The patient pathway

Before your appointment

A first consultation is more productive when the relevant history is already in the room. Bring what you have; nothing is required to be seen.

• Any previous imaging — X-rays, ultrasound, MRI, CT — ideally the images themselves, not only the report
• Written reports from previous clinicians, operation notes or discharge summaries
• A current list of your medications, including anticoagulants
• Relevant medical history: diabetes, thyroid disease, inflammatory arthritis, previous injury to the same limb
• When the problem started, what makes it worse, and what you have already tried

If you have imaging on a disc or patient portal, bring the disc or login details. Repeating imaging that already exists costs you time and money.

Your consultation

The consultation begins with your account of the problem, followed by a focused clinical examination of the hand, wrist, elbow or nerve territory involved. Examination findings, not imaging alone, usually determine the diagnosis.

• A history of the symptoms and how they affect your work and daily activity
• Examination of movement, strength, stability, sensation and specific provocative tests
• Review of existing imaging where available
• Further investigation only where it would change the plan — nerve conduction studies, ultrasound, MRI or CT

Conditions treatedFrequently asked questions

Understanding your options

You will be told what the problem is, what is likely to happen without treatment, and what each option realistically offers. A significant proportion of hand and upper-limb problems are managed without an operation.

• Activity modification, splinting or bracing
• Hand therapy and structured rehabilitation
• Injection where it is genuinely indicated
• Surgery, where the expected benefit clearly outweighs the alternatives
• Observation, where the natural history favours waiting

Not every patient needs surgery, and being told an operation is not required is a legitimate outcome of a specialist consultation.

Treatments offeredSecond opinion

If surgery is recommended

Before anything is booked you should understand the specific procedure, what it is intended to achieve, and what it cannot achieve. Consent is a conversation, not a signature at the end.

• The procedure, in plain terms, and the problem it addresses
• The realistic expected outcome, including any limits on recovery
• The main risks specific to that operation
• The type of anaesthesia — many hand procedures are done under local or regional block
• Expected time off work, driving and sport
• What happens if you decide not to proceed

You are entitled to time to consider, and to ask for the plan in writing.

Treatment or surgery

Most hand and wrist procedures are day-case: you come in, are treated, and go home the same day. More complex reconstruction, microsurgery or trauma may require an inpatient stay.

• Admission and pre-operative checks
• Anaesthesia — local, regional block or general, depending on the procedure
• The procedure itself
• Dressing, splint or cast as appropriate
• Written aftercare instructions and a point of contact before you leave

Recovery & rehabilitation

For tendon, nerve and complex fracture surgery in particular, rehabilitation determines the result as much as the operation does. Hand therapy is part of the treatment, not an optional extra.

• Wound care, dressing changes and suture removal
• Elevation and swelling control in the early period
• A specific hand therapy programme where indicated, often starting within days
• Graded movement, then strengthening, in a defined sequence
• Pain management appropriate to the procedure

Recovery timelines differ substantially between procedures. Yours will be given to you specifically rather than as a general average.

Follow-up & return to function

Follow-up continues until the outcome is settled. Return to work, driving and sport is decided on demonstrated function — range, strength, stability and healing — rather than on the calendar alone.

• Scheduled review appointments with clinical reassessment
• Repeat imaging only where it informs a decision
• Progressive return to work, with modified duties where appropriate
• Return to driving once you can control the vehicle safely
• Return to sport or manual work when strength and stability allow

Request an appointmentFor referring physicians