Wrist Arthroscopy This is a form of minimally invasive surgery which allows the surgeon to see the inside of the joint and is predominantly diagnostic and helps asses the status of the cartilage, bone and ligaments. With technical advancements, it is now increasingly being used to perform more complex therapeutic interventions. Find out more: https://www.assh.org/handcare/condition/wrist-surgery-arthroscopy

Learn about Mr Philip Mathew, a leading London orthopaedic surgeon specialising in hand and wrist surgery, with years of expertise and patient-focused care. Philip Mathew If you’re looking for high quality and personal service from your hand surgeon, I can help. I am committed to taking care of you and believe in shared decision making and guiding you through the myriad of treatment options. This may well be non operative treatment in the form of specialist hand therapy, splinting or image guided injections. Not all problems require surgery. However if surgery is the best option then I can inform you of all the possible choices , their advantages and disadvantages and help you make an informed decision. I will then guide and support you through your surgical pathway, recovery and post-operative rehabilitation with our team of nurses and therapists. I value your feedback and look forward to providing you with great care. Your comments do help make a difference so do please leave your feedback. I am lecturer at Queen Marys University Hospital, London and teach Diploma Candidates as a tutor for the BSSH Hand Diploma. I am an examiner for the BSSH Diploma in Hand Surgery and sit on the Diploma Commitee. I am part of the faculty on the AO principles of fractures fixation course. I am passionate about hand and wrist surgery and committed to providing a high standard of care for my patients. I keep myself up to date and present at international and national conferences and am a reviewer for the Journal of Hand surgery Values I am committed to taking care of you and believe in shared decision making and guiding you to help make the right decision for your treatment. The service I provide is based on the values of compassion, commitment and accountability. Treatment options for hand and wrist sports injury Inspiration Whilst in Medical School I was inspired by reading about Dr Paul Brand, the British missionary surgeon, who travelled to India and pioneered the tendon transfer techniques still used today to allow the hands and feet of leprosy patients to function properly once again. Training Following an intensive Orthopaedic training on the prestigious Percivall Pott Rotation in London, I pursued my training in hand surgery through overseas fellowships awarded by The British Society for Surgery of the Hand, The British Orthopaedic Trainees Association and the AO Foundation. These fellowships enhanced by understanding of hand and wrist pathology and the various treatments for these problems through working with some of the giants in hand and wrist surgery in the US, India, Spain and France. On my return I then completed a years hand fellowship at the world renowned Pulvertaft Hand Unit in Derby. I worked as a Consultant Hand and Wrist Surgeon for 6 years at Barking Havering Redbridge NHS Trust prior to taking up my current post as a full time Hand and Wrist Surgeon at Chelsea and Westminster Hospital NHS Trust in 2020. Passion My passion lies in understanding and treating predominantly wrist pathology from fractures to arthritis to instability. I offer WALANT (wide awake), open and keyhole surgery as appropriate to the condition. I also treat a wide range of hand and wrist conditions from nerve compression, ganglions, stiff joints to Dupuytren’s disease. Teaching and Training responsibilities I am an Hon. Senior Lecturer on the Queen Mary’s University, London MSc in Trauma program. I am an approved tutor for the BSSH Diploma in Hand Surgery. As part of my additional teaching responsibilities, I have previously taught as faculty for the Miller FRCS Course for Orthopaedic trainees. I am an examiner for the BSSH Diploma in Hand Surgery and sit on the Diploma Committee. I am part of the faculty on the AO Principles of Fracture Fixation course. I am also involved in the training of Registrars and junior doctors in the Hand and Wrist Unit at Chelsea and Westminster and have set up the online education website www.chelwesthandandwristeducationhub.com . Research Interests I believe research plays a vital role in advancing our understanding of disease and improving treatment outcomes. I previously served as Principal Investigator at Barking, Havering and Redbridge Hospital for a national randomised controlled trial on fracture healing. I am currently leading another national trial as Principal Investigator, comparing joint replacement with trapeziectomy for the treatment of thumb base arthritis. Additionally, I have submitted my MSc dissertation, which focused on midcarpal instability. Social Mr Mathew is married to a plastic surgeon Miss Mughal ( Guys and StThomas Hospital) and they enjoy tennis, travelling, exploring and reading in their free time. He also supports charities like Medecins Sans Frontiers and Crisis UK. Mr Mathew is a reviewer for the And also has published his work. Find our more: Google scholar publications link here

