Treatment options
Treatments
Specialist treatment for the hand, wrist and upper limb. Treatment is individualised and may range from non-operative management through to specialist reconstruction and microsurgery.
Non-Operative Care
Conservative Treatment
Most hand and upper-limb problems are treated without an operation. Conservative treatment means using splinting, changes to how you load the hand, medication and hand therapy to settle symptoms and give tissue the conditions it needs to heal. It is not a delaying tactic or a box to tick before surgery is allowed. For a large proportion of conditions it is the definitive treatment, and the decision to continue it is made on how you are progressing rather than on a fixed number of weeks. Where it is unlikely to work — a displaced fracture, a divided tendon, established muscle wasting from nerve compression — that is said plainly rather than discovered after months of trying.
Read treatment guide →Injection Therapy
A targeted injection delivers medication — most often a corticosteroid combined with local anaesthetic — directly into the tendon sheath, joint or compartment that is generating symptoms. Its purpose is to reduce local inflammation so that pain settles and function returns, and in several conditions it is definitive rather than temporary. An injection is offered where the diagnosis is clear and the target is specific. It is not a general painkiller for an undiagnosed hand, and it is not used to postpone an operation that is already clearly indicated. Where the expected benefit is short-lived, that is said before the injection, not after it.
Read treatment guide →Hand & Wrist Surgery
Carpal Tunnel Release
The median nerve passes through a tunnel at the wrist bounded by the carpal bones and roofed by the transverse carpal ligament. Where pressure in that tunnel is persistently raised, the nerve loses its blood supply intermittently, then structurally. Carpal tunnel release divides the transverse carpal ligament so the tunnel can open and the pressure falls. The ligament is not repaired or replaced; the gap fills with scar tissue in a wider position. It is one of the most predictable operations in hand surgery, and its purpose is as much to stop further nerve damage as to relieve symptoms.
Read treatment guide →Trigger Finger Release
Flexor tendons run through a series of pulleys that hold them against the bone. Where the first of these — the A1 pulley — thickens, or the tendon beneath it swells, the tendon no longer glides smoothly. The finger catches, then locks, and often has to be straightened with the other hand. Trigger finger release divides the A1 pulley so the tendon can move freely again. The pulley is not essential to function at that level and dividing it does not weaken the finger.
Read treatment guide →Tendon Repair
A divided tendon does not heal by itself — the cut ends retract and the muscle can no longer move the joint. Tendon repair reapproximates those ends with suture techniques strong enough to allow early controlled motion, because a tendon that is immobilised heals stuck to everything around it. This is one of the few areas of hand surgery where the rehabilitation is as important as the operation, and where the result depends on both being right.
Read treatment guide →Fracture Fixation
Most fractures of the hand and wrist heal without an operation. Fixation is used where the fragments will not stay in an acceptable position on their own, where the joint surface is disrupted, or where holding the bone still in plaster for long enough would cost more in stiffness than it gains in alignment. Plates, screws, wires or an external frame hold the bone in the corrected position while it heals biologically. The metal does not heal the fracture — it holds the conditions in which the bone heals itself, and in the hand its main advantage is that it allows movement to start early.
Read treatment guide →Wrist Arthroscopy
Wrist arthroscopy passes a camera two to three millimetres in diameter into the wrist joint through small incisions, allowing the cartilage, ligaments and the triangular fibrocartilage complex to be seen directly and, in the same sitting, treated. It remains the most accurate way of assessing the interior of the wrist: MRI is useful but both over- and under-calls ligament and TFCC injury, and arthroscopy shows whether a structure is not only torn but unstable, which is what determines treatment.
Read treatment guide →Ligament Reconstruction
Ligaments hold joints in alignment through their range of movement. Where a ligament is torn and cannot be repaired directly — because it was not treated acutely, because the tissue has degenerated, or because the injury was not recognised at the time — the joint becomes unstable, loads abnormally and eventually wears. Reconstruction uses a tendon graft or local tissue to recreate the function of the missing ligament. The aim is to restore stability and prevent progressive arthritis, and it is a more involved undertaking than a direct repair.
Read treatment guide →Nerve Surgery
Nerve Decompression
A peripheral nerve can be compressed at any point where it passes through a confined space. Sustained pressure first interferes with blood flow, producing intermittent symptoms, then damages the myelin sheath, and finally the nerve fibres themselves, at which point recovery becomes incomplete. Decompression releases the specific structure causing the compression so the nerve can glide and its blood supply is restored. The operation is named for the site — carpal tunnel, cubital tunnel, radial tunnel, Guyon's canal — but the principle is identical, and its value lies as much in halting progression as in relieving symptoms.
Read treatment guide →Nerve Repair
A divided nerve does not recover on its own. The fibres beyond the injury degenerate, and regrowth from the cut end has nowhere organised to go, producing permanent numbness, loss of muscle function and often a painful neuroma. Repair aligns the two ends accurately under magnification so that regenerating axons can find their original pathways. Where a gap exists that cannot be closed without tension, a graft or conduit is used to bridge it, because a repair under tension fails. Timing, accuracy and magnification are what determine the result.
Read treatment guide →Cubital Tunnel Release
The ulnar nerve passes behind the medial epicondyle of the elbow through the cubital tunnel, a space that narrows as the elbow bends. Compression there causes numbness in the little and ring fingers, weakness of grip and pinch, and eventually wasting of the small muscles of the hand. It is the second commonest compression neuropathy in the upper limb. Release divides the structures compressing the nerve; where the nerve is unstable and snaps over the epicondyle afterwards, it is moved in front of it.
Read treatment guide →Reconstruction
Microsurgery
Microsurgery is not a single operation but a technique: operating under a microscope, with instruments and sutures finer than a human hair, on structures that cannot be repaired reliably by eye. It makes it possible to join blood vessels under a millimetre across, align the internal architecture of a nerve, and move living tissue from one part of the body to another with its own blood supply. In hand surgery it underpins replantation, free tissue transfer, nerve grafting and reconstruction after tumour or trauma. Its defining characteristic is that the margin for error is measured in fractions of a millimetre, which is why it is done slowly and by a surgeon who does it regularly.
Read treatment guide →Complex Trauma Reconstruction
Some injuries damage several tissue types at once — bone, tendon, nerve, vessel and skin — and cannot be treated by addressing each in isolation. Complex trauma reconstruction is a coordinated, often staged plan that sequences those repairs so each has the conditions it needs to succeed. The order matters: a stable skeleton before soft-tissue repair, healthy well-vascularised cover before tendon or nerve reconstruction, and a plan for movement from the outset. The goal is stated in terms of function — grip, pinch, sensation, a hand that can be used — rather than in terms of restoring normal anatomy, which is frequently not achievable.
Read treatment guide →Not sure which treatment applies to you?
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