Meet Mr. Cloke
Consultant Orthopaedic Surgeon, Mr Cloke has specialised in upper limb surgery in the North East for ten years. He is an examiner for the final exams for consultants (FRCS), and is the regional advisor in orthopaedics for the British Orthopaedic Association and the Royal College of surgeons. He has served in the Army Reserve for 19 years including Afghanistan.
Should I have an operation on my arm or hand?
Any patient approaching surgery should have a careful guided discussion about the surgery and the expectations and any potential implications. There are a few conditions which would lead me to advise that surgery is a clear best option. Fortunately, very rarely, we encounter conditions such as cancer or infection in bones and joints, but most of our conditions cause degrees of pain and disability without any actual threat to life. In some injuries such as true tears in the tendons of the shoulder or around the elbow (rotator cuff, pectoralis major, biceps and triceps) early surgery has clear great advantages over no surgery, but ultimately the choice is still the patients.
When would you recommend surgery?
When patients have problems that cause a combination of pain and limited movement, Surgery may offer benefit. That benefit may include pain relief, better movement of a joint, improved position of the hand, etc. There are a number of factors to consider. No operation guarantees success – and the success that can be expected is variable. Most operations involve a prolonged period of healing. For example, I advise that most patients after shoulder operations will not feel any better for a good three months or more, and it may take up to a year to see the full benefit. I say that these operations are not a guarantee or a quick fix.
What are the risks of hand surgery?
There are generic risks with any operation - it may not achieve the desired effect, it may get worse again, there is always the possibility of getting worse if there is a complication such as infection or inadvertent injury to other structures around the area of the operation. In hand surgery, it can take some weeks or even months for swelling, stiffness and pain to settle. The particular risks in hand surgery include temporary or permanent injury to nerves - e.g. in the wrist in carpal tunnel surgery, or fingers in Dupuytrens disease.
What are the common types of hand surgery procedures?
The most common hand procedures include carpal tunnel release for carpal tunnel syndrome, Trapeziectomy for thumb arthritis, and correction of Dupuytrens Disease of the fingers.
Can hand surgery help arthritis?
There are certainly operations for hand arthritis - but generally only an option if it affects just a couple of joints, not several in the hand. Operations for arthritis include removing the arthritic bone (commonly done for thumb arthritis by removing the trapezium bone - Trapeziectomy), fusing arthritis joints together so they are no longer painful, but don't move (most commonly the end joints of the fingers), or joint replacements. There are a few joint replacements done for thumb arthritis or for finger joint or knuckle joint arthritis, but they are either new and experimental procedures (in the case of the thumb), or not particularly strong (in the fingers), so are used with caution in selected cases.
What advice would you give to someone considering an upper limb operation?
At the end of the day, surgery of conditions of the shoulder, elbow wrist and hand very often produces very happy and grateful patients, for whom their pain or difficulties in using the limb is much improved. However, surgery is not always the answer for conditions. We as doctors have to carefully discuss all the options with you, including their pros and cons. If we do this correctly, and allow you to make the decision you feel is right for you, then I think we are doing our job.