Important information from Mr Philip Mathew to help you prepare for hand or wrist surgery in London and ensure a smooth recovery. Things To Remember 1. If you are insured, it is extremely helpful to all if you could kindly get pre-authorisation for your consultation, follow–up, surgery or therapy treatments as appropriate from your insurer prior to the consultation. 2. A few minutes to run through in your mind the answers to the question below prior to the consultation will make your visit more productive. a. What is the main problem- pain, instability, weakness b. Can you characterise the type of pain and its duration c. Duration of symptoms d. Any associated trauma e. Any other medical problems f. Any allergies g. What medication are you on h. What treatment have you had to date

Are there surgical options for painful Arthritis in the hand and wrist? The tendons in your wrist are affected by De Quervain’s tenosynovitis, which is a painful ailment. It happens when the two tendons at the base of your thumb swell. The sheaths (casings) that cover the tendons become inflamed and cause a narrowing of the passage through which the tendons run. This causes pain specifically with certain repetitive movements like lifting your child. Although the actual aetiology of de Quervain’s tenosynovitis is unknown, any activity that requires repeated hand or wrist movement, such as gardening, golf, or racket sports, or lifting your child, might aggravate the condition. Symptoms Sharp or dull Pain and swelling or discomfort at the base of your thumb is the most common symptom of de Quervain’s tenosynovitis. You may also have soreness up your forearm. The discomfort may grow gradually or unexpectedly. This can become quite intense and restrict your function. Other symptoms are: The base of your thumb hurts. The base of your thumb is swollen. When you’re performing something that requires grabbing or pinching, it’s difficult to move your thumb and wrist. When you move your thumb, it feels sticky. If you wait too long to cure your problem, the discomfort may move to your thumb, back into your forearm, or both. Pinching, clutching, and other thumb and wrist actions worsen the discomfort. Causes Chronic wrist overuse, alterations in your hormone levels, swelling and repetitive movements are the most common causes of de Quervain’s tenosynovitis. Lifting a youngster into a car seat is one regular activity that causes it. Lifting large grocery bags by the handles is another possible cause. You are more prone to de Quervain’s tenosynovitis: If you are a woman (new mothers develop it about 6 weeks after delivery If repetitive hand and wrist motions are a part of your hobbies or employment. If our wrist has been injured, tendon mobility can be restricted by inflammation and swelling. Diagnosis Your doctor may do a simple test to diagnose de Quervain’s tenosynovitis. The Finkelstein test is what it’s called. You begin by bending your thumb so that it lays over your palm. Then you close your fingers around your thumb and create a fist. Finally, you bend your wrist in the direction of your little finger. De Quervain’s tenosynovitis is characterised by discomfort or pain near the base of the thumb. Other tests, such as X-rays, are typically not required to diagnose the problem but may at times be helpful to differentiate other causes. Treatment De Quervain’s tenosynovitis is treated by lowering discomfort and swelling. Treatment options include: Heat or ice can be applied to the affected region. Using a nonsteroidal anti-inflammatory medication (NSAID) either topically to the region or in oral tablet form (if not contra indicated- asthma/ allergies/ stomach ulcers etc.) can help with the pain Activity modification by identifying movements that cause discomfort and oedema and avoiding them. Those that need repetitive hand and wrist motions should be avoided at all costs. To rest your thumb and wrist, wear a splint as advised by your hand therapist or hand surgeon steroid injections are quite effective and are often used to manage the problem and are usually injected under ultrasound guidance into the tendon compartment. It is essential that you see your surgeon and the therapist who can then guide you on the appropriate treatment plan tailored for you. If these therapies don’t have the desired result, your surgeon may recommend surgery to you. When should you see a hand surgeon? if you’re already tried: Avoid utilizing the thumb that is affected. Using ice on the affected area non-steroidal anti-inflammatory medications If you’re still having difficulties with pain or function a hand surgeon can help advise you on the various non operative options, recommend a good hand therapist and guide you on the surgical option should the non-operative options fail. The operation when required is curative.

Review Mr Philip Mathew’s clinical audit results and commitment to excellence in hand and wrist surgery for patients in London. Audit of Practice If approached to participate in the BSSH audit, your help in completing the audit is much appreciated.Why audit? This Audit tool is designed to enable the surgeon to audit his practice and outcomes and check if the outcomes are. This information is used by the surgeon to inform annual appraisal and target areas for Continuing Professional Development and thus improve the service he provides. In addition regular audits of readmission rates, post-op infection rates, patient satisfaction etc, are also collected and monitored to improve the patient experience.

