Hand Therapy: Hand therapy is an important part of strengthening the hands and helping them to overcome pain and stiffness, in particular in the early stages of your arthritis, or after surgery. You may also be given splints, supports or gadgets in order to help you with your day-to-day activities.

 

Medical Treatment: Your GP or rheumatologist may initially prescribe analgesia (pain killers), anti-inflammatory medications or specific medications targeted towards the type of  inflammatory arthritis that you are experiencing.

 

Steroid Injections: Professor Ben Miranda offers special arthritis steroid injections in London and Essex that are given directly into your joint using an extremely fine needle to help minimise the discomfort. Steroid injections are good treatments to use prior to surgery and in most cases can be administered at the time of your outpatient visit; in some instances, X-ray guidance is recommended in order to ensure that the steroid has been given in exactly the correct place. Steroid injections are very safe as they are administered into your joint and do not cause 'systemic' or 'whole-body' effects; however, as with all procedures there are potential side effects such as infection, bruising, skin thinning or pigment change (very rare and more likely with multiple repeated injections). 

 

• Anaesthetic: Local.

• Procedure Time: 5 minutes.

• Recovery Time: 1-2 days.

• Time off Work: 2-3 days (depends on occupation).

 

Arthritis Surgery in London & Essex: The timing of your arthritis hand surgery in London or Essex is crucial, as there is a delicate balance between operating too early or late; if left for too long, the cartilage of the joints becomes completely destroyed and the joints may auto-fuse (ankylosis). Correct timing requires good judgement and a thorough discussion about your arthritis hand surgery in London or Essex, between you and Professor Miranda. Also, there are a large variety of arthritis surgery treatment options available for you, however not all may be suitable to your requirements; again, careful discussion between you and Professor Miranda is important when it comes to deciding which of the following options may be best for your arthritis hand surgery in London or Essex: 

 

Denervation: The small joints of the hand receive a sensory nerve supply from nerves that run to or across them. These nerves are responsible for carrying pain signals from the joints; surgical division of these sensory nerves may therefore be a good first surgical treatment option to remove pain without requiring a more extensive operating on the joint itself. In most cases denervation can be made using carefully placed small incisions. However, the results of denervation may be slightly unpredictable in terms of the amount of pain reduction and/or the duration of pain relief that it provides to you; this is further influenced by the extent of arthritis that you have and therefore may not always be the best option for you. 

 

• Anaesthetic: Regional or general.

• Surgery Time: 60 minutes.

• Hospital Stay: Day case.

• Recovery Time: 1-2 weeks.

• Time off Work: 2 weeks.

 

Joint Replacement / Arthroplasty: Joint replacement is one of the more frequently requested procedures by patients, especially for the knuckles and small joints of the fingers. Professor Ben Miranda performs a high volume of joint replacement surgery for patients with osteoarthritis or inflammatory arthritis such as rheumatoid arthritis. Surgery involves removing the cartilage and bone from the affected joint and in most cases inserting a silicone hinge joint prosthesis. However, in some cases a metal joint can be used, such as in the base of the thumb. Following your procedure you will need to complete a course of formal hand therapy in order maximise your range of movement.

 

• Anaesthetic: Regional or general.

• Surgery Time: 60 minutes.

• Hospital Stay: Day case.

• Recovery Time: 4-6 weeks.

• Time off Work: 4-6 weeks (return to light use and driving). A further 4-6 weeks of protection in a splint is required to allow the tissues to recover full strength; return to work time is therefore variable according to your progress and occupation, and Professor Miranda will discuss this prior to your joint replacement hand surgery in London or Essex.

 

Joint Fusion / Arthrodesis: Joint fusion can be a very good option to treat your arthritis, in particular if you have severe pain and stiffness and your arthritis is extremely advanced, if you have had a previously failed joint replacement or heavy manual use is anticipated post-operatively; it is also a very good option for the finger tip joints. The aim of joint fusion surgery is to provide you with a pain free, stable joint which Professor Miranda ensures is in a 'functional' position. Surgery involves removing the cartilage from the joint and inserting either screws or wires to assist the bones to fuse; the choice of metalwork required will be discussed with you during your joint fusion surgery consultation in London or Essex with Professor Miranda. Following your procedure you will need to complete a course of formal hand therapy in order maximise your range of movement.  

 

• Anaesthetic: Regional or general.

• Surgery Time: 60 minutes.

• Hospital Stay: Day case.

• Recovery Time: 4-6 weeks.

• Time off Work: 4-6 weeks (return to light use and driving when X-rays show that the bone-ends are joining together). A further 4-6 weeks of protection in a splint is required to allow the bones ends to fully heal together and become strong; return to work time is therefore variable according to your progress and occupation, and Professor Miranda will discuss this prior to your joint fusion hand surgery in London or Essex.

 

Trapeziectomy (base of thumb surgery only): When appropriate, trapeziectomy is generally considered to be a very good operation that treats the pain you may be experiencing in advanced arthritis at the base of your thumb. Surgery involves removing the degenerated bone at the base of the thumb via a small incision; a ligament resuspension may also be added to the surgical procedure to maintain thumb height but is not always necessary. Following surgery you will be put into a splint for 2 weeks, following which time your dressings will be removed and you will need to begin formal hand therapy to maximise your range of movement. 

 

• Anaesthetic: Regional or general.

• Surgery Time: 60-90 minutes.

• Hospital Stay: Day case.

• Recovery Time: 4-6 weeks.

• Time off Work: 6-8 weeks (return to light use and driving), 3-6 months (return to work that involves heavy activity).

 

Tendon Rebalancing & Repair: Inflammatory arthritis, such as rheumatoid arthritis, is well known for affecting your ligaments and tendons, resulting in severe deformity in advanced cases. Thankfully, the evolution of drug treatments has meant that there is a decline in severe deformity seen in patients; Professor Miranda however has a specialist practice that deals with severe deformity in such cases. Professor Miranda undertakes a variety of tendon rebalancing and repair procedures in London and Essex for patients. Choosing the correct procedure is vital and involves in-depth consultation and discussion. Following your procedure you will need to begin formal hand therapy to maximise your range of movement.

 

• Anaesthetic: Regional or general.

• Surgery Time: 60-90 minutes.

• Hospital Stay: Day case.

• Recovery Time: 4-6 weeks.

• Time off Work: This is highly variable depending on the extent of tendon surgery and type of tendon surgery required; smaller operations will likely see a much faster return to work that the following estimates: 6-8 weeks (return to light work e.g. clerical, and driving), 8-10 weeks (return to medium work e.g. shop-keeper / light engineering, and motorbike or HCV driving) 10-12 weeks (return to work e.g. heavy engineering / building, and contact sports).