surgical skill. Many of my operations are
keyhole, for which I need accurate hand-
eye co-ordination. Other operations are
performed using magnifying surgical glasses,
because I’m working on things smaller than
a millimetre. Overall, the best bit is making
people better so they can get on with
What are the latest developments
in upper limb surgery?
A lot of the developments in upper limb
surgery are technical advances. I’m attending
the British Elbow and Shoulder Society
meeting soon, and the British Society for
Surgery of the Hand in the autumn – these
meetings are designed for surgeons to share
and learn about advances.
There is a new shoulder device that may be
useful in patients whose tendons are beyond
repair. For these people there has often been
little choice other than a major shoulder
replacement. It looks very promising, but I
want to see real scientific data before I start
advising it. In the hand, the new thing is an
Xiapex injection that dissolves the collagen
cords of Dupuytren’s Contracture. It is clever,
expensive, certainly fashionable amongst hand
surgeons, and reports show patients tolerate
it well.What we don’t know yet is whether it
is really any better than previous treatments.
What are the practical steps to
identify common upper limb
I start with a history; the patient’s description
of what they feel, how it started and so on.
Reports from physios, GPs, osteopaths and
other specialists are all useful information,
as is the response to previous treatments.
Most of the diagnosis is made at this stage.
A physical examination is then used to
test my first thoughts. Hopefully they are
confirmed, but if the exam doesn’t match
my expectations, I have to consider other
diagnostic possibilities. Imaging provides
further evidence, from X-ray, CT, ultrasound
or MRI. These are all available at Sevenoaks
Medical Centre. Blood tests are sometimes
needed too. Putting everything together,
I reach a conclusion, then we can start
discussing treatment options.
From a patient’s perspective, the important
practical step is to ask a professional.
Symptoms have many different causes, and
self-diagnosis is unsafe and unwise. Sevenoaks
has great GPs, physios and osteopaths, so ask
What are your thoughts on the
We’ll get a new physio gym which will be
great.All the X-rays and scans are now
connected to London Bridge Hospital
computers which means no matter where
I see patients, I have all the information
Why did you want to become an
There wasn’t a plan, I discovered it along
the way. As a teenager, I wanted to be an
actor, but ultimately I decided against this.
I decided to become a doctor in order to
find something complex and interesting,
that was a blend of art and science. During
medical school I realised I was good at
surgery, and during surgical training, I really
enjoyed orthopaedics. I work in the upper
limb because it is so complicated. There is so
much that can go wrong with all the different
tissues, there are endless challenges.