Transparent costs for private hand and wrist surgery in London with Mr Philip Mathew. Learn about consultation, treatment, and surgery fees. Costs and Medical Insurance Mr Mathew is recognised as a provider by all the major medical insurance companies (BUPA, BUPA International, AXA PPP, Aviva, WPA, Standard Life, Pruhealth Cigna etc.) Mr Mathew’s billing company Mediaccounts will invoice the insurance company directly, providing you have obtained ‘preauthorization’. Insurance companies usually require a referral from your GP as a condition of the insurance policy. It is recommended that you contact your insurance company prior to your initial consultation and if surgery is planned. The insurance company will give you a pre-authorisation number, which will smooth the process of account payment. Please bring your insurance details (policy number and authorization number) to the initial consultation. If preauthorization has not been obtained prior to the consultation, you will be asked to pay on the day (cash or card) and you should then forward invoices to your insurance company for reimbursement. Self-funding Patients Most private hospitals now tend to offer package deals for a variety of treatments inclusive of investigations and surgery. They may require payment in full or a deposit at or before the time of treatment for self-funding patients. The hospital may require further payments on account with payment of the balance in full on discharge. The value of the deposit will vary with treatment and is at the discretion of the hospital providing treatment. For majority of patients who are self funding and do not wish to avail any of the packages provided by the hospitals, Mr Mathew will provide an accurate estimate (assuming no medical complications) prior to commencing any treatment. The hospitals and anesthetist will have additional charges for their services. Please contact my secretary prior to the appointment if you wish to discuss this further. Organising payment in advance of your treatment will save time on the day of admission.

Carpal Tunnel Surgery: What To Expect What is carpal tunnel release surgery, and how does it work? Carpal tunnel release (CTR) is one of the most common hand operations, and the results are usually curative. Major complications are extremely uncommon. The transverse carpal ligament is a tight band deep in the palm at the level of the wrist. This ligament forms the roof of a tunnel bordered by the small bones in the wrist. This tunnel allows passage of 9 tendons and one nerve ( the median nerve) from the forearm into the hand. Any pathology that decreases space within the tunnel can compress the median nerve and cause symptoms of carpal tunnel syndrome. While it may seem illogical to purposely cut a ligament to improve hand function, long-term outcome studies have demonstrated continuous improvement of symptoms with few side effects. The surgery is nearly always done as an outpatient procedure (i.e. you will go home the same day). We’ll go over what to expect before, during, and after surgery in this section. What should I do to be ready for surgery? You may be requested to go without food and drink on the day of surgery, depending on the type of anaesthesia used (more on this below). This usually means no food or drink after midnight the night before your procedure if you are having a general anesthetic. Ask your surgeon for advice if you typically take drugs in the morning. On the day of operation, what should I expect? CTR can take place in a hospital, an ambulatory surgery facility, or even a clinic or a doctor’s office. Documentation: Prior to surgery, you may be asked to sign certain paperwork, the most significant of which is the informed consent form. The concept of informed consent is that you and your surgeon have reviewed the risks and advantages of surgery and that both the physician and the patient agree to proceed with surgery. Anesthesia: Anesthesia for CTR can be provided in a variety of ways, including the following: A breathing tube is used in conjunction with general anaesthesia. Sedation is a type of anaeshetic that makes you sleepy but you dont have a breathing tube inserted and is used in combination with some form of local anaesthetic for pain relief. Local anesthetic with tourniquet. WALANT: wide awake local anesthetic no tourniquet.Anesthesia administered locally (usually with lidocaine with adrenaline, similar to what is used for numbing your mouth for dental work) By far the most common technique used in my practice is WALANT, it has the minimal risks and permits quick recovery and early return home. All of these methods have advantages and downsides, which your surgeon and/or anesthesiologist will likely address on the day of surgery or during an office visit prior to surgery. Fasting is essential for general anaesthesia and sedation, and an IV line must be established prior to operation. There is no need to fast if the surgery is performed with only local anaesthetic, and you will be awake throughout the process. Patients frequently worry that if they are awake, they will feel the pain of the operation. You should feel no pain during the operation after the initial injection of lidocaine. You may feel the surgeon move your hand, and you may even feel touch, but the lidocaine blocks pain very well. What may I expect following surgery? Following surgery, engage in the following activities: You’ll be sleepy after surgery if you’ve had general anesthesia and sedation, and you’ll need a ride home. For the rest of the day, you should plan on resting. You should plan on doing only light activities for the rest of the day, regardless of the type of anesthetic you received (walking, eating, reading, TV).You’ll start to feel increasing pins and needles in your hand and fingers as the anesthetic wears off. The operation can cause numbness that lasts anywhere from a few hours to a day. Summary Carpal tunnel release is a simple outpatient procedure that has a high success rate. The operation can be performed under general or local anaesthetic. Techniques that are both open and endoscopic are used. The endoscopic technique is more risky and reserved for specific indications only. Elevation and over-the-counter pain medications are used to manage pain following surgery. You could be back in a few days or weeks, depending on your job. Light activities week 3 , heavy activities week 6.