Upper Limb
Shrewsbury and Telford Hospital Upper Limb Service provides a wide range of Orthopaedic treatments for the shoulder, elbow, wrist and hand. This includes support from Nurse Practitioners, Hand Therapist and dedicated Upper Limb Physiotherapists.
The Upper Limb Team at Princess Royal Hospital prides itself for the comprehensive service that they provide patients, including the award-winning ‘One Stop Carpal Tunnel Screening Clinic’ led by Nurse Practitioners.
Conditions treated include:
- Shoulder replacement for Osteoarthritis
- Arthroscopic (key-hole) shoulder surgery, including rotator cuff repair, shoulder stabilisation and ACJ reconstruction
- Elbow replacement, elbow instability and arthroscopic elbow surgery
- A wide range of hand surgeries, including carpal tunnel decompression, dupuytrens surgery, osteoarthritis of the thumb and fingers, Joint replacement and arthroscopic wrist surgery.
- Sports related injuries to the upper limb
We run an award-winning Practitioner-led Carpal Tunnel Screening Service.
What are Nerve Conduction Studies (NCS)?
These are simple, routine tests that specialists perform to investigate how your nerves work.
Why am I having the test done?
Your Consultant/GP has asked for you to have the test to assist in making a diagnosis of carpal tunnel syndrome.
Where will I have the tests done?
The tests are performed in the orthopaedic out patient department at the Princess Royal Hospital (PRH), Telford.
How long does it take?
The tests usually take 30-45 minutes but can occasionally take up to an hour. We hope you appreciate that due to this variation, some appointments occasionally run late.
Please arrive promptly for your appointment.
Who will do the tests?
The test will be carried out by either a Nurse practitioner or Hand therapist both specialising in upper limb/carpal tunnel assessment & diagnosis. The room used to carry out the test is quite small. However, there is room for someone to come with you, should you wish.
What do the tests involve?
As you are taken into the recording room you will be asked to warm up your hands in warm water. It is essential that your hands are at the correct temperature for the nerve conduction test to be carried out. An infra red thermometer will be used to check the temperature of your hands.
The Nerve Conduction Study (NCS)
This involves placing felt or sticky pads along certain parts of your hand/fingers and elbow. The practitioner will then stimulate your nerve(s). During this short time you will feel a throbbing sensation – a similar feeling to a TENS machine or muscle-toning belt. Most people can tolerate this, but some may find it uncomfortable or painful. It is only on for several seconds at a time. A number of nerves are tested. During the recording it is important to be as relaxed as possible. This enables us to record clear signals and helps lessen electrical interference when stimulating your nerves.
Do I need to bring anything?
No, you do not need to bring anything to these tests.
Do I need to do anything?
Please inform us if you have a cardiac pacemaker, if you are diabetic or if you have ever had MRSA.
Please try to wear loose clothing around the upper part of your body and loose sleeves so we can easily get to these areas to test your upper limbs. You are not normally required to undress but please be advised this is a possibility if you are wearing restrictive clothing over the areas to be tested.
We will ask you to remove any bracelets and watches before we start the tests.
Feel free to eat and drink before the test as you would do normally.
What happens afterwards?
The NCS should not leave you with any side effects.
When will I receive my results?
You may not get any results on the day as your results may need to be discussed with a colleague/ consultant before a diagnosis can be made.
A small percentage of patients may require further testing either on the same day or at a later date. This will normally be the case if the practitioner is unable to obtain sufficient information about your nerves and wishes to obtain further testing and a second opinion. If this should occur a referral may be made for you to have further nerve tests at Telford under the care of a Consultant Neurophysiologist or a colleague at the PRH to verify the results.
Further information
If you require any further information please feel free to contact one of the practitioners direct and we will do our very best to answer your questions. We would also be grateful if you could inform us if you are unable to make your appointment on the date given to you and an alternative date/time will be arranged.
We also run specialist Osteoporosis Clinics – Contact Jan Flavell for further information.
Jan Flavell
Nurse Practitioner Orthopaedics/Trauma – Tel. 01952 641222
Available Monday – Friday (except Wednesdays) 07.00-16.00
Email: janet.flavell-raybone@nhs.net
Suzanne Sharp
Clinical Specialist, Occupational Therapy (Hand Therapy) – Tel. 01952 641222 Ext: 4102
Available Tuesday, Thursday & Friday 8.00-17.00
Email: suzanne.sharp1@nhs.net
Meet the Team
Upper Limb – Consultants
Consultant Orthopaedic Surgeon, Shoulder and Elbow Specialist
GMC: 3408027
Telephone: 01952 641 222 Ext 5654
PA: Becky Smith (becky.smith25@nhs.net)
Other Role: MSK Lead
Professional Background
Ron qualified from St Marys Medical School, London in 1989 and completed his Specialist Orthopaedic Training on the Bristol Rotation. He completed his Shoulder Fellowship at Reading with Steve Copeland in 1999, along with the SECEC (European Society for Surgery of the Shoulder and the Elbow) Travelling Fellowship in 1999. He was appointed to SaTH and Robert Jones and Agnes Hunt Hospital in Oswestry (RJAH) in 1999.
