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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

their lives.

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

their advice.

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

orthopaedic surgeon?

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.

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