Will I need extra tests?
Patients who come to see me with an injury, or with a problem such as arthritis will generally need an x-ray which can be arranged the same day. Some conditions need to be evaluated further and I may recommend an ultrasound scan, a CT scan, or an MRI scan. These are sometimes available the same day, but may require a follow up appointment. For patients with problems related to nerves I often order a nerve conduction test to help with diagnosis and to help you understand how severe the problem is so that you know if it’s safe to watch and wait, or whether more urgent treatment is required.
Can I have injections in the clinic?
I use steroid and local anaesthetic injections for many conditions causing pain in the hand and wrist. For carpal tunnel syndrome, trigger digits, and thumb arthritis I usually administer these injections myself at the same time as our meeting in the clinic. For areas that need guidance for the needle such as the wrist joint or small joints in the finger I usually organise these under ultrasound or x-rays guidance, using local anaesthetic.
How will the injection affect me?
I use a mixture of corticosteroid medicine and local anaesthetic. Most of the time when I’m doing this the intention is to make your pain better. But sometimes it is because we’re not sure what the exact diagnosis is, and so we want to know if the pain is coming from a certain site. Corticosteroid injected into or around joints is generally very safe. Very little of it is absorbed systemically, and so it doesn’t give side effects like taking steroid tablets might do (weight gain etc). However, it can thin the skin around the injection site, and it can bleach the skin a little too which can be more noticeable in people with more skin pigment. This can get better spontaneously, but sometimes it can be a permanent colour change. The steroid is often a little painful at the time of the injection, but it can also cause a flare of symptoms for a few days afterwards, so I normally recommend that you have a ready supply of basic pain killers to take for a couple of nights afterwards. Generally we don’t recommend driving straight home after a steroid injection, because you might find gripping the steering wheel difficult, so if you’re expecting an injection it might be better to get someone to drive you to the hospital, or take public transport.
What if I need surgery?
If you need surgery we will spend a lot of time talking about the different options first. It is really important that you understand what the alternatives to surgery are, and usually there might be a splinting or steroid injection option to try first. It’s also crucial that you understand what the risks of surgery are, and we will talk over these together. Some risks are important because they happen commonly (for example Dupuytren’s disease often progresses to other areas) and some are important because although rare, if they happen they have a big impact on people.
Having decided on the appropriate treatment for you we will go through a consent process which starts in the clinic when I talk to you about the procedure. You should then have some time to go away and think about our discussion, and you will receive a copy of my letter from the clinic, in case anything wasn’t clear. I would encourage you to read online as much information about your procedure as possible, and more and more there are patient groups who can describe their experience of similar procedures to others. On the day of surgery we confirm the consent together, and you have another opportunity to ask questions.
The preoperative nursing team will go through some additional forms with you, and if your operation is to be under general anaesthetic (asleep) or regional anaesthetic (nerve block around the shoulder) then the anaesthetic doctor will come to meet with you aswell. Shortly before the surgery the team will ask you to change into a hospital gown, and then they will bring you into the operating theatre.
Do I need to be fasted before the surgery?
Many of my procedures are conducted under local anaesthetic. In these cases you can eat and drink throughout and you don’t need to be fasted. If you are having a general anaesthetic (going to sleep) or a regional anaesthetic (nerve block around the shoulder) then you need to stop food and coloured drinks and chewing gum for six hours before the surgery. You can have clear fluids or water until two hours before the surgery.
What happens after the surgery?
The team in the pre-op area will monitor you for a while after the surgery. Generally if your pain is under control and you’ve had something to eat and drink then they will be happy to let you home. If you’ve had a general or regional anaesthetic you need an escort to take you home as you may still feel a little weak, and there should be someone in the house/flat with you that night too.
Your discharge paperwork will inform you when you need to come back for a wound check, and whether there are stitches to be taken out. It will also tell you what number to call if you have any issues or need more information. We will also write to your GP to let the know you’ve had a procedure.
What if I’m taking blood thinners?
Generally I advise you to stop blood thinners before surgery, even for minor operations. This is because they can cause blood clots which increase the risk of infection. For patients taking drugs like apixaban (DOACs) or warfarin, the preop team will give you a bridging plan and prescribe some injections that you can have instead of your blood thinners. The injections are a short acting blood thinner, so they are out of your system quickly if there is a problem.
Can you tell me what time my operation will be?
Unfortunately we can only tell you whether your surgery will be in the morning, the afternoon or the evening. Whenever we try to give people time estimates these are often wrong. This is because surgery can be very dynamic, with some procedures taking longer, and others being shorter than predicted. We have to ask for your patience on the day of surgery, and we always try to keep patients up to speed with how the list is running.