HOW OSWA HAND SURGERY WORKS

Three Simple Steps for patient centric hand surgery

1. Virtual assessment by Orthopaedic Wide Awake Hand Surgeon
2. Patient books the slot of their choosing with QASMC
3. Surgery And Rehabilitation delivered by Wide Awake Hand Surgeon in one management stop

Harley Street Hand Clinic

Wide Awake Fasciectomy For Dupuytren's Contracture

Through the OSWA approach, a pathanatomical and logical approach can be utilized.  In this case the young gentleman presented to our OSWA service requesting amputation of his ring and little fingers- he had previous surgery under GA years before.  At OSWA surgery we fully corrected the ring finger deformity by removal of the diseased fascia and there was also a partial correction of the little finger on account of the natatory cord which was removed.

Extensor Carpi Ulnar injuries and the three Rs for soft tissue injuries

The ECU is a guider on the back of the wrist near the little finger.  It is particularly vulnerable in racquet sports when the wrist deviates towards the little finger (ulnar deviation).  The tendon can be painful or damaged.  My general approach for sporting tendon problems are the three R's: rest; rehabilitate; and reinstitute activity in a stepwise fashion and with protection of the injured structure and attention to sporting technique.  www.mskbismil.co.uk

World Wide Awake Hand Surgery

Worldwide Dr Prof Don Lalonde from Canada must be credited with the promotion of wide awake hand surgery.  Please read the abstract to one of his latest publications here.  He summarises the potential wide awake advantage as follows: "Patients spend less time and money and get to speak to their surgeon and receive education during the surgery itself. Improvements in operations such as flexor tendon repair have happened, because surgeons can see movement during the case and make adjustments before the skin is closed. Surgeons can perform more cases in the same amount of time with fewer personnel. The cost of the surgery is decreased, as all expenses surrounding the provision of sedation are removed."
#movingsensatehand #oswa #handsurgery

Wide Awake Hand Surgery And The Diagnostic Nerve Decompression

Please see this recently published case report.  Nerve conduction studies have a significant false negative and significant false positive rate (around the 5% range).  Each year we have seen cases where a nerve conduction study result has confounded the diagnosis in a hand surgery patient.  With wide awake hand surgery during which the operation is performed with a #movingsensatehand the concept of a diagnostic decompression arises.  www.onestopwideawake.co.uk

One Stop Wide Awake Hand Surgery London Mucoid (Mucous) Cyst

Mucoid cysts are ganglion variants which usually arise from the end joint of a digit.  They contain jelly-like ganglion fluid and communicate with the joint.  At OSWA surgery we remove the lesion and clean the joint.  Reasons to opt for surgery include discharging of the fluid, pain and if the lump is causing deformity of the nail...

Wide Awake Dupuytren's Fasciectomy Pathoanatomical Approach

Photo from the original OSWA Dupuytren's paper, please goto the website for more info

Golf Grips And Finger Strain

I have spent some time studying golf grips and the baseball grip is the most kind on your fingers even though it is not the most popular grip.  The interlock places quite a lot of strain on the dominant little finger joint (PIP joint).  My advice (in terms of hands, not golfing handicap) is try the baseball grip.  If you have golfing related mild finger pain you can try finger rehabilitation at the bottom of this page.

Ulnar nerve entrapment

The ulnar nerve can be pinched in the neck, elbow or wrist.  This diagram shows ulnar nerve entrapment at the elbow.  This area is known as the cubital tunnel and in cubital tunnel syndrome the patient usually experiences pain, tingling and and numbness in the little and ring fingers. Please read our patient's account here also reproduced here...

Trigger Finger / Thumb

In trigger finger and thumb the guiders (flexor tendons) are dysfunctional and give rise to locking and / or pain in the finger and thumb.  Despite the diagram showing an index finger, this is uncommon.  Also please note that the digit locks in flexion ie. bent rather than straight.

Ring, middle and thumb are the commonly triggering digits.  In the early stages a cortisone injection may work, or sometimes the condition will settle spontaneously.  Exercise may also help.  In resistant cases wide awake trigger digit surgery may be a good option.

Wide Awake Carpal Tunnel Decompression In London

In Carpal Tunnel Decompression we release the transverse carpal ligament shown in green here; at OSWA we steadfastly perform this using true wide awake hand surgery (no tourniquet) and in only one management stop (OSWA)

Wide Awake Hand Surgery

Wide Awake Hand Surgery (WAHS) is hand surgery performed purely under local anaesthesia with no tourniquet, no sedation, no general anaesthesia and no regional anaesthesia.  WAHS can enable patient-centricity and accelerated rehabilitation.  It is very suitable for conditions such as carpal tunnel syndrome, cubital tunnel syndrome, ulnar tunnel syndrome, ganglia, mucoid cysts, De Quervain's tenosynovitis, Tennis Elbow and not least Dupuytren's contracture.