Hand Surgery Research

Grant awarded to Max Stewart

(Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford)

Non-invasive electrical stimulation to augment peripheral nerve regeneration

Carpal tunnel syndrome (CTS) is a condition in which nerve compression at the wrist leads to pain, tingling and weakness in the hand. CTS affect one in ten people. The usual treatment is surgery to decompress the nerve, but some people still get symptoms and incomplete recovery after the operation. We know that electricity can help nerves heal after surgery, but currently this requires implanting electrodes in the wrist. Our research is about developing ways to electrically stimulate nerves through the skin instead, to help people recover better after CTS or other nerve surgery.

Read the full report

Grant awarded to Manel Patel (Small grant £520)

(Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford)

Double tendon turndown repair: A biomechanical study & proposed classification

Upper limb trauma represents approximately 30% of A&E attendances. Flexor tendons are commonly injured resulting in loss of finger flexion. Frequently used repair techniques include tendon lengthening, grafting or tendon transfers. A less commonly described technique is tendon turnover (see figure) which avoids the complications associated with other repair techniques and precludes the need for a secondary wound from graft tendon retrieval. The aim of this study is to analyse the mechanical properties of tendon turndown. This would help demonstrate that it is biomechanically secure and therefore may be convenient and safe for tendon reconstruction in the upper limb.

Read the full report

Grant awarded to Mira Pecheva

(University of East Anglia)

Establishing inhibition of MMP-14 as a viable therapeutic in Dupuytren’s Disease

Dupuytren’s disease therapy: MMP-14 enzyme blocking

Dupuytren’s disease (DD) is characterised by thickening of a structure present in all hands (the palmar fascia), affecting hand use, with psychological, family and employment effects. 2 million people have DD in the UK. Treatment is through surgery, but the disease can return. The enzyme MMP-14 is associated with DD severity and recurrence. This project will outline the role of MMP-14 in DD. In the near-term, patients can donate tissue excised as part of their treatment, playing an active role in research. The translation of this research into therapy will provide long-term non-surgical treatment.

Read the full report

Grant awarded to Justin Wormald

(Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford)

Understanding and Preventing Surgical Site Infection following Surgery for Hand and Wrist Trauma

Hand and wrist injuries account for 1-in-5 emergency hospital visits, with 350 injuries per day in the UK. The hand and wrist are important in daily life and for earning a living. Many injuries need surgery, with a risk of infection afterwards. We don’t know the extent of post-operative infection for these injuries, including the effect on recovery and function. Anti-bacterial stitches used to repair injuries might reduce infection. I want to better understand infection after hand and trauma surgery and see whether we can test anti-bacterial stitches to prevent it.

Read the full report

Grant awarded to Gurdas Singh

(Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford)

Health economic modelling to understand NHS Dupuytren’s disease treatment

Choosing cost-effective treatments for Dupuytren’s disease

Dupuytren’s disease is a common condition in which scar-like tissue forms under the palm skin. This forms cords of tissue that pull the fingers into the palm and limits function. It typically occurs in men over 50. In the UK, about 20% of people over 65 have some form.

Decision-analytic mathematic models estimate the expected costs and effectiveness of different treatments. They can account for people then needing further treatment, and so may provide a more realistic way to understand the impact of treatments in ways that can inform clinical and commissioning decisions.

Read the full report

Grant awarded to Rowa Taha

(Centre for Evidence Based Hand Surgery, Department of Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham)

Surgical versus non-surgical treatment for finger metacarpal shaft fracture(s) in adults: a feasibility study

MSF are common hand injuries (100,000people/year) that affect working-age people, so have a significant societal impact. We do not know which treatment is best, so patients are treated differently throughout the country.

My research will determine how best to plan a national randomised study to establish the most effective treatment. The aim is for the best care for patients, while ensuring value for money for the NHS.

This research will also help researchers outside hand surgery improve how they design and carry out surgical trials.

Grant awarded to Thomas Layton

(Kennedy Institute for Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford)

Defining the myofibroblast phenotype in Dupuytren’s disease

Identifying and exploring novel myofibroblast markers in Dupuytren’s Disease.

Dupuytren’s disease (DD) is a fibrotic disorder of the hand affecting 4% of the UK population. It leads to impairment of hand function as the fingers curl irreversibly into the palm. The cells responsible for the deposition of the excessive tissue and contraction are myofibroblasts. However, we still lack a clear understanding of these cells and this has hampered efforts to develop new treatments. We aim to better understand the myofibroblast in DD by defining genes specific to these cells compared to control cells from the same patients, and subsequently exploring their function

Grant awarded to Karishma Shah

(Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford)

Can we predict hand osteoarthritis?

Development of a Risk Prediction Model for Hand Osteoarthritis

Over 1.5 million people in the UK have hand and wrist osteoarthritis (OA). It leads to pain, stiffness and loss of function. However, most people with hand and wrist OA do not need surgery. We will investigate the burden of hand and wrist OA in the UK population. We aim to identify risk factors and to create a prediction model for the development of hand and wrist OA and predict who will need surgery. This will enable doctors and patients to identify who is at highest risk of symptomatic disease, and to enable those patients to get targeted treatment.

