Orthopaedics 18 May 2017

The Orthopaedics department would like to introduce Mr Brian Stephens from the USA as a locum over the next 6 months (with a view to longer).

The Orthopaedics department would like to introduce Mr Brian Stephens from the USA as a locum over the next 6 months (with a view to longer). He is a well-regarded surgeon who has worked for Kaiser Permanente and has wide range of experience including hand surgeries such as Carpal tunnel and Dupuytren’s.

We have had a query about the direct access carpal tunnel service. The service is undertaken in the Eastern Bay but patients can be referred from across the whole DHB.  Please see the Bay Navigator pathway which includes the requirements for access and exclusion criteria that I have outlined below.

Requirements are:

• Either: Positive Phalen's or median compression nerve test (Tinels not sensitive or specific)
  • Sensory loss
  • Thenar wasting
  • Nocturnal parasthesia greater than 6 months
• A trial of steroid injection into carpal tunnel, or splinting (must have trial of non-operative without neurological compromise)

Exclusion criteria:

• On anticoagulants - includes Clopidogrel and dabigatran
• Age <30 or >80
• Previous significant trauma or surgery to wrist
• Patient not happy to go on direct access
• Pregnancy