoid type arthritis. We don't really know what causes osteoarthritis, possibly a small genetic element, wear and tear and much commoner in us ladies and that may be to do with our ligament becoming weaker bottom of the thumb over time. Whatever the cause it certainly gives a lot of people grief and pain, over the years, and it's a very satisfying condition to treat, if that's the case. The most common hand condition that I treat is arthritis at the base of the thumb. In the early stages the thumb can wear and tear at the base and the causes are wear and tear of the cartilage between the bone. During hand therapy we provide advice and education regarding the causes of osteoarthritis and we discuss joint protection and also treatment programmes for the strengthening and stability of the thumb. If someone has painful arthritis in their hands and it hasn't responded to treatment with simple painkillers perhaps some physiotherapy or sometimes even a cortisone injection into the painful joint, then there are a variety of operations that we can do, such as fusing bones together. Even for painful finger joints we can replace these now with a tiny artificial joint which can work well at relieving the pain and allowing the joint to move. Although thumb based arthritis tends to be treated by simple excision of the trapezium bone in the wrist, there are much more complex but very successful operations available for arthritis affecting the small joints of the digits in particular what we call the proximal interphalangeal joint that is the middle of the joints on the finger. For the middle joint of the finger, the operation that is most commonly carried out is what's called a surface replacement arthroplasty. It's a sort of small version of a hip or a knee replacement and is very good at relieving pain and preserving a functional range of motion and is a popular operation. In fact arthritis is a very common condition in the hand, and affects all the joints to a varying degree. There are things we can do about, any joint in the hand that has arthritis in it. Although it's true to say that in most, people surgery is not needed, and simple conservative measures such as modifying your activities, taking different painkillers and in some areas wearing a splint to support the hand in heavier activities is all that's needed. If that doesn't do the trick, then, a well placed steroid injection into the area of maximum discomfort can really give dramatic improvement in function even though it doesn't actually take the arthritis away. It can remove the inflammation, from that joint and make it much more comfortable to use. Finally, if all of those things, don't do the trick, there are surgical solutions which vary within the hand depending on which joint you're looking at. And these take the form of taking away some of the bones which are grating and grinding, fusing the grating and grinding bones together to make them solid so that they're not painful anymore or even, more recently replacing the joints with tiny little joint replacements. Some of them look like baby knee replacements and one we've more recently started using at the bottom of the thumb looks like a tiny baby hip replacement and some people have called this a hamster hip. It certainly looks small enough to be put into a hamster. During hand therapy your therapist will talk to you about joint protection, protecting your joints from wear and tear, avoiding stressful and strains upon the small joints of your fingers. Also talk about strengthening and stability exercises to support and sandwich the joints to reduce any stress and strain. They may provide you with splints and supports to improve pain, function and use of your hand. I don't have much skill but I enjoy playing golf, obviously having to hold a golf club. A lot of my patients are keen golfers as well, and one of the first questions they'll often ask me is when can I get back to playing golf after my hand surgery? And after a lot of the things that we do, three to four weeks from an operation someone would hopefully be getting back to the golf course. My number one hobby when I'm not at work is photography and my big interest, my passion is underwater photography, which for me is a great opportunity to travel to great places and also get great images. So my dexterity is key to allow me to press all those key buttons, that I need to control the camera that I'm using and get the images that I'm trying to take of all the wonderful marine life in tropical waters. I used to be very keen on needlework and sewing, and that requires quite a deal of dexterity. Over the last few years I've been rather busier and my sewing endeavors have really been limited to sewing on name tape labels for my school clothes which is perhaps a bit less exciting than what I used to do before. Outside of the Hauler Centre I have two children and I have recently set up a Lego club after school club and during that session we use the Lego for fine dexterity, educational, engineering and mathematical problems.