To read the full report

Grant awarded to Kavit Amin

(Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester)

Triggers For Fibrosis In A Novel Porcine Gliding Fascia Model.
How hand injury leads to stiffness

Patients who have an injury, infection or surgery to the hand, experience pain and swelling. Inflammation of the hand progresses to stiffness. This usually resolves with good hand physiotherapy, however in many the stiffness persists. There are gliding layers in the hand, under the skin, that are “sponge-like” and scar after injury. How this occurs is not fully understood. Our study aims to identify the cells and signals that promote scarring of this tissue to find treatments that can be given immediately after injury or before surgery to reduce stiffening of the hand, restoring function and quicker return to work.

Read the full report

Grant awarded to Hawys Lloyd-Hughes

Read the full report

Grant awarded to Abhi Jain

(Associate Professor Plastic and Hand Surgery, University of Oxford and Imperial College NHS Trust, London)

Nail Bed Injury Analysis –Pilot (NINJA-P)

Nail bed injuries are the commonest hand injury in children. During surgery, the nail is removed and the cut stitched up. The nail can either be put back on or thrown away. Some doctors think that the replaced nail prevents infection; others think that it may cause them. We undertook a randomised controlled trial and compared the two treatments on cosmetic appearance, occurrence of  infection, pain, and healthcare use. We recruited 451 patients from 20 NHS hospitals.

The number of infections and cosmetic appearance were similar in both groups. However, replacing the nail increased costs and was unlikely to be cost-effective.

Read the full report

Grant awarded to Will Mason

(Gloucestershire Royal Hospital, Gloucester)

Prospective Randomised Controlled Trial of Open Carpal Tunnel versus Steroid Injection for Moderate Carpal Tunnel Carpal Tunnel Syndrome - Surgery or Injection?

Carpal Tunnel Syndrome is the UK’s commonest upper limb disorder. Excessive tightness around a nerve in the wrist causes pain, pins and needles, numbness or weakness. These symptoms often wake sufferers each night and can cause difficulty with their work or hobbies. Mild cases are often treated by splints and steroid injections while more severe cases require surgical decompression of the affected nerve. For moderate cases, there is currently little evidence to guide surgeons and patients as to whether injection or surgery is the best. This study will address this problem by comparing outcomes of both treatments after two years.

Read the full report

2023 Alex Woods

Using big data and cell biology to understand carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a condition where compression of a nerve in the wrist leads to hand pain, numbness, and weakness. CTS affects one in ten people. We don’t have a medication for CTS - it is treated with surgery, but up to one in four patients have incomplete recovery after surgery. This research will use big data and laboratory experiments to understand why this nerve compression occurs, and to identify drugs that can be effective in the treatment of CTS. To read the full report

2022 Max Stewart

Non-invasive electrical stimulation to augment peripheral nerve regeneration

Carpal tunnel syndrome (CTS) is a condition in which nerve compression at the wrist leads to pain, tingling and weakness in the hand. CTS affect one in ten people. The usual treatment is surgery to decompress the nerve, but some people still get symptoms and incomplete recovery after the operation. We know that electricity can help nerves heal after surgery, but currently this requires implanting electrodes in the wrist. Our research is about developing ways to electrically stimulate nerves through the skin instead, to help people recover better after CTS or other nerve surgery. To read the full report

2012 Will Mason

Prospective Randomised Controlled Trial of Open Carpal Tunnel versus Steroid Injection for Moderate Carpal Tunnel

Carpal Tunnel Syndrome - Surgery or Injection?

Carpal Tunnel Syndrome is the UK’s commonest upper limb disorder. Excessive tightness around a nerve in the wrist causes pain, pins and needles, numbness or weakness. These symptoms often wake sufferers each night and can cause difficulty with their work or hobbies. Mild cases are often treated by splints and steroid injections while more severe cases require surgical decompression of the affected nerve. For moderate cases, there is currently little evidence to guide surgeons and patients as to whether injection or surgery is the best. This study will address this problem by comparing outcomes of both treatments after two years. To read the full report

2021 Mira Pecheva

Establishing inhibition of MMP-14 as a viable therapeutic in Dupuytren’s Disease

Dupuytren’s disease therapy: MMP-14 enzyme blocking

Dupuytren’s disease (DD) is characterised by thickening of a structure present in all hands (the palmar fascia), affecting hand use, with psychological, family and employment effects. 2 million people have DD in the UK. Treatment is through surgery, but the disease can return. The enzyme MMP-14 is associated with DD severity and recurrence. This project will outline the role of MMP-14 in DD. In the near-term, patients can donate tissue excised as part of their treatment, playing an active role in research. The translation of this research into therapy will provide long-term non-surgical treatment. To read the full report

2019 Gurdas Singh

Choosing cost-effective treatments for Dupuytren’s disease

Dupuytren’s disease is a common condition in which scar-like tissue forms under the palm skin. This forms cords of tissue that pull the fingers into the palm and limits function. It typically occurs in men over 50. In the UK, about 20% of people over 65 have some form.