Clinical Interest/Treatment:
All aspects of shoulder and upper limb surgery and revision shoulder replacement.
Consultant Orthopaedic Surgeon, Hand and Wrist Specialist
GMC: 3557543
Telephone: 01952 641 222 Ext 5743
PA: Kerry Webb (kerry.webb5@nhs.net)
Other Role: Clinical Director
Professional Background
Piers Moreau qualified from Jesus College, Cambridge University and Barts Medical School London in 1991. He completed his surgical training in London. In 1997 he joined the Stoke/Oswestry Specialist Orthopaeadic Training Rotation, and subsequently completed a Hand & Wrist Fellowship at the world renown Pulvertaft Unit, Derby Royal Infirmary in 2002. Piers was appointed to SaTH and Robert Jones and Agnes Hunt Hospital (RJAH) in Oswestry in 2003, with a special interest in Hand, Wrist and Elbow Surgery. He is an active member of the British Society for Surgery of the Hand and a member of the British Orthopaedic Association.
Clinical Interest/Treatment
All aspects of Hand, Wrist and Elbow problems including joint disorders, soft tissue, nerve and bone problems.
Consultant Orthopaedic Surgeon, Shoulder and Upper Limb Specialist
GMC: 6071480
Telephone: 01952 641 222 Ext 4434
PA: Gemma Craddock (gemma.craddock@nhs.net)
Other Role: Clinical Supervisor
Professional Background
Having qualified from Royal Free University College Medical School, Jae Rhee completed surgical training on the Middlesex/UCH circuit. He subsequently joined the renowned Stoke/Oswestry Specialist Orthopaedic Training Rotation in 2008, and completed Shoulder and Upper Limb Fellowships at UCLH and Chelsea & Westminster Hospital London. He was also awarded the EFORT (European Federation of National Associations of Orthopaedics and Traumatology) Travelling Fellowship to the Karolinska Sports Institute in Stockholm. He was appointed to SaTH 2014.
Clinical Interest/Treatment
All aspects of Shoulder and Upper Limb Surgery.
Specialist interest in Sports related Shoulder injuries and Arthroscopic Shoulder surgery (including Stabilisations, Rotator Cuff Repair and Acromioclavicular Joint Reconstruction).
Consultant Orthopaedic Surgeon, Upper Limb Specialist
GMC: 4035983
Telephone: 01952 641 222 Ext 4470
PA: Angela Boycott (angela.boycott@nhs.net)
Other Roles: Senior Tutor and Lecturer at the University of Keele Medical School; T&O Governance Lead; Clinical Supervisor.
Professional Background
Robert Turner qualified from the University Of Wales College of Medicine in 1993. He completed his surgical training in South Wales and in Cambridge. He was a research registrar in Bath from 1999 – 2001. In 2001 he joined the Wessex Specialist Registrar Training Rotation. He subsequently completed an Upper Limb Fellowship at the world renown Hand & Upper Limb Centre in Ontario, Canada. (The largest upper limb unit in Canada). He subsequently undertook a visiting Fellowship at the Mayo Clinic, USA with Dr O’Driscoll to gain further training in complex elbow problems.
Mr Turner was appointed to SaTH in 2008. He is an active member of the British Elbow and Shoulder Society.
He has a keen interest in teaching. He teaches on the British Elbow Arthroscopy course. He is the lead tutor for Keele Medical School undergraduate medical students studying musculoskeletal medicine at the Shrewsbury and Telford Hospitals.
He is trained in the surgical treatment of orthopaedic problems but will often be able to successfully treat patients with non-surgical treatments including injection treatments. He has medical publications on injection treatment.
Clinical Interest/Treatment
All aspects of hands & shoulder & elbow surgery including complex upper limb trauma.
He also routinely undertakes shoulder arthroscopic surgery (including subacromial decompression, rotator cuff and stabilisation procedures), shoulder joint replacement as well as treating hand and wrist problems including Dupuytrens (Surgery, fasciotomy and Xiapex treatments), carpal tunnel, ulna nerve, ganglions and hand / wrist arthritis problems.
He has a special interest in elbow surgery, including elbow arthroscopy.
Upper Limb – Nurse Practitioner’s
Profile:
Jan works with Mr Dodenhoff and Mr Moreau, and has done for the past 12 years. She runs two totally nurse-led upper limb clinics per week and sees a variety of upper limb post-operative patients.
She also runs a ‘One Stop Carpal Tunnel Screening Clinic’ using nerve conduction testing. This clinic is in conjunction with her colleague Suzanne Sharp (Specialist Hand Therapist). This clinic has been well established for the past 2 years, and was originally set up to reduce the 18 weeks target from referral to treatment for our patients with Carpal Tunnel Syndrome. The Clinic offers a full patient assessment, nerve conduction testing and interpretation of the results. Results are discussed in detail with our patients, and treatment options are offered to devise a plan of action, whilst following Best Practice Guidelines.
Upper Limb Nurse Practitioner
Profile:
Gill works with and supports Mr Rhee and Mr Turner. She works as first assistant in theatres and also runs her own nurse lead clinics for her consultants.
She sees a range of patients following Upper Limb surgery whilst working autonomously, utilising her wealth of nursing experience.