Decision-analytic mathematic models estimate the expected costs and effectiveness of different treatments. They can account for people then needing further treatment, and so may provide a more realistic way to understand the impact of treatments in ways that can inform clinical and commissioning decisions. To read the full report

2017 Thomas Layton

Defining the myofibroblast phenotype in Dupuytren’s disease

Identifying and exploring novel myofibroblast markers in Dupuytren’s Disease.

Dupuytren’s disease (DD) is a fibrotic disorder of the hand affecting 4% of the UK population. It leads to impairment of hand function as the fingers curl irreversibly into the palm. The cells responsible for the deposition of the excessive tissue and contraction are myofibroblasts. However, we still lack a clear understanding of these cells and this has hampered efforts to develop new treatments. We aim to better understand the myofibroblast in DD by defining genes specific to these cells compared to control cells from the same patients, and subsequently exploring their function. To read the full report

2015 Hawys Lloyd-Hughes

Improving the Qualitative and Quantitative Outcomes of Dupuytren’s Disease

To read the full report

2024 
Improving the outcomes of hand infections in low- and middle-income countries.

Hand infections often happen after hand injuries. These infections can mean people lose the use of their hand, and in the worst cases the hand needs to be removed to save their life. Even less serious infections can affect people’s ability to work and manage daily life. In poorer countries, hand infections may be more common. However, we don’t know the scale of the problem, what healthcare is available and how to best treat these infections in these countries. Through this research, I aim to answer these questions by performing three projects. To read the full report

2020 Justin Wormald

Understanding and Preventing Surgical Site Infection following Surgery for Hand and Wrist Trauma

Hand and wrist injuries account for 1-in-5 emergency hospital visits, with 350 injuries per day in the UK. The hand and wrist are important in daily life and for earning a living. Many injuries need surgery, with a risk of infection afterwards. We don’t know the extent of post-operative infection for these injuries, including the effect on recovery and function. Anti-bacterial stitches used to repair injuries might reduce infection. I want to better understand infection after hand and trauma surgery and see whether we can test anti-bacterial stitches to prevent it. To read the full report

2016 Kavit Amin

Triggers For Fibrosis In A Novel Porcine Gliding Fascia Model

How hand injury leads to stiffness

Patients who have an injury, infection or surgery to the hand, experience pain and swelling. Inflammation of the hand progresses to stiffness. This usually resolves with good hand physiotherapy, however in many the stiffness persists. There are gliding layers in the hand, under the skin, that are “sponge-like” and scar after injury. How this occurs is not fully understood. Our study aims to identify the cells and signals that promote scarring of this tissue to find treatments that can be given immediately after injury or before surgery to reduce stiffening of the hand, restoring function and quicker return to work. To read the full report

2021 Manel Patel

Double tendon turndown repair: A biomechanical study & proposed classification

Upper limb trauma represents approximately 30% of A&E attendances. Flexor tendons are commonly injured resulting in loss of finger flexion. Frequently used repair techniques include tendon lengthening, grafting or tendon transfers. A less commonly described technique is tendon turnover (see figure) which avoids the complications associated with other repair techniques and precludes the need for a secondary wound from graft tendon retrieval. The aim of this study is to analyse the mechanical properties of tendon turndown. This would help demonstrate that it is biomechanically secure and therefore may be convenient and safe for tendon reconstruction in the upper limb. To read the full report

2017 Karishma Shah

Development of a Risk Prediction Model for Hand Osteoarthritis

Can we predict hand osteoarthritis?

Over 1.5 million people in the UK have hand and wrist osteoarthritis (OA). It leads to pain, stiffness and loss of function. However, most people with hand and wrist OA do not need surgery. We will investigate the burden of hand and wrist OA in the UK population. We aim to identify risk factors and to create a prediction model for the development of hand and wrist OA and predict who will need surgery. This will enable doctors and patients to identify who is at highest risk of symptomatic disease, and to enable those patients to get targeted treatment. To read the full report

2014 Abhi Jain

Nail Bed Injury Analysis –Pilot (NINJA-P)

Nail bed injuries are the commonest hand injury in children. During surgery, the nail is removed and the cut stitched up. The nail can either be put back on or thrown away. Some doctors think that the replaced nail prevents infection; others think that it may cause them. We undertook a randomised controlled trial and compared the two treatments on cosmetic appearance, occurrence of  infection, pain, and healthcare use. We recruited 451 patients from 20 NHS hospitals.

The number of infections and cosmetic appearance were similar in both groups. However, replacing the nail increased costs and was unlikely to be cost-effective. To read the full report

2019 Rowa Taha

Surgical versus non-surgical treatment for finger metacarpal shaft fracture(s) (MSF) in adults: a feasibility study

Surgery versus no surgery for metacarpal shaft fractures (MSF)

MSF are common hand injuries (100,000people/year) that affect working-age people, so have a significant societal impact. We do not know which treatment is best, so patients are treated differently throughout the country.

My research will determine how best to plan a national randomised study to establish the most effective treatment. The aim is for the best care for patients, while ensuring value for money for the NHS.

This research will also help researchers outside hand surgery improve how they design and carry out surgical trials. To read